RESUMEN
The slogan Undetectable equals Untransmittable (U = U) communicates that people living with HIV (PLHIV) who are on antiretroviral therapy (ART) will not transmit HIV to their sexual partners. We describe awareness of U = U among sexual and gender minorities (SGM) living in Brazil, Mexico, and Peru by self-reported HIV status (PLHIV, negative, unknown) during 2021 using an online survey. We estimated two models using Poisson regression for each population group: Model A including socio-demographic factors (country, gender, age, race, education, and income), and then Model B including taking ART (for PLHIV) or risk behavior, ever-taking PrEP, and HIV risk perception (for HIV-negative or of unknown HIV status). A total of 21,590 respondents were included (Brazil: 61%, Mexico: 30%, Peru: 9%). Among HIV-negative (74%) and unknown status (12%), 13% ever used PrEP. Among PLHIV (13%), 93% reported current use of ART. Awareness of U = U was 89% in both Brazil and Mexico, which was higher than in Peru 64%. Awareness of U = U was higher among PLHIV (96%) than HIV-negative (88%) and HIV-unknown (70%). In multivariate models, PLHIV with lower education were less aware of U = U, while those taking ART were more aware. Among HIV-negative, non-cisgender, lower income, and those with lower education had lower awareness of U = U, while individuals ever using PrEP had higher awareness. In conclusion, awareness of U = U varied by HIV status, socio-demographic characteristics, and HIV risk behavior. The concept of U = U should be disseminated through educational strategies and include a focus on SGM to combat HIV stigma.
RESUMEN: Indetectable = Intransmisible (I = I) comunica que las personas que viven con VIH (PVVIH) y reciben tratamiento antirretroviral (TAR) no transmitirán el VIH a sus parejas sexuales. En este estudio, describimos la concienciación sobre I = I entre las minorías sexuales y de género (MSG) de Brasil, México y Perú según el estado de VIH autoreportado (PVVIH, negativo, desconocido) durante 2021 utilizando una encuesta en línea. Se estimaron dos modelos mediante regresión de Poisson para cada grupo: Modelo A, que incluyó factores sociodemográficos (país, sexo, edad, raza, educación e ingresos) y Modelo B, que incluyó recibir TAR (para PVVIH) o comportamiento de riesgo, uso de PrEP y percepción de riesgo (para VIH negativo o desconocido). Se incluyó 21,590 encuestados (Brasil: 61%, México: 30%, Perú: 9%). Entre aquellos negativos para VIH (74%) y con estado desconocido (12%), el 13% utilizó alguna vez PrEP. Entre las PVVIH (13%), el 93% reportó recibir actualmente TAR. La concienciación de I = I fue del 89% tanto en Brasil como en México, superior al 64% de Perú. La concienciación de I = I fue mayor entre PVVIH (96%) que entre los VIH-negativos (88%) y los VIH-desconocidos (70%). En los modelos multivariados, las PVVIH con menor educación eran menos conscientes de I = I, mientras que los que tomaban TAR eran más conscientes. Entre los VIH-negativos, las personas no cisgéneros, con menores ingresos y con menor educación eran menos consciente de I = I, mientras que los que tenían experiencia usando PrEP eran más conscientes. En conclusión, la concienciación sobre I = I varió según el estado serológico de VIH, las características sociodemográficas y el comportamiento de riesgo. El concepto de I = I debe difundirse a través de estrategias educativas, incluyendo un enfoque en MSG para combatir el estigma del VIH.
