XVIII International AIDS Conference

Abstract

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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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