Background We piloted a bio-behavioral intervention for MSM in Peru based on rectal gonorrhea (GC)/chlamydia (CT) screening as an integrated HIV-STI prevention strategy.
Methods Between August-December 2018, we screened 605 MSM for rectal GC/CT using Aptima TMA and identified 101 cases among 469 HIV-uninfected men. Subjects were randomly assigned to traditional or Personalized Cognitive Counseling (PCC) at 3- and 6-Months. PCC session notes and Self-Justification Evaluation Instruments (SJEIs) were analyzed for thematic content. HIV/STI testing and behavioral risk assessments were repeated at 3- and 6-months. Statistical comparisons were conducted using Chi-square and Generalized Estimating Equations.
Results All participants reported reductions in condomless insertive (CIAI) and receptive anal intercourse (CRAI), with no significant differences between arms. In the Control arm, CRAI declined from a mean of 4.0 Partners (77% of recent sexual contacts) at Baseline to 1.3 (43%) at 3-Months and 0.7 (24%) at 6-Months. CRAI in the intervention arm decreased from 2.8 Partners (58% of contacts) to 1.1 (35%) to 0.8 (20%) (p≥0.05). At 3-Months, we identified 9 HIV infections and 24 new GC/CT cases across arms. At 6-Months, we diagnosed 2 HIV infections and 7 GC/CT cases (7/45; 15.6%) in the control arm (4.4%; 2/45), with 0 HIV infections (0%; 0/46) and 9 GC/CT recurrences (9/46; 19.6%) among PCC participants (p≥0.05). Thematic analysis demonstrated four common self-justifications: (1) Isolated events that don’t reflect typical behavior; (2) Informal HIV status assessments based on partner appearance or behavior; (3) Fear of ruining the moment by discussing HIV; and (4) Structural barriers to condom availability during intercourse.
Conclusion Our pilot assessment supports the feasibility and acceptability of PCC for reducing HIV risk following rectal GC/CT diagnosis. Risk behavior reductions were similar between arms, though no new HIV infections were observed after PCC. Additional research is needed to apply PCC to problems of post-STI behavior change and PrEP uptake.
Disclosure No significant relationships.
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