Asunto(s)
Infecciones por VIH , Conocimientos, Actitudes y Práctica en Salud , Autoinforme , Minorías Sexuales y de Género , Humanos , Masculino , Femenino , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/psicología , Infecciones por VIH/epidemiología , Adulto , Brasil/epidemiología , Perú/epidemiología , Minorías Sexuales y de Género/psicología , Minorías Sexuales y de Género/estadística & datos numéricos , Persona de Mediana Edad , México/epidemiología , Adulto Joven , Adolescente , Conducta Sexual/psicología , Asunción de Riesgos , Encuestas y Cuestionarios , Parejas Sexuales , Profilaxis Pre-Exposición/estadística & datos numéricosRESUMEN
BACKGROUND: Current syphilis tests cannot distinguish between active and past syphilis among patients with serofast rapid plasma reagin (RPR) titers. We investigated whether cytokine profiles might provide insight in the differentiation of active and treated syphilis. METHODS: We collected quarterly serum samples from participants at risk for incident syphilis in a prospective cohort study of men and male-to-female transgender women. We defined incident syphilis as a new RPR titer ≥ 1:8 or a fourfold increase from a prior RPR titer and a positive Treponema pallidum particle agglutination assay. We measured cytokine expression using a 63-multiplex bead-based Luminex assay (eBiosciences/Affymetrix, San Diego, California, USA). We used tertile bins and Chi square tests to identify differences in proportions of cytokines between samples from patients with active and treated syphilis. We constructed a network of cytokine profiles from those findings. We used R software (R version 3.4.1, R, Vienna, Austria) to fit models. RESULTS: We identified 20 pairs of cytokines (out of 1953 possible pairs) that differed between active and treated syphilis. From those, we identified three cytokine networks of interest: an Eotaxin-Rantes-Leptin network, a Mig-IL1ra-Trail-CD40L network, and an IL12p40-IL12p70 network. CONCLUSIONS: Differences in cytokine profiles are present among men and male-to-female transgender women with active and treated syphilis. Cytokine assays may be a potentially useful tool for identifying active syphilis among patients with serologic syphilis reactivity.
Asunto(s)
Citocinas/sangre , Sífilis/sangre , Treponema pallidum , Adulto , Estudios de Cohortes , Femenino , Humanos , Incidencia , Masculino , Sífilis/epidemiología , Personas Transgénero/estadística & datos numéricos , Treponema pallidum/inmunología , Adulto JovenRESUMEN
HIV infections in Peru are concentrated among men who have sex with men (MSM) and transgender women (TW). HIV testing rates among them remain low, delaying entrance into care. We assessed the prevalence of frequent HIV testing (at least every 6 months) and associated factors among 310 MSM and TW who attend sexual health clinics in Lima, Peru, and who reported that they were HIV seronegative or unaware of their status. Only 39% of participants tested frequently, and 22% had never tested; 29% reported that they were at low or no risk for acquiring HIV. Reporting low or no risk for acquiring HIV was associated with frequent testing (adjusted prevalence ratio [aPR] = 1.53, 95% CI 1.13-2.08); those reporting unprotected anal sex were less likely to test frequently (aPR = 0.66, 95% CI 0.50-0.87). HIV prevalence was 12% and did not vary by risk perception categories. This at-risk population tests infrequently and may not understand the risk of having unprotected sex.
Asunto(s)
Infecciones por VIH/diagnóstico , Homosexualidad Masculina/psicología , Tamizaje Masivo/estadística & datos numéricos , Aceptación de la Atención de Salud/estadística & datos numéricos , Personas Transgénero/psicología , Sexo Inseguro/estadística & datos numéricos , Adulto , Femenino , Infecciones por VIH/transmisión , Investigación sobre Servicios de Salud , Homosexualidad Masculina/estadística & datos numéricos , Humanos , Masculino , Evaluación de Necesidades , Perú/epidemiología , Prevalencia , Factores de Riesgo , Personas Transgénero/estadística & datos numéricos , Adulto JovenRESUMEN
Alcohol abuse can influence sexual risk behavior; however, its measurement is not straightforward. This study compared self-reported alcohol use, via the AUDIT and CAGE, with levels of phosphatidylethanol (Peth), a phospholipid biomarker that forms with chronic, heavy drinking, among high-risk MSM and TW in Lima, Peru. Chi square, Fisher's exact, Wilcoxon ranksum tests compared the instruments. Receiver operating curves determined sensitivity and specificity of the self-reported measures. Among 69 MSM and 17 TW, PEth was positive for 86% (95% CI 77-93%) of participants, while 67% reported binge-drinking in the last 2 weeks. The AUDIT classified 25% as hazardous drinkers while CAGE identified 6% as problem drinkers. Self-reported binge drinking was more sensitive than the AUDIT for PEth positivity (71% vs. 27%, p = 0.022). Among high-risk MSM and TW in Lima, validated, self-report measures of alcohol abuse underestimated biological measures. Further research correlating bio-markers and self-reported alcohol abuse measures is needed.
