Reporting male sex partners imparts significant risk of incident STI/HIV infection among a population of heterosexually identified men in three coastal Peruvian cities
K.A. Konda1, A.G. Lescano2, D.D. Celentano3, E.R. Hall4, S.M. Montano5, T.J. Kochel5, T.J. Coates6, C.F. Caceres7,8, NIMH Collaborative HIV/STD Prevention Trial Group
1John Hopkins Bloomberg School of Public Health, Epidemiology, Lima, Peru, 2Naval Medical Research Center Detachment, Parasitology, Lima, Peru, 3John Hopkins Bloomberg School of Public Health, Epidemiology, Baltimore, United States, 4Naval Medical Research Center Detachment, Bacteriology, Lima, Peru, 5Naval Medical Research Center Detachment, Virology, Lima, Peru, 6University of California Los Angelos, Division of Medicine, Los Angeles, United States, 7Universidad Peruana Cayetano Heredia, School of Public Health, Lima, Peru, 8Universidad Peruana Cayetano Heredia, Institute of Studies in Health, Sexuality and Human Development, Lima, Peru
Background: In HIV epidemics concentrated among men who have sex with men (MSM), the potential for bisexual men to act as a bridge for HIV infection from the core population of MSM to heterosexual women has been extensively debated. Detailed information on the sexual behavior of bisexual and non-gay identified men and longitudinal relationship between same-sex behavior and HIV/STI incidence are limited. This study provides information on the sexual behavior with male partners of heterosexually identified, socially-marginalized men in urban, coastal Peru and the relationship of this behavior with HIV/STI incidence.
Methods: We analyzed data from a study including 2146 heterosexually-identified men with a baseline and then two years of annual follow-up, including detailed information on sexual behavior with up to 5 sex partners in the last 6 months, to determine 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 three study visits, sex with a man was reported by 18.9% of men and 90% of these men 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, HSV-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 risk for incident HIV, HSV-2, and gonorrhea. Recent sex with a man was associated with increased STI incidence, HR 1.76 (95% CI 1.18 - 2.64), after adjusting for socio-demographic variables and other sexual risk behaviors.
Conclusions: Given the prevalence of recent sex with men and the relationship of this behavior with STI incidence, interventions with heterosexually identified men who have sex with men and their partners are warranted.
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