Abstract
In Peru, there is little information about the HIV care continuum. Therefore, we conducted a study to describe the HIV care continuum among male sex workers (MSWs) in Lima. We applied close-ended surveys with 209 MSWs about their engagement in the HIV care continuum and open-ended surveys with 34 MSWs who are people living with HIV (PLHIV) to explore their linkage to and retention in HIV care. Of 209 MSWs, only 71% (n=148) reported a lifetime HIV test and 56% (n=116) of all MSWs received confirmatory HIV test results. Of the 34 MSWs who are PLHIV, 76% had received HIV care at least once, but only 59% were currently in care, 50% were currently taking ART(antiretroviral therapy) and an even lower 32% had been on ART for 6 months or more. The primary reason for non-linkage to HIV care is the multiple visits to link at the Ministry of Health (MOH). Remaining in care was also challenging, particularly at non-governmental organizations (NGOs). Substantial barriers linking to and remaining in HIV care result in significant delays in linkage and high proportions of PLHIV that remain unlinked or become unstably linked following initial linkage. Urgent implementation science research is needed to facilitate linkage to HIV care and strengthen retention in HIV care post-linkage.
Highlights
Initiation of antiretroviral therapy (ART) has been shown to improve individual health outcomes of people living with HIV (PLHIV) and decrease HIV transmission, with the potential to change HIV incidence at the population level [1,2,3,4,5]
There are several drop-offs in the HIV care continuum (Figure 1), which we depict using a figure based on the HIV and Transitions Framework proposed by Powers and Miller.[34]
The second drop-off is between the HIV screening test and receipt of the screening and/or confirmatory test result, with only 56% (n=116) of all participants reporting receipt of at least one HIV test result in their lifetime
Summary
Initiation of antiretroviral therapy (ART) has been shown to improve individual health outcomes of people living with HIV (PLHIV) and decrease HIV transmission, with the potential to change HIV incidence at the population level [1,2,3,4,5]. Lowerincome MSWs reported that they engage in survival sex work that consumes most of their daily lives and results in low earnings and an inability to take steps toward achieving life goals and, for those that wish to, exit sex work. They perceive high HIV risk and vulnerability but, given lack of agency, they perceive significant challenges to using condoms [11]. We conducted a study to describe the HIV care continuum among male sex workers (MSWs) in Lima
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