Asunto(s)
Consumo de Bebidas Alcohólicas/epidemiología , Alcoholismo/epidemiología , Glicerofosfolípidos/sangre , Asunción de Riesgos , Conducta Sexual , Personas Transgénero , Adolescente , Adulto , Consumo de Bebidas Alcohólicas/sangre , Alcoholismo/sangre , Alcoholismo/psicología , Biomarcadores/sangre , Femenino , Infecciones por VIH/diagnóstico , Infecciones por VIH/epidemiología , Infecciones por VIH/transmisión , Humanos , Masculino , Perú/epidemiología , Autoinforme , Parejas SexualesRESUMEN
Combining the detection of syphilis and HIV antibodies into one point-of-care test integrates syphilis screening into already existing HIV screening programs, which may be particularly beneficial in settings such as antenatal care. Using the INSTI Multiplex downward-flow immunoassay, we tested 200 stored serum samples from high-risk patients enrolled in a longitudinal study on HIV infection and syphilis in Peruvian men who have sex with men and transgender women. This rapid assay detected HIV and Treponema pallidum serum antibodies with sensitivities of 100% (95% confidence interval [CI], 95.9% to 100%) and 87.4% (95% CI, 81.4% to 92.0%), respectively, and specificities of 95.5% (95% CI, 89.9% to 98.5%) and 97.0% (95% CI, 84.2% to 99.9%), respectively (n = 200). The sensitivity for syphilis antibody detection was higher in patients with a rapid plasma reagin titer of ≥1:8 (97.3%) than in those with a titer of ≤1:4 (90%) or a nonreactive titer (66.7%).
Asunto(s)
Anticuerpos Antibacterianos/sangre , Técnicas de Laboratorio Clínico/métodos , Anticuerpos Anti-VIH/sangre , Infecciones por VIH/diagnóstico , Inmunoensayo/métodos , Sistemas de Atención de Punto , Sífilis/diagnóstico , Femenino , VIH/inmunología , Humanos , Estudios Longitudinales , Masculino , Perú , Sensibilidad y Especificidad , Personas Transgénero , Treponema pallidum/inmunologíaRESUMEN
BACKGROUND: Alcohol use disorders (AUDs) may enhance the likelihood of risky sexual behaviors and the acquisition of sexually transmitted infections (STIs). Associations between AUDs with condomless anal intercourse (CAI) and STI/HIV prevalence were assessed among men who have sex with men (MSM) and transgender women (TW) in Lima, Peru. METHODS: MSM and TW were eligible to participate based on a set of inclusion criteria which characterized them as high-risk. Participants completed a bio-behavioral survey. An AUDIT score ≥8 determined AUD presence. Recent STI diagnosis included rectal gonorrhea/chlamydia, syphilis, and/or new HIV infection within 6 months. Prevalence ratios (PR) were calculated using Poisson regression. RESULTS: Among 312 MSM and 89 TW, 45% (181/401) had an AUD. Among those with an AUD, 164 (91%) were hazardous/harmful drinkers, and 17 (9%) had alcohol dependence. Higher CAI was reported by participants with an AUD vs. without, (82% vs. 72% albeit not significant). Reporting anal sex in two or more risky venues was associated with screening AUD positive vs. not (24% vs. 15%, p=0.001). There was no difference in recent STI/HIV prevalence by AUD status (32% overall). In multivariable analysis, screening AUD positive was not associated with CAI or recent STI/HIV infection. CONCLUSIONS: In our sample AUDs were not associated with CAI or new HIV infection/recent STI. However higher prevalence of CAI, alcohol use at last sex, and anal sex in risky venues among those with AUDs suggests that interventions to reduce the harms of alcohol should be aimed toward specific contexts.
Asunto(s)
Consumo de Bebidas Alcohólicas/psicología , Infecciones por VIH/epidemiología , Homosexualidad Masculina/psicología , Conducta Sexual/psicología , Enfermedades de Transmisión Sexual/epidemiología , Personas Transgénero/psicología , Adolescente , Adulto , Anciano , Consumo de Bebidas Alcohólicas/epidemiología , Femenino , Homosexualidad Masculina/estadística & datos numéricos , Humanos , Masculino , Persona de Mediana Edad , Perú/epidemiología , Prevalencia , Conducta Sexual/estadística & datos numéricos , Encuestas y Cuestionarios , Sexo Inseguro/psicología , Adulto JovenRESUMEN
We assessed the laboratory performance of the Chembio dual-path platform HIV-syphilis rapid immunodiagnostic test and electronic reader for detection of HIV and Treponema pallidum antibodies in 450 previously characterized serum specimens. For visual or electronic reader HIV antibody detection, the sensitivity was 100% and the specificity was 98.7%. For visual T. pallidum antibody detection, the test sensitivity was 94.7% and the specificity was 100.0%; with the electronic reader, the sensitivity was 94.7% and the specificity was 99.7%.
