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In Peru, Reporting Male Sex Partners Imparts Significant Risk of Incident HIV/Sexually Transmitted Infection: All Men Engaging in Same-Sex Behavior Need Prevention Services

Konda, Kelika A. PhD*†; Lescano, Andres G. PhD‡§; Celentano, David D. ScD*; Hall, Eric PhD; Montano, Silvia M. MD**; Kochel, Tadeusz J. PhD††; Coates, Thomas J. PhD*; Cáceres, Carlos F. PhD‡‡; the NIMH Collaborative HIVSTD Prevention Trial Group

Sexually Transmitted Diseases: July 2013 - Volume 40 - Issue 7 - p 569–574
doi: 10.1097/OLQ.0b013e3182956eeb
Original Study

Background: Detailed information on the sexual behavior of bisexual, non–gay-identified men and the relationship between same-sex behavior and HIV/sexually transmitted infection (STI) incidence is limited. This study provides information on the sexual behavior with male partners of non–gay-identified men in urban, coastal Peru and the relationship of this behavior with HIV/STI incidence.

Methods: We analyzed data from 2146 non–gay-identified men with a baseline and then 2 years of annual follow-up, including detailed information on sexual behavior with up to 5 sex partners, to determine the characteristics associated with bisexual behavior. Discrete time proportional hazards models were used to determine the effect of self-reported sex with men on subsequent HIV/STI incidence.

Results: Over the 3 study visits, sex with a man was reported by 18.9% of men, 90% of whom also reported sex with a female partner. At baseline, reported bisexual behavior was associated with other sexual risk behaviors such as exchanging sex for money and increased risk of HIV, herpes simplex virus type 2, and gonorrhea. The number of study visits in which recent sex with men was reported was positively correlated with risk of other sexual risk behaviors and incident HIV, herpes simplex virus type 2, and gonorrhea. Recent sex with a man was associated with increased HIV/STI incidence (hazard ratio, 1.79; confidence interval, 1.19–2.70), after adjusting for sociodemographics and other sexual risk behaviors.

Conclusions: Given the prevalence of recent sex with men and the relationship of this behavior with HIV/STI incidence, interventions with non–gay-identified men who have sex with men and their partners are warranted.

Peruvian non–gay-identified men have higher rates of HIV/sexually transmitted infections when reporting male sex partners for 24 months and should be included in prevention services.

From the *Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; †Division of Infectious Diseases, David Geffen School of Medicine, University of California, Los Angeles, CA; ‡Department of Parasitology, US Naval Medical Research Center Detachment, Lima, Peru; §Facultad de Salud Publica y Administracion, Universidad Peruana Cayetano Heredia, Lima, Peru ¶Naval Medical Research Center, Bethesda, MD; Departments of **Bacteriology and ††Virology, US Naval Medical Research Center Detachment, Lima, Peru; ‡‡Facultad de Salud Publica, Universidad Peruana Cayetano Heredia, Lima, Peru; and §§National Institute of Mental Health, Bethesda, MD

Acknowledgments: We thank the study participants and study staff of the National Institute of Mental Health (NIMH) Collaborative HIV/STD Prevention Trial in Peru.

This study was funded by National Institutes of Health (NIH)/NIMH Grant No. U10 MH61536, which was a 5-country Cooperative Agreement being conducted in China, India, Peru, Russia, and Zimbabwe. K.A.K. was supported by NIMH F31 MH084765 and NIMH T32MH080634. The participation of Dr Lescano in this project is sponsored by the Training Grant NIH/FIC 2D43 TW007393 awarded to NAMRU-6 by the Fogarty International Center of the US NIH.

Conflict of interest: None declared.

Disclaimer: The views expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the Department of the Navy, Department of Defense, or the US government.

Copyright statement: Several authors of this article are military service members or employees of the US government. This work was prepared as part of their duties. Title 17 U.S.C. § 105 provides that “Copyright protection under this title is not available for any work of the United States Government.” Title 17 U.S.C. § 101 defines a US government work as a work prepared by a military service member or employee of the US government as part of that person’s official duties.

Correspondence: Kelika A. Konda, PhD, C/ Diez Canseco 333, Oficina 1, Lima, 18, Peru. E-mail:

Received for publication October 18, 2012, and accepted April 3, 2013.

© Copyright 2013 American Sexually Transmitted Diseases Association