Transcript HIV/STI Testing among MSM in Lima, Peru: opportunities for treatment and risk modification RG Deiss, ER Segura, JL Clark, S Leon, KA Konda, CF.

HIV/STI Testing among MSM in
Lima, Peru: opportunities for
treatment and risk modification
RG Deiss, ER Segura, JL Clark, S Leon,
KA Konda, CF Caceres, TJ Coates
Meeting of the American Public
Health Association
October 29, 2012
No Disclosures
Background
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“Test and Treat” forms a key component
of HIV prevention
Beyond the benefit of suppressing
community viral load, several studies
have found that individuals modify
sexual risk behaviors after learning they
are HIV+
“Repeat testers” nonetheless may
continue to engage in higher frequency
of sexual risk behaviors
HIV/STI Testing in Peru
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HIV prevalence of 11%
among MSM in Peru
High prevalence of
syphilis (10-29%), HSV
(45%) and other STIs
Prior studies have
reported testing rates of
~50% among MSM
UNAIDS. Global Report. 2012.
Blas MM et al. PLoS ONE 2011;6(11):e27334.
Caceres CF et al. AIDS Behav 2008;12:544–51.
Clark JL et al. SexTransm Infect. 2008;84:449–54. :
Lama JR. J Infect Dis: 2007;194(10):1459–66
Sanchez J et al. J AIDS. 2011:44(5):578–85.
Data Collection
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Comunidades Positivas: Convenience sample
from 16 neighborhoods of Lima, Peru (2008)
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Men 18-45 years of age with >1 sexual encounter with
male/ transgender partner (TGP) in the past 12 months
Acknowledged sexual preference toward men or TGP
Live/work near the intervention area
Plan to stay in the area for the whole study period (18
months)
Willing/able to provide informed consent.
STI Testing: HIV, HSV-2, Syphilis, oral/rectal
GC/chlamydia
Data Collection
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Computer-Assisted Personal Interview:
sociodemographics, health care seeking
behavior, sexual risk behaviors and
substance use.
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Audio-assisted self interview: HIV history/status
Questions on HIV testing:
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Most recent test
Total times tested
Reasons for being/not being tested
Whether results were obtained
Data Analysis
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Primary outcome variable:
History of prior HIV testing
To compare repeat testers
versus non-repeat testers, we
used descriptive statistics,
along with Chi-square and
Mann-Whitney tests
Results
Patterns of HIV testing
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77% of 718 individuals report prior HIV test
(median 3 tests, IQR1:2,6)
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No difference in HIV prevalence among repeat
testers than first-time testers (17% vs 14%,
p=0.34)
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Of these, 87% obtain results
Excluding known HIV+ individuals, results do not
appreciably change (12% among repeat testers, p=0.58)
Most common reasons for testing:
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Routine exam (39%);
Unprotected encounter (33%);
Free testing (24%)
1Interquartile
Range
Age1 (median, IQR2)
Repeat
testers
(n=548)
%
29 (24,36)
First-time
testers
(n=170)
%
27 (21,32)
Born outside of Lima
47
45
Completed high school
71
77
Self-identify as gay/bisexual
47
55
Self identify as transgendered/transsexual1
32
18
Median age at first sexual encounter (IQR)
15 (12,17)
14 (12,16)
Demographics
1p<0.05
Prior STI diagnosis
Repeat
testers
(n=548)
%
35
First-time
testers
(n=170)
%
16
<0.01
HIV Infection
17
14
0.34
HSV-2 infection
70
52
<0.01
C. trachomatis infection (oral or rectal)
22
23
0.08
N. gonorrhea infection (oral or rectal)
14
9
0.13
History of syphilis infection
(RPR/TPPA+)
Active syphilis infection (titer > 1:8)
26
17
0.01
11
8
0.27
Health Care
P-value
Repeat
testers
(n=548)
%
Sexual Risk behavior
First-time
testers
(n=170)
%
P-value
Failed to always use condoms in last 6 months
63
61
0.71
Received compensation for sex in last six
months
--Always used condom in these encounters
59
39
<0.01
57 (n=331)
45 (n=62)
0.08
Paid for sex in last six months
25
18
0.07
--Always used condom in these encounters
58 (n=141)
59 (n=29)
0.96
Problem drinkers (CAGE questionnaire)
62
53
<0.05
Used alcohol at last sexual encounter
45
49
0.357
Used drugs at last sexual encounter
7
5
0.22
Median number of partners in last six
months (IQR)
6 (2, 20)
3 (2,9)
<0.01
Conclusions
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High prevalence of sexual risk behaviors
among individuals who had been tested
previously for HIV
Prior testing did not seem to impact many
sexual risk behaviors among MSM
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Transactional sex
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High proportion of individuals who use condoms less than
always
Significantly higher prevalence of HSV-2 and
syphilis infection among repeat testers
Study Limitations
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Sub-analysis of a larger study
Cross-sectional analysis, therefore causal
inferences cannot be drawn
Potential for reporting bias
Limited data on psychosocial factors
surrounding testing
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Importance of staying HIV-negative?
Implications
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HIV/STI testing and treatment centers:
important points of contact for high-risk
populations including MSM
Individuals with history of STI or current
symptoms should be especially targeted for
HIV prevention efforts
Further study and interventions to reduce
sexual risk behaviors among high-risk MSM in
the context of STI testing and treatment
programs are warranted.
Acknowledgments
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NIH Grant R01MH078752
Project Staff and Co-Authors
Most importantly, study participants who gave
their time
Thank you