Asunto(s)
Coinfección , Infecciones por VIH/diagnóstico , Pruebas Inmunológicas , Sistemas de Atención de Punto , Sífilis/diagnóstico , Antígenos Bacterianos/inmunología , Anticuerpos Anti-VIH/inmunología , Proteína p24 del Núcleo del VIH/inmunología , Humanos , Pruebas Inmunológicas/métodos , Pruebas Inmunológicas/normas , Reproducibilidad de los Resultados , Sensibilidad y EspecificidadRESUMEN
The emergence of opportunities for support from the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) for HIV-related projects has so far generated funding of over US$75 million for three proposals in Peru. The size of this investment creates the need for close monitoring to ensure a reasonable impact. This paper describes the effects of collaboration with the GFATM on key actors involved in HIV-related activities and on decision-making processes; on health sector divisions; on policies and sources of financing; on equity of access; and on stigma and discrimination of vulnerable and affected populations. Data analysed included primary data collected through interviews with key informants, in-depth interviews and group discussions with vulnerable and affected populations, as well as several public documents. Multisectorality, encouraged by the GFATM, is incipient; centralist proposals with limited consultation, a lack of consensus and short preparation times prevail. No accountability mechanisms operate at the Country Coordinating Mechanism (CCM) level regarding CCM members or society as a whole. GFATM-funded activities have required significant input from the public sector, sometimes beyond the capacity of its human resources. A significant increase in HIV funding, in absolute amounts and in fractions of the total budget, has been observed from several sources including the National Treasury, and it is unclear whether this has implied reductions in the budget for other priorities. Patterns of social exclusion of people living with HIV/AIDS are diverse: children and women are more valued; while transgender persons and sex workers are often excluded.
Asunto(s)
Infecciones por VIH/prevención & control , Accesibilidad a los Servicios de Salud/economía , Agencias Internacionales/economía , Malaria/prevención & control , Tuberculosis/prevención & control , Poblaciones Vulnerables , Femenino , Apoyo Financiero , Salud Global/economía , Infecciones por VIH/economía , Infecciones por VIH/epidemiología , Gastos en Salud , Implementación de Plan de Salud , Accesibilidad a los Servicios de Salud/normas , Disparidades en Atención de Salud , Homosexualidad , Humanos , Malaria/economía , Malaria/epidemiología , Masculino , Perú/epidemiología , Prevalencia , Evaluación de Programas y Proyectos de Salud , Trabajadores Sexuales , Estigma Social , Personas Transgénero , Tuberculosis/economía , Tuberculosis/epidemiologíaRESUMEN
OBJECTIVES: To assess the prevalence of sexually transmitted infections (STIs), the frequency of sexual risk behaviours, and the relation between knowledge of HIV infection status and sexual risk behaviour among men who have sex with men (MSM) infected with HIV attending an STI clinic in Peru. METHODS: We recruited a convenience sample of 559 MSM from a municipal STI clinic in Lima, Peru. Participants completed a survey and provided blood for HIV, syphilis and HSV-2 antibody testing, and urine for gonorrhoea and chlamydia nucleic acid testing. RESULTS: Among 124 MSM with HIV, 72.6% were aware that they were infected with HIV. Active syphilis (RPR> or =1:8) was diagnosed in 21.0% of men infected with HIV, HSV-2 in 79.8%, urethral gonorrhoea in 1.6% and chlamydia in 1.6%. Among 41 participants reporting insertive anal intercourse with their last sex partner, 34.2% did not use a condom. Of the 86 participants reporting receptive anal intercourse, 25.6% did not use a condom. At least one episode of insertive unprotected anal intercourse (UAI) with a partner uninfected with HIV during the past 6 months was reported by 33.6% (35/104) of participants, and receptive UAI with a partner uninfected by HIV was reported by 44.6% (45/101). There was no difference in frequency of UAI with partners infected or uninfected with HIV observed between men who knew their serostatus compared with those who were previously undiagnosed (all p values >0.05). CONCLUSIONS: MSM with HIV in Peru engaged in high-risk behaviours for spreading HIV and STIs. Knowledge of whether someone was infected with HIV was not associated with a decreased frequency of UAI. Additional efforts to reduce risk behaviour after the diagnosis of HIV infection are necessary.
