Factors associated with previously undiagnosed human immunodeficiency virus infection in a population of men who have sex with men and male-to-female transgender women in Lima, Peru

Abstract

The aim of the study was to identify factors associated with undiagnosed human immunodeficiency virus (HIV) infection among men who have sex with men (MSM) and male-to-female transgender women in Lima, Peru.We analyzed characteristics of 378 MSM and transgender women recruited from 2 sexually transmitted infection (STI) clinics in Lima, Peru. Descriptive analyses compared: (A) HIV-uninfected, (B) previously undiagnosed HIV-infected, and (C) previously diagnosed HIV-infected participants. Multivariable logistic regression models identified: (1) correlates of previously undiagnosed HIV-infection among participants thought to be HIV-uninfected (B vs A); and (2) correlates of previously undiagnosed HIV-infection among HIV-infected participants (B vs C). Subanalysis identified correlates of frequent HIV testing among participants thought to be HIV-uninfected.Among participants, 31.0% were HIV-infected; of those, 35.0% were previously undiagnosed. Among participants thought to be HIV-uninfected (model 1), recent condomless receptive anal intercourse and last HIV test being over 1-year ago (compared to within the last 6-months) were associated with increased odds of being previously undiagnosed HIV-infected (adjusted odds ratio [aOR] = 2.43, 95% confidence interval [95%CI] = 1.10–5.36; aOR = 2.87, 95%CI = 1.10–7.53, respectively). Among HIV-infected participants (model 2), recent condomless receptive anal intercourse was again associated with previously undiagnosed HIV-infection (aOR = 2.54, 95%CI = 1.04–6.23). Achieving post-secondary education and prior syphilis infection were associated with lower odds of having previously undiagnosed HIV-infection (aOR = 0.35, 95%CI = 0.15–0.81; aOR = 0.32, 95%CI = 0.14–0.75, respectively).Reporting semiannual testing was associated with higher educational attainment, identifying as a transgender woman, or reporting a history of syphilis (aOR = 1.94, 95%CI = 1.11–3.37; aOR = 2.40, 95%CI = 1.23–4.70; aOR = 2.76, 95%CI = 1.62–4.71, respectively). Lower odds of semiannual testing were associated with recent condomless insertive anal intercourse or reporting a moderate or high self-perceived risk of acquiring HIV (aOR = 0.56, 95%CI = 0.33–0.96; aOR = 0.32, 95%CI = 0.18–0.59 and aOR = 0.43, 95%CI = 0.21–0.86, respectively).In our study, undiagnosed HIV-infection was associated with recent condomless receptive anal intercourse, infrequent HIV testing, lower education, and absence of prior syphilis diagnosis. Infrequent HIV testing was associated with lower education, not identifying as transgender, recent condomless insertive anal intercourse, absence of prior syphilis diagnosis, and higher self-perceived risk of HIV. Further efforts to decrease HIV transmission and increase HIV-serostatus awareness should be directed towards effectively promoting condom use and frequent HIV testing, integrated with STI management.

Factors Associated with HIV Viral Suppression Among Transgender Women in Lima, Peru

“…Past research in Peru, however, has often aggregated findings across both MSM and TGW. 5,[8][9][10] To our knowledge, this is the first study to identify specific factors associated with viral suppression among TGW in Peru.…”

“…Previous HIV research in Peru, including from our group, has included TGW with cohorts of cisgender men who have sex with men (MSM) and has not assessed the unique barriers to care experienced by TGW. 5,[8][9][10] Analyses that combine TGW and cisgender MSM have often ignored substantial differences between the two populations, including higher rates of substance use and higher levels of social exclusion among transgender individuals, as well as the unique experiences of stigma that they face. 3,11,12 Identifying specific barriers to viral suppression among TGW is necessary to achieve the UNAIDS goal of 90-90-90, such that 90% of individuals with HIV will know their status, 90% of all people diagnosed with HIV will receive antiretroviral therapy (ART), and 90% of people receiving ART will achieve viral suppression.…”

Latin American Internet Survey for Men who have Sex with Men (LAMIS-2018): Design, methods and implementation

“…They are associated with increased psychological distress, depressive symptoms, and unhealthy practices [ 19 , 22 ], including risky sex and lower adherence to antiretroviral treatment [ 20 ]. It has been shown that in several LA countries, lower socioeconomic status (SES) is associated with lower condom use [ 23 ], less knowledge about HIV transmission and pre-exposure prophylaxis (PrEP) [ 24 , 25 ], less testing and awareness of HIV serostatus [ 26 ] but more self-reported positive HIV status [ 27 ].…”

A multivariate prognostic score for predicting mortality of acquired immunodeficiency syndrome patients with Hypoxemic Respiratory Failure and Pneumocystis Jiroveci Pneumonia

“…In high-income countries, opportunistic respiratory infections such as Pneumocystis jiroveci pneumonia (PJP) no longer represent the primary reason for ICU admission in patients with HIV infection. However, in developing countries, a high percentage of individuals are unaware that they are carriers of HIV and have not received ARVT or prophylaxis 9,10 . These patients represent the greatest number of admissions to respiratory ICUs (RICUs) due to severe acute hypoxemic respiratory failure (SAHRF) secondary to PJP.…”