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“The Peruvian Positive Communities Trial” - methodological overview and baseline data
J. Martínez Ponce de León1, A. Silva-Santisteban1, E. Segura1, S. León1, T. Coates2, C. Cáceres1
1Unidad de Salud Sexualidad y Desarrollo Humano-Universidad Peruana Cayetano Heredia, Lima, Peru, 2UCLA, Los Angeles, United States
Background: Factors such as poverty, marginalization, and homophobia/transphobia,
likely contribute to the disproportionately high HIV burden faced by men who
have sex with men (MSM) and transgender persons in Peru. More comprehensive
interventions targeting social drivers of the epidemic, rather than just
focusing on individual-level variables, should be tested for prevention
purposes.
Methods: A 2x2
factorial cluster randomized control trial, aimed to evaluate the effects of
two interventions (structural and biomedical) to reduce sexual risk, vulnerability
and incident STIs, is currently ongoing in 24 lower-income neighborhoods
of Lima.
Men aged 18 - 45, self-identified as gay/homo/bisexual or transgender, reporting
at least one sexual encounter with another man in the past 12 months, were
included. Interventions tested were:
1) Positive
Communities (PC), including leadership training
and the creation of community centers,
2) Enhanced Partner Treatment (EPT) of curable STIs, including health
promotion and communication campaigns.
Study endpoints include:
i) Any-STI-aggregate
Incidence rate (Laboratory-confirmed HIV, HSV-2, Syphilis, Chlamydia and/or
Gonorrhea), and
ii) Proportion of individuals reporting unprotected intercourse
with a non-primary partner within last six-months.
In addition to the baseline assessment,
two follow-up visits will be conducted.
Results: 718 individuals were enrolled in 2008 (Age: median=29,
range=18-45; Self-identified as Gay/Homosexual=65% and transgender=29%). 59%
were not able to satisfy their basic economic needs in the last 12 months. Baseline
STI prevalence was: HIV, 20%, HSV-2, 66%, Rectal Chlamydia,19%, Rectal
Gonorrhea, 10% and chronic Syphilis, 25%. Overall Unprotected anal sex in last
6 months was reported by 62%.
Conclusions: The study
population shows high prevalence of HIV/STI and high risk sexual practices in a
context of poverty and social exclusion. The trial is expected to be completed in mid 2011 and its findings
will provide important insights for social change and rights-based HIV
interventions with highly vulnerable populations.
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