Asunto(s)
Homosexualidad Masculina/estadística & datos numéricos , Enfermedades de Transmisión Sexual/transmisión , Adulto , Escolaridad , Infecciones por VIH/epidemiología , Infecciones por VIH/transmisión , Humanos , Masculino , Perú/epidemiología , Prevalencia , Factores de Riesgo , Parejas Sexuales , Enfermedades de Transmisión Sexual/epidemiología , Sexo Inseguro/estadística & datos numéricos , Adulto JovenRESUMEN
OBJECTIVES: To conduct a systematic review of published and unpublished data from research and public health information systems on the prevalence of male-to-male sex in the total male population; as well as among men who have sex with men (MSM), data on prevalence of heterosexual activity and heterosexual unions; prevalence of condom use with male and female partners; and prevalence of HIV infection and other sexually transmitted infections (STIs). METHODS: Key indicators were defined (a) among men in the general population: prevalence of sex with a man ever and last year; (b) among MSM: prevalence of heterosexual experiences ever and last year; proportion of male-female transgenders; proportion of sex workers; prevalence of HIV and other STIs, condom use in last sexual encounter; consistent condom use with men last year; never used a condom with a man. With help from key informants, study searches were conducted in Pubmed, LILLACS, institutional databases, conference records and other sources. Methodology and quality of information were assessed, and the best data available for 2003-7 were selected. Indicator estimates from each study were used to propose regional estimate ranges. RESULTS: A total of 83 new entries were entered into the database in addition to the previous 561, totalling 644. Of these, 107 showing 2003-7 data were selected. Many new studies came from sub-Saharan Africa, portraying hidden HIV epidemics among MSM. The most frequently reported estimate was HIV infection, with high estimate ranges in most of the regions, except for Middle East and North Africa and Eastern Europe. The next most frequently reported was lifetime frequency of heterosexual sex, showing that roughly 50% of MSM ever had sex with a woman. The small number of newer studies reporting prevalence of "sex with a man in last 12 months" between 2003 and 2007, did not warrant enough new evidence to revise our 2005 size estimates for MSM populations. CONCLUSIONS: A considerable number of new studies with estimates of relevance to understanding sexual behaviour and HIV among MSM were identified, with an encouraging amount of new data coming from sub-Saharan Africa. However, limitations in the quality, utility and comparability of available information persist. At least three measures could be promoted for use in surveillance and academic studies: standardised indicators for MSM studies; standardised operational definitions of, and instructions to describe, variables; and standardised research designs and data gathering strategies. A prerequisite for this all is intense advocacy to ensure a social climate in which research into such matters is prioritised, resources are made available as needed and the human rights of MSM are respected.
Asunto(s)
Países en Desarrollo/estadística & datos numéricos , Infecciones por VIH/epidemiología , Homosexualidad Masculina/estadística & datos numéricos , Enfermedades Bacterianas de Transmisión Sexual/epidemiología , Condones/estadística & datos numéricos , Femenino , Heterosexualidad/estadística & datos numéricos , Humanos , Masculino , Prevalencia , Parejas Sexuales , Factores Socioeconómicos , Sexo Inseguro/estadística & datos numéricosRESUMEN
The goal of this study was to determine the prevalence of bacterial vaginosis (BV) in Peruvian women from socioeconomically deprived populations and to determine the association between BV and risk factors for sexually transmitted diseases (STDs). Women were administered an epidemiologic survey to determine sexual risk behaviour and they provided biological samples to test for BV and STDs. The prevalence of BV was high (27%) and was significantly associated with having a bacterial STD or trichomoniasis. Age, marital status, and a history of sex work, but not of sexual experience, frequency of intercourse, and unprotected intercourse, were associated with BV. As BV may be a marker for STDs, screening for STDs should be performed in individuals with BV to promote early detection and treatment of co-infecting sexually transmitted pathogens.
