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Sexual and gender politics inform relational expectations surrounding sexual experiences of Peruvian transgender women (TW) and men who have sex with men (MSM). We used the framework of sexual role strain, or incongruence between preferred sexual role and actual sexual practices, to explore potential conflicts between personally articulated identities and externally defined norms of gender and sexuality and its potential to increase HIV/STI risk. Cross-sectional individual- and dyad-level data from 766 TW and MSM in Lima, Peru were used to assess the partnership contexts within which insertive anal intercourse was practiced despite receptive role preference (receptive role strain), and receptive anal intercourse practiced despite insertive role preference (insertive role strain). Sexual role strain for TW was more common with non-primary partners, while for MSM it occurred more frequently in the context of a primary partnership. Receptive role strain was more prevalent for TW with unknown HIV status (reference: without HIV) or pre-sex drug use (reference: no pre-sex drug use). For homosexual MSM, receptive role strain was more prevalent during condomless anal intercourse (reference: condom-protected) and with receptive or versatile partners (reference: insertive). Among heterosexual or