Prevalence of Same-Sex Sexual Behavior and Associated Characteristics among Low-Income Urban Males in Peru

Jesse L Clark,Susan M Kegeles,Jeffrey D Klausner,Franca R Jones,Nimh Std/Hiv Collaborative Prevention Trial ,Kelika A Konda,Thomas J Coates,Carlos F Caceres,Segundo R Leon,Andres G Lescano

doi:10.1371/journal.pone.0000778

Jesse L Clark, Susan M Kegeles + Show 8 more

Open Access

https://doi.org/10.1371/journal.pone.0000778

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Abstract

BackgroundPeru has a concentrated HIV epidemic in which men who have sex with men are particularly vulnerable. We describe the lifetime prevalence of same-sex sexual contact and associated risk behaviors of men in Peru's general population, regardless of their sexual identity.Methods and ResultsA probability sample of males from low-income households in three Peruvian cities completed an epidemiologic survey addressing their sexual risk behavior, including sex with other men. Serum was tested for HSV-2, HIV, and syphilis. Urine was tested for chlamydia and gonorrhea. A total of 2,271 18–30 year old men and women were contacted, of whom 1,645 (72.4%) agreed to participate in the study. Among the sexually experienced men surveyed, 15.2% (85/558, 95% CI: 12.2%–18.2%) reported a history of sex with other men. Men ever reporting sex with men (MESM) had a lower educational level, had greater numbers of sex partners, and were more likely to engage in risk behaviors including unprotected sex with casual partners, paying for or providing compensated sex, and using illegal drugs. MESM were also more likely to have had previous STI symptoms or a prior STI diagnosis, and had a greater prevalence of HSV-2 seropositivity.ConclusionsMany low-income Peruvian men have engaged in same-sex sexual contact and maintain greater behavioral and biological risk factors for HIV/STI transmission than non-MESM. Improved surveillance strategies for HIV and STIs among MESM are necessary to better understand the epidemiology of HIV in Latin America and to prevent its further spread.

Highlights

HIV infection in Peru is concentrated within the core risk group of men who have sex with men (MSM)
Surveillance studies of HIV infection in Peru have noted a prevalence in MSM ranging from 11.0–18.5%, but only 1.6% in female sex workers (FSWs) and less than 1% in the general population [1,2,3,4,5]
Current understandings of HIV epidemiology among Peruvian MSM are based on studies with venue-based convenience samples that do not provide a complete understanding of the lifetime risk factors or an accurate estimate of the prevalence of HIV and sexually transmitted infections (STIs) among all men who have engaged in sex with men

Summary

Introduction

HIV infection in Peru is concentrated within the core risk group of men who have sex with men (MSM). Current understandings of HIV epidemiology among Peruvian MSM are based on studies with venue-based convenience samples that do not provide a complete understanding of the lifetime risk factors or an accurate estimate of the prevalence of HIV and sexually transmitted infections (STIs) among all men who have engaged in sex with men. Researchers studying same-sex sexual contact and related risk behaviors among Latino men have described a construction of sexuality that links penetration with masculinity and receptive intercourse with femininity, through which male same-sex sexual contact does not necessarily presume a homosexual identity [19,20,21,22,23,24,25,26,27]. Many low-income Peruvian men have engaged in same-sex sexual contact and maintain greater behavioral and biological risk factors for HIV/STI transmission than non-MESM. Improved surveillance strategies for HIV and STIs among MESM are necessary to better understand the epidemiology of HIV in Latin America and to prevent its further spread

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