Asunto(s)
Enfermedades de Transmisión Sexual/epidemiología , Vaginosis Bacteriana/epidemiología , Adolescente , Adulto , Estudios Transversales , Femenino , Infecciones por VIH/epidemiología , Infecciones por VIH/microbiología , Humanos , Masculino , Perú/epidemiología , Pobreza , Prevalencia , Factores de Riesgo , Enfermedades de Transmisión Sexual/economía , Enfermedades de Transmisión Sexual/microbiología , Enfermedades de Transmisión Sexual/virología , Población Urbana , Vaginosis Bacteriana/economía , Vaginosis Bacteriana/virologíaRESUMEN
OBJECTIVES: To review and summarise various types of Peruvian evidence on sexual behaviour, HIV/STI exposure and risk, and discuss how to increase its usefulness for HIV/STI risk trend monitoring in Peru. METHODS: Review HIV sentinel surveillance conducted by the Ministry of Health; data from the Demographic and Health Surveys (DHS); and academic publications on sexual behaviour in combination with biological markers. Changes over time, quality of data, size of studies, and intended audience are discussed. RESULTS: Data from HIV sentinel surveillance showed very high (8-23%) HIV seroprevalence among men having sex with men, but stable, relatively low figures among female sex workers (1%) and antenatal clinic patients (under 0.5%). DHS data suggest that single women increased their sexual activity throughout the 1990s but did not raise their contraceptive use accordingly, resulting in increased early conceptions. The contribution of condoms to overall contraceptive protection increased threefold in 1992-2000. According to the 1996 survey, men become sexually active 2.5 years earlier than women, but marry or cohabit four years later than women; women marry or cohabit 1.5-2.5 years after first sex, whereas men take eight years to do so. Finally, published studies confirmed dramatic differences in HIV prevalence between men who have sex with men and other populations, and also suggested patterns of bridging from men to women. CONCLUSIONS: Data available from the three sources are numerous, although limitations of each approach reduce their monitoring utility: Ministry of Health studies should select better sentinel populations and timely process behavioural data. Future demographic surveys should incorporate an AIDS risk perspective and include men.
Asunto(s)
Conducta Sexual/estadística & datos numéricos , Enfermedades de Transmisión Sexual/epidemiología , Adolescente , Adulto , Factores de Edad , Condones/estadística & datos numéricos , Anticoncepción , Recolección de Datos/métodos , Femenino , Infecciones por VIH/epidemiología , Infecciones por VIH/psicología , Humanos , Masculino , Persona de Mediana Edad , Perú/epidemiología , Prevalencia , Vigilancia de Guardia , Conducta Sexual/psicología , Parejas Sexuales , Enfermedades de Transmisión Sexual/psicología , Sexo Inseguro/psicología , Sexo Inseguro/estadística & datos numéricosRESUMEN
OBJECTIVES: To review current approaches to HIV surveillance among men who have sex with men (MSM), identify illustrative best practices and lessons learned, and outline ways to enhance surveillance systems. METHODS: Review of the literature and institutional guidelines for HIV/AIDS, sexually transmitted infection (STI), and behavioral surveillance and summary of results of an international workshop. RESULTS: On-going formative research, HIV/AIDS and STI case reporting, HIV prevalence and incidence studies, and behavioral surveys are essential components of an effective HIV surveillance system for MSM. Alliances with key organizations and actors in MSM communities provide points of access, assist in the development of measures, and guide appropriate use of data. Sampling techniques (convenience, snowball, quota, microsite, time-location, and population-based) offering a range of methods, complexity, and cost have been successfully implemented in MSM communities. Plausible estimates of the size of MSM populations, which are ultimately crucial to the interpretation of surveillance data, can be improved upon using primary and secondary data. CONCLUSIONS: The purpose of HIV surveillance among MSM is not only to monitor disease occurrence and its antecedents, but to regularly use data to plan and evaluate prevention and care programs, advocate for prevention resources, and improve the health, social welfare and human rights of MSM. Practical, incremental steps can be taken to improve HIV surveillance among MSM in all regions of the world in all stages of the epidemic.
Asunto(s)
Infecciones por VIH/epidemiología , Homosexualidad Masculina/estadística & datos numéricos , Vigilancia de la Población/métodos , Análisis por Conglomerados , Estudios Transversales , Resistencia a Medicamentos , Infecciones por VIH/prevención & control , Humanos , Estudios Longitudinales , Masculino , Práctica de Salud Pública/legislación & jurisprudencia , Estudios Seroepidemiológicos , Conducta SexualRESUMEN
BACKGROUND: In Iquitos, Peru, motorcycle taxis are a common form of public transportation used both by residents and visitors. GOAL: To evaluate the prevalence of factors associated with sexually transmitted disease risk and of Neisseria gonorrhoeae and Chlamydia trachomatis infections among motorcycle taxi drivers working in Iquitos, Peru. STUDY DESIGN: A convenience sample of motorcycle taxi drivers was recruited through street outreach. Participants were confidentially interviewed and provided urine specimens for gonococcal and chlamydial infection testing. RESULTS: A history of sexually transmitted disease (62%) or symptoms in the past year (35%) and of referral of clients to commercial sex workers (60%) was common. The prevalence of gonococcal or chlamydial infection was 3.5%. CONCLUSIONS: Motorcycle taxi drivers are a major means of public transportation in Iquitos, Peru, have high personal risks for sexually transmitted disease, and interface often with at-risk persons.
