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Being Unaware of Being HIV-Infected is Associated with Alcohol Use Disorders and High-Risk Sexual Behaviors Among Men Who have Sex with Men in Peru

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Abstract

This study compared the correlates of HIV risk among men who have sex with men (MSM) with newly diagnosed versus previously known HIV infection among 5,148 MSM recruited using modified snowball sampling in 5 Peruvian cities. Participants, if age ≥18 years and reporting sex with a male in the previous 12 months, underwent standardized computer-assisted risk assessments and HIV and syphilis testing. Overall, 420 (8.2 %) participants tested HIV seropositive, most of whom (89.8 %) were unaware of their HIV status. Compared to those who knew themselves to be HIV-infected, multivariate logistic regression demonstrated that unprotected anal intercourse at last encounter [AOR = 2.84 (95 % CI 1.09–7.40)] and having an alcohol use disorder (AUD) [AOR = 2.14 (95 % CI 1.01–5.54)] were independently associated with a newly diagnosed HIV infection. Being unaware of being HIV-infected was associated with high-risk sexual behaviors and AUDs, both of which are amenable to behavioral and medication-assisted therapy interventions.

Resumen

Nuestro estudio comparó los factores de riesgo para el VIH entre hombres que tienen sexo con hombres (HSH) que tenían diagnóstico reciente y diagnóstico previo de infección por VIH. Reclutamos 5,148 HSH en 5 ciudades del Perú, usando una técnica modificada de “bola de nieve”. Los participantes, que fueron mayores de edad (≥18 años) y reportaron haber sexo con otro hombre en los previos 12 meses previos, respondieron una encuesta estandarizada asistida por computadora para evaluar comportamientos de riesgos, y se les realizó análisis de sangrel VIH y sífilis. En total, 420 (8.2 %) de los participantes resultaron positivos al test para el VIH, y la mayoría de estos (89.8 %) no tenían conocimiento de su estado seropositivo. En comparación con los que tenían conocimiento de su estado seropositivo, un análisis de regresión logística multivariada demostró que el haber tenido relaciones sexuales anales sin protección [AOR = 2.84 (95 % CI 1.09–7.40)], y tener un trastorno por consumo de alcohol (TCA) [AOR = 2.14 (95 % CI 1.01–5.54)] estaban independientemente asociados con una diagnóstico reciente de VIH. La falta de conocimiento sobre el estado seropositivo estuvo también asociado con comportamientos sexuales de riesgo y tener un trastorno por consumo de alcohol. Ambos factores pueden ser corregidos con intervenciones conductuales y tratamiento médico.

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Acknowledgments

The authors would like to acknowledge the subjects who participated in this study; all the medical and research personnel at Impacta, Peru; Dr. Jeffrey Wickersham at the Yale AIDS Program and the Yale University StatLab for their help and advice with the statistical analyses; Enrico Ferro at Yale College; Paula Dellamura and Ruthanne Marcus at the Yale AIDS Program for their continued support of this project. This research was funded by The Global Fund to Fight AIDS, Tuberculosis and Malaria Grants PER-506-G03-H and PER-607-G05-H awarded to CARE PERU; unrestricted discretionary core funds from Asociacion Civil Impacta Educacion y Salud; and from the National Institute on Drug Abuse through research (R01 DA032106) and career development awards (K24 DA017072) to FLA. The funding sources played no role in study design, data collection, data analysis, data interpretation, writing of the manuscript or the decision to submit the paper for publication.

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Correspondence to Panagiotis Vagenas.

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Since the original submission, this paper has been selected for presentation as an oral abstract at the International AIDS Society Conference in Kuala Lumpur, in June/July 2013.

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Vagenas, P., Ludford, K.T., Gonzales, P. et al. Being Unaware of Being HIV-Infected is Associated with Alcohol Use Disorders and High-Risk Sexual Behaviors Among Men Who have Sex with Men in Peru. AIDS Behav 18, 120–127 (2014). https://doi.org/10.1007/s10461-013-0504-2

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