Screening for Drug and Alcohol Use Disorders and Their Association with HIV-Related Sexual Risk Behaviors among Men Who Have Sex with Men in Peru

Kaysia T Ludford,Jesus Peinado,Monica Pun,Javier R Lama,Frederick L Altice,Rene Leiva,Jorge Sanchez,Pedro Gonzales,Panagiotis Vagenas,For The Peruvian Hiv Sentinel Surveillance Working Group

doi:10.1371/journal.pone.0069966

Kaysia T Ludford, Jesus Peinado + Show 8 more

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https://doi.org/10.1371/journal.pone.0069966

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Abstract

BackgroundPeru's HIV epidemic is concentrated among men who have sex with men (MSM). The contribution of alcohol use disorders (AUDs) to known high-risk behaviors associated with HIV transmission in this context has not been well characterized.MethodsBetween June and October 2011, 5,148 sexually active MSM were recruited using convenience sampling in five cities to participate in a cross-sectional bio-behavioral survey. Five high-risk sexual criteria previously associated with incident HIV infection in this setting were selected a priori as the dependent outcomes. Screening for AUDs used the validated Alcohol Use Disorders Identification Test (AUDIT) and AUDS were stratified by severity. Unadjusted and adjusted odds ratios (AOR) were computed to establish the independent correlates of the five dependent outcomes.ResultsThe majority (62.8%) of participants met screening criteria for having an AUD, which were independently correlated with each of the following high-risk sexual risk behaviors in the previous 6 months: 1) >5 sexual partners [AOR = 1.76; (1.54–2.02)]; 2) sex with an HIV-infected partner [AOR = 1.29; (1.03–1.62)]; 3) having a sexually transmitted infection [AOR = 1.38; (1.13–1.68)]; 4) being a sex worker [AOR = 1.61; (1.40–1.87)]; and 5) unprotected sex during last encounter [AOR = 1.22; (1.09–1.38)]. Recent drug use was also correlated with having >5 sexual partners [AOR = 1.42 (1.19–1.71)], sex work [AOR = 1.97 (1.63–2.39)] and unprotected sex during last encounter [AOR = 1.31 (1.11–1.54)]. For each dependent variable, the association with AUDs significantly increased with increasing AUD severity.ConclusionsAUDs are highly prevalent among MSM in Peru and are associated with increased HIV risk-taking behaviors that are associated with HIV transmission. Strategies that target problematic drinking such as medication-assisted therapy, behavioral counseling and structural interventions could potentially reduce risky behaviors and ultimately reduce HIV transmission among MSM in Peru.

Highlights

IntroductionThe contribution of alcohol use disorders (AUDs) to known high-risk behaviors associated with HIV transmission in this context has not been well characterized
Peru’s HIV epidemic is concentrated among men who have sex with men (MSM)
Nearly two thirds (62.8%) of participants met criteria for having an alcohol use disorders (AUDs) with most of these being in the hazardous drinking category (AUDIT 8–16)

Summary

Introduction

The contribution of alcohol use disorders (AUDs) to known high-risk behaviors associated with HIV transmission in this context has not been well characterized. While HIV prevalence in Peru remains low at 0.2%, it underestimates the country’s concentrated HIV epidemic among men who have sex with men (MSM) [1]. The extent to which these risk behaviors are mediated by the disinhibiting use of alcohol and/or other drugs is not well characterized. Global, situational, and to a lesser extent event-level studies in North America and Africa have demonstrated associations between alcohol use and risky sexual behaviors [8,9,10,11,12]. The extent to which alcohol consumption meets screening criteria as a treatable alcohol use disorder (AUD) in most available studies has yet to be examined

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