Asunto(s)
Infecciones por Chlamydia/epidemiología , Gonorrea/epidemiología , Vehículos a Motor , Enfermedades de Transmisión Sexual/epidemiología , Adolescente , Adulto , Infecciones por Chlamydia/prevención & control , Gonorrea/prevención & control , Humanos , Entrevistas como Asunto , Persona de Mediana Edad , Perú/epidemiología , Prevalencia , Trabajo Sexual , Enfermedades de Transmisión Sexual/prevención & control , Orina/microbiologíaRESUMEN
PURPOSE: To determine the prevalence and correlates of sexual coercion in young adults in Lima, Peru. METHODS: Lifetime sexual coercion and that at first sexual experience were studied in 629 sexually active young people, drawn from representative samples of 611 adolescents and 607 young adults. RESULTS: Almost half of the young women and a quarter of the young men in the study reported sexual coercion. In multiple logistic regression analyses, men and women who reported having been coerced at heterosexual initiation also reported more lifetime sexually transmitted diseases and a lower age at first sex than those not reporting coercion. Men who reported coercion at heterosexual initiation also reported a lower number of lifetime heterosexual partners and less sexual knowledge than men not coerced. CONCLUSION: Experiencing heterosexual initiation as coercive appears to be a marker for a riskier sexual career for both genders and for future homosexual behavior in men.
Asunto(s)
Abuso Sexual Infantil/estadística & datos numéricos , Coerción , Violación/estadística & datos numéricos , Conducta Sexual , Adolescente , Adulto , Abuso Sexual Infantil/psicología , Femenino , Heterosexualidad , Homosexualidad , Humanos , Modelos Logísticos , Masculino , Perú , Violación/psicología , Factores de Riesgo , Conducta Sexual/psicología , Parejas Sexuales/psicologíaRESUMEN
BACKGROUND: Iquitos Peru, a densely populated port city housing both a large military base and a booming tourist industry, provides a thriving market for commercial sex and, consequently, sexually transmitted disease (STD). The purpose of this study was to characterize the prevalence of gonococcal and chlamydial infections among commercial sex workers (CSWs) and to correlate those findings with social/behavioral characteristics. METHODS: One hundred CSWs, recruited through street and brothel outreach, were administered questionnaires. Urine specimens were collected for gonorrhea and chlamydia testing using ligase chain reaction assays. RESULTS: Twenty-eight percent of CSWs were positive for chlamydia (22%) or gonorrhea (14%). Registered CSWs were more likely to have worked more than 5 years (p = 0.03), report 10 or more partners (p = 0.002), and work in brothels (p < 0.001). Significant associations were also noted between infection status and age, with adolescents at increased risk (odds ratio [OR] = 4.13, p = 0.001), and duration of employment, with those employed less than 5 years at increased risk (OR = 3.72, p = 0.04). The latter association, however, was because of age. Also, most CSWs believed themselves to be at no/small risk or didn't know their risk of future gonococcal infection (30%/12% and 25%, respectively) and AIDS (25%/8% and 35%, respectively), with 11% perceiving AIDS as more of a threat. CONCLUSIONS: High infection rates, lack of knowledge regarding STD/HIV risk assessment, and other high-risk behavior prevalent among this population stress the need for STD intervention. The study further suggests that educational/risk assessment programs and risk reduction interventions could be successful.
PIP: This study aims to characterize the prevalence of gonococcal and chlamydial infections among commercial sex workers (CSWs) in Iquitos, Peru, which provides a thriving market for CSWs and, consequently, sexually transmitted diseases (STDs) and to correlate those findings with social/behavioral characteristics. About 100 CSWs, recruited through street (n = 37) and brothel outreach (n = 67), were interviewed through questionnaires. Urine specimens were collected for gonorrhea and chlamydial testing. Findings revealed that registered CSWs were significantly more likely to have worked in the sex trade for more than 5 years, report 10 or more sex partners per week, and to work in brothels. Nonetheless, there were no significant differences in age, average charge for sex, or STD prevalence between registered and unregistered CSWs. Overall, 28% of CSWs were positive for chlamydia (22%) and gonorrhea (14%). Furthermore, a number of CSWs stated that they did not know whether they were at risk or assessed their risk as being low for contracting gonorrhea or AIDS. There was no significant association between self-perception of STD risk and STD prevalence. High infection rates, lack of knowledge regarding HIV/AIDS and STD risk assessment, and other high-risk behaviors prevalent among this population stress the need for STD intervention programs and risk reduction behavior.
