The risk of stable partnerships: associations between partnership characteristics and unprotected anal intercourse among men who have sex with men and transgender women recently diagnosed with HIV and/or STI in Lima, Peru.

Mary C Cambou,Eddy R Segura,Jesse L Clark,Amaya G Perez-Brumer,Jorge Sanchez,Javier R Lama,H Javier Salvatierra,Garrett Prestage

doi:10.1371/journal.pone.0102894

Mary C Cambou, Eddy R Segura + Show 6 more

Open Access

https://doi.org/10.1371/journal.pone.0102894

Copy DOI

Abstract

BackgroundPartnership type is an important factor associated with unprotected anal intercourse (UAI) and subsequent risk for HIV and sexually transmitted infections (STI). We examined the association of partnership type with UAI among men who have sex with men (MSM) and male-to-female transgender women (TGW) in Lima, Peru, recently diagnosed with HIV and/or STI.MethodsWe report data from a cross-sectional analysis of MSM and TGW recently diagnosed with HIV and/or STI in Lima, Peru between 2011 and 2012. We surveyed participants regarding UAI with up to their three most recent sexual partners according to partner type. Multivariable Generalized Estimate Equating (GEE) models with Poisson distribution were used to estimate prevalence ratios (PR) for UAI according to partner type.ResultsAmong 339 MSM and TGW recently diagnosed with HIV and/or STI (mean age: 30.6 years, SD 9.0), 65.5% self-identified as homosexual/gay, 16.0% as bisexual, 15.2% as male-to-female transgender, and 3.3% as heterosexual. Participants provided information on 893 recent male or TGW partners with whom they had engaged in insertive or receptive anal intercourse: 28.9% stable partners, 56.4% non-stable/non-transactional partners (i.e. casual or anonymous), and 14.7% transactional partners (i.e. transactional sex client or sex worker). Unprotected anal intercourse was reported with 41.3% of all partners. In multivariable analysis, factors associated with UAI included partnership type (non-stable/non-transactional partner APR 0.73, [95% CI 0.59–0.91], transactional partner APR 0.53 [0.36–0.78], p<0.05) and the number of previous sexual encounters with the partner (>10 encounters APR 1.43 [1.06–1.92], p<0.05).ConclusionUAI was more commonly reported for stable partners and in partnerships with >10 sexual encounters, suggesting UAI is more prevalent in partnerships with a greater degree of interpersonal commitment. Further research assessing partner-level factors and behavior is critical for improving HIV and/or STI prevention efforts among Peruvian MSM and TGW.

Highlights

The HIV epidemic in Peru is concentrated among men who have sex with men (MSM) and male-to-female transgender women (TGW), with estimates of HIV prevalence among MSM ranging from 11.0 to 18.5% [1,2] and as high as 30% among TGW [3]
unprotected anal intercourse (UAI) has been more commonly reported in primary partnerships when compared to casual partnerships among both HIV-infected and HIV-uninfected MSM [10,11,18], suggesting an association between partnership type and willingness to engage in UAI
Detailed knowledge of how partner type influences sexual risk behavior among MSM and TGW in Latin America will contribute to the development of culturally- and epidemiologically-specific interventions to control the spread of HIV and sexually transmitted infections (STI) in this population. To address this gap in knowledge, we assessed the association between partnership type and UAI among up to the three most recent partners of MSM and TGW recently diagnosed with HIV and/or STI in Lima, Peru

Summary

Introduction

The HIV epidemic in Peru is concentrated among men who have sex with men (MSM) and male-to-female transgender women (TGW), with estimates of HIV prevalence among MSM ranging from 11.0 to 18.5% [1,2] and as high as 30% among TGW [3]. In a prior surveillance study of sexual risk behavior among MSM in Lima, Peru, only 54.4% of HIV-uninfected and 48.4% HIV-infected MSM reported condom use with their last male sex partner [2]. Previous research has suggested an association between partner type and sexual risk behavior in MSM and TGW partnerships [1,7,8,9,10,11,12,13,14,15,16]. Partnership type is an important factor associated with unprotected anal intercourse (UAI) and subsequent risk for HIV and sexually transmitted infections (STI). We examined the association of partnership type with UAI among men who have sex with men (MSM) and male-to-female transgender women (TGW) in Lima, Peru, recently diagnosed with HIV and/or STI

Methods

Results

Discussion

Conclusion