Objective While men who have sex with men (MSM) are disproportionately affected by Peru’s overlapping HIV and STI epidemics, there are few data on how partnership-level and network-level factors affect STI transmission in Peru. We explored partnership-level and network-level factors associated with gonorrhoea/chlamydia (Neisseria gonorrhoeae and/or Chlamydia trachomatis (NG/CT)) and/or syphilis infection among MSM in Peru.
Methods We present the results of a cross-sectional secondary analysis of MSM (n=898) tested for syphilis and NG/CT infection as part of the screening process for two STI control trials in Lima, Peru. Participants completed questionnaires on demographics, sexual identity and role, characteristics of their three most recent sexual partners (partner sexual orientation, gender, role, partnership type, partner-specific sexual acts) and 30-day sexual network characteristics (number of sexual partners, partnership types, frequency of anal/vaginal intercourse). Participants were tested for syphilis and urethral, rectal and oropharyngeal NG/CT. Differences in network characteristics were analysed with χ2 and Kruskal-Wallis tests.
Results Approximately 38.9% of participants had a new STI diagnosis (syphilis (rapid plasma reagin ≥16): 10.6%; NG/CT: 22.9%; syphilis-NG/CT coinfection: 5.4%). Condomless anal intercourse (CAI) was not significantly associated with an STI diagnosis. Gay-identified participants with exclusively homosexual networks had a higher prevalence of STIs (47.4%) than gay-identified MSM with only heterosexual/bisexual partners (34.6%, p=0.04), despite reporting fewer sexual partners (any partners: 2, 1–4 vs 3, 2–6; p=0.001; casual partners: 1, 0–3 vs 2, 1–4; p=0.001) and more stable partnerships (1, 0–1 vs 0, 0–1; p=0.003) in the last month.
Conclusions Network size and the number of casual sexual partners were associated with NG/CT infection among MSM in Peru. Despite reporting fewer sexual risk behaviours (smaller network size, more stable partnerships, less CAI), MSM with homosexual-only sexual networks had a higher prevalence of NG/CT and syphilis. These findings suggest network composition among MSM in Peru plays an important role in the risk for STI acquisition.
- sexual networks
- Latin America
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Handling editor Professor Jackie A Cassell
Contributors JLC designed the data collection tools. ERS, JS, JRL and JLC monitored the data collection. CB, RCP, ERS and JLC wrote the statistical analysis plan, analysed the data, and drafted and revised the paper. All authors revised the draft paper.
Funding Research funding was provided by NIH grants R25 MH087222, K23 MH084611 and R21 MH092232 to JLC, and K23 AI110532 to JEL.
Competing interests None declared.
Patient consent for publication Not required.
Ethics approval Written informed consent was obtained from all participants prior to enrolment. The study protocol was reviewed and approved by the Office of Human Research Participant Protection (OHRPP) at the University of California, Los Angeles (IRB 11–0 03 095), the Comite Institucional de Bioética at Asociación Civil Impacta Salud y Educación (Certificate 0053–2012-CE), and NAMRU-6 (Protocol HRPP NAMRU6.2012.0033).
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement Data are available upon reasonable request.