Asunto(s)
Infecciones por Chlamydia/epidemiología , Gonorrea/epidemiología , Trabajo Sexual/estadística & datos numéricos , Adolescente , Adulto , Infecciones por Chlamydia/microbiología , Chlamydia trachomatis/aislamiento & purificación , Condones , Femenino , Humanos , Neisseria gonorrhoeae/aislamiento & purificación , Oportunidad Relativa , Perú/epidemiología , Proyectos Piloto , Prevalencia , Medición de Riesgo , Orina/microbiologíaRESUMEN
PIP: The Cayetan Heredia University in Lima, Peru, developed a community-based intervention program on sexual and reproductive health of the youth. The Sexual Health in a Young City program covers all individuals aged 15-24 years living in two communities in Lima, Brena, and Pueblo Libre. The program departed from the argument that the youth could organize themselves and act for change in regard to their own sexual and reproductive lives. Rooted on the strategies of community education and empowerment, the intervention also seeks to mobilize community resources to improve the reproductive and sexual health of the youth. The 3 major components of the program are: 1) motivating and involving community actors; 2) strengthening and publicizing adolescent health services; and 3) designing and implementing a campaign for youth sexual health. However, the program encountered constraints and limitations. Despite these flaws, the program showed that the more important social actors in a community could be involved in coordinating efforts to promote reproductive and sexual health of the youth.^ieng
Asunto(s)
Adolescente , Participación de la Comunidad , Servicios de Salud , Medicina Reproductiva , Investigación , Factores de Edad , Américas , Atención a la Salud , Demografía , Países en Desarrollo , Salud , América Latina , Organización y Administración , Perú , Población , Características de la Población , América del SurRESUMEN
PIP: This study provides a perspective on the sexual culture, self-representations and behaviors of men who have sex with men. Focus groups and semi-structured interviews were conducted with gay-identified men from both working class and middle-class backgrounds, non-gay-identified men who had sex with men, "fletes" (young men who sell homosexual sex), and transvestites. Ages among the study group ranged from 18 to 35. Issues explored included homosexuality and bisexuality, sexual experiences, socialization and support networks, "fleteo" and prostitution, AIDS-related concerns, emotional attachment, sexual identity and self-image. Findings suggest that a unitary homosexual culture does not exist in Lima. Ideologies structuring relationships within homoerotic culture range from more the more traditional, in which relationships are organized according to gender-transformed relationships, whereby ordinary males performed as "activos" with feminized "pasivo" males, to contemporary Western patterns involving equals who are able to exchange sexual roles. Awareness of this diversity should facilitate the identification of different sexual health needs and the protection of sexual rights, leading to the development of programs more sensitive to the cultural heterogeneity of male homosexualities in Lima.^ieng
Asunto(s)
Síndrome de Inmunodeficiencia Adquirida , Cultura , Recolección de Datos , Homosexualidad , Hombres , Investigación , Conducta Sexual , Conducta Social , Américas , Conducta , Países en Desarrollo , Enfermedad , Infecciones por VIH , América Latina , Perú , Muestreo , América del Sur , VirosisRESUMEN
OBJECTIVE: To describe sexual behavior patterns and identify psychosocial and situational correlates of safer practices among men who have sex with other men in Lima. DESIGN: A cross-sectional survey. SUBJECTS AND METHODS: In 1992, 223 mostly young, working- and middle-class homosexually active men in Lima, who reported either being seronegative or not knowing their HIV status, were recruited from public places, gay organizations and through snowballing techniques. Measurements included patterns of sexual behavior and socialization with other homosexually active men, and psychosocial and situational factors. Three risk behavior indicators were used: the practice of unprotected receptive anal intercourse, the practice of unprotected anal intercourse (insertive or receptive) and an index of behavioral risk based on numbers of sexual partners for different risk practices. RESULTS: The subjects (mean age 24.9 years, SD 6.3) were mostly exclusively homosexual (74%) and self-identified as gay/homosexual (73%); 41% had had unprotected anal intercourse during the last 4 months (75% of them in the receptive role). Reporting sex in public places consistently predicted riskier behavior by any of the three indices, whereas a lower perception of benefits of condoms/safer sex, poor AIDS knowledge, participation in a steady relationship and higher self-efficacy were associated with one or two of the indices. CONCLUSIONS: Besides considering basic AIDS information and the promotion of condoms and safer sex, intervention programs for homosexually active men in Lima should emphasize the need for open discussions on safety in steady relationships, promote accurate perceptions of personal risk and sensitively address the special difficulties posed by sexual activity in public places.