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Let’s Talk About Sex: The Impact of Partnership Contexts on Communication About HIV Serostatus and Condom Use Among Men Who Have Sex with Men (MSM) and Transgender Women (TW) in Lima, Peru

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Abstract

Sexual communication with partners informs risk assessment and sexual practices. We evaluated participant, partner, and network factors associated with communication about condom use and HIV serostatus and explored their relationships with condomless anal intercourse (CAI) among 446 men who have sex with men (MSM) and 122 transgender women (TW) in Lima, Peru. Generalized estimating equations assessed contextual influences on communication and practices with recent sexual partners. More frequent HIV communication was reported by MSM who: identified as heterosexual, compared to bisexual or gay; characterized partnerships as stable, compared to casual, anonymous, or commercial; or discussed HIV/STIs with close social contacts (p < 0.05). TW in concurrent partnerships discussed condom use more frequently than those in monogamous relationships (p < 0.05). Condom use discussions and alcohol use among MSM were associated with CAI (p < 0.05). Findings highlight complexity in sexual decision-making and call for further study of conversation content and practices to inform HIV prevention messaging.

Resumen

La comunicación sexual entre parejas informa sobre la valoración de riesgos y las prácticas sexuales. Evaluamos los factores de participantes, sus parejas y sus redes en relación con la comunicación sobre el uso de condones y el serostatus del VIH, y exploramos sus asociaciones con el sexo anal sin condón (CAI) entre 446 hombres que tienen sexo con hombres (HSH) y 122 mujeres transgéneros (MT) en Lima, Perú. Usamos ecuaciones de estimación generalizadas para evaluar las influencias contextuales en la comunicación y las prácticas con parejas sexuales recientes. La comunicación sobre el VIH fue más frecuente entre los HSH: que se identificaron como heterosexuales, en comparación con bisexuales o gay; quienes reportaron sus relaciones de pareja como estables, en comparación a casuales, anónimas o comerciales; o quienes discutieron el VIH/ITS con contactos sociales cercanos (p < 0.05). Las MT con relaciones concurrentes discutieron el uso de condones con más frecuencia que las que reportaron relaciones monógamas (p < 0.05). Las discusiones sobre el uso de condones y el consumo de alcohol se asociaron con CAI entre los HSH (p < 0.05). Estos resultados resaltan la complejidad de las decisiones sexuales y ameritan un mayor estudio del contenido y las prácticas de conversación para informar los mensajes de prevención del VIH.

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Data Availability

The data that support the findings of this study are available upon reasonable request to the authors, pending approval from the UCLA IRB and Ethics Committee of Asociación Civil Vía Libre. Data utilized in this study are not publicly available due to restrictions on publication of human participant data without consent.

Code Availability

The code used in analysis of these findings is available upon reasonable request to the authors.

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Acknowledgements

We would like to thank the study participants for devoting their time and experiences to this project. We would also like to thank the research staff for their efforts to make this study possible.

Funding

The US National Institute of Health (NIH) provided funding for this work through Grants NIH R25 MH087222 (South American Program in HIV Prevention Research; PI: J. Clark) and NIH R34 MH105272 to J. Clark.

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Authors and Affiliations

  1. South American Program in HIV Prevention Research, David Geffen School of Medicine, University of California Los Angeles, 10833 Le Conte Avenue, Los Angeles, CA, USA

    Amrita Ayer, Eddy R. Segura, Jordan E. Lake, Robinson Cabello & Jesse L. Clark

  2. David Geffen School of Medicine, University of California Los Angeles, 10833 Le Conte Avenue, CHS 37-121, Los Angeles, CA, 90095, USA

    Amrita Ayer

  3. Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada

    Amaya Perez-Brumer

  4. Escuela de Medicina, Universidad Peruana de Ciencias Aplicadas, Lima, Peru

    Eddy R. Segura

  5. Asociación Civil Via Libre, Lima, Peru

    Susan Chavez-Gomez, Rosario Fernandez, Cecilia Arroyo, Alex Barrantes & Robinson Cabello

  6. Department of Internal Medicine, Division of Infectious Diseases, McGovern Medical School at UT Health, Houston, TX, USA

    Jordan E. Lake

  7. Department of Medicine, Division of Infectious Diseases, UCLA David Geffen School of Medicine, Los Angeles, CA, USA

    Jesse L. Clark

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  1. Amrita Ayer
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Contributions

JLC, ERS, APB, JEL, and AA contributed to the conceptualization of this analysis. RC, JLC, ERS, SCG, RF, CA, and AB contributed to the data acquisition and study protocol implementation. ERS and AA contributed to data analysis. JLC, APB, ERS, JEL, and AA contributed to the interpretation of results and drafting of the manuscript. All authors reviewed, edited, and approved the final version of the manuscript and agree to be accountable for all aspects of the work, including its accuracy and integrity.

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Correspondence to Amrita Ayer.

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The authors have no relevant financial or non-financial interests to disclose.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the the Institutional Review Board at the University of California, Los Angeles and the Ethics Committee of Asociación Civil Vía Libre as well as the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The parent study was registered with ClinicalTrials.gov (Identifier: NCT03010020).

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Informed consent was obtained from all individual participants included in the study.

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Ayer, A., Perez-Brumer, A., Segura, E.R. et al. Let’s Talk About Sex: The Impact of Partnership Contexts on Communication About HIV Serostatus and Condom Use Among Men Who Have Sex with Men (MSM) and Transgender Women (TW) in Lima, Peru. AIDS Behav 25, 2139–2153 (2021). https://doi.org/10.1007/s10461-020-03144-1

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