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.

seroreactivity. Estimates were weighted by the inverse of the participant social network size.

gonococcal porA pseudogene and multi-copy opa genes. Cycle threshold (Ct) values obtained were used as semi-quantitative measures of gonococcal DNA. Sampling adequacy was assessed using a real-time PCR for human endogenous retrovirus 3 (ERV3). Results 100 MSM with culture positive pharyngeal gonorrhoea were included. Isolation rates by culture from the tonsils and posterior oropharynx were 62% and 52% respectively (p = 0.041). PCR was significantly more sensitive than culture at both the tonsils (84% vs. 62%; p < 0.001) and oropharynx (81% vs. 52%; p < 0.001). Culture positivity was greater with higher gonococcal DNA loads at both the tonsils (p = 0.001) and oropharynx (p < 0.001). At the oropharynx, higher ERV3 DNA load was associated with improved gonococcal detection using culture (p = 0.013) as well as PCR (p = 0.045). At the tonsils, higher ERV3 DNA load was associated with improved gonococcal detection by PCR (p = 0.040). Conclusion Neisseria gonorrhoeae can be cultured from the tonsils as well as the posterior oropharynx with greater isolation rates where gonococcal loads are higher. While PCR is substantially more sensitive than culture at each site, like culture, PCR is dependent on the adequacy of sampling.

likely to use a condom than those in CNB (14.1% vs 5.5%, [age adjusted] AOR=0.32, 95%CI:0.18-0.56). In URB, condom use was associated with being male (16.7% vs 12.2% female, [age/region adjusted] AOR=1.47, 95%CI:1.12-1.94) and weakly associated with being older (16.5% among 17-19y vs 12.9% among 14-16y, AOR=1.27, 95% CI: 0.97-1.68, p=0.08). In CNB, condom use was associated with being female (10.5% vs 1.7% male, AOR=0.16, 95% CI: 0.04-0.58). Among URB participants, condom use was associated with sexual activity within the previous month (21.0% vs 4.4% non-recent activity, AOR=2.26, 95%CI:1.37-3.74). In univariable analysis, participants who reported sexual debut at 15y (17.9%) were more likely to report condom use than <15y (17.9%, OR=1.24, 95%CI: 0.95-1.62, p=0.08). Conclusions Reported condom use at last sexual encounter was low among adolescents in URB and CNB schools, particularly among adolescents of both sexes in CNB. Younger adolescents, those with a lower age of sexual debut, and especially females in URB and males in CNB, require targeted interventions to increase condom use at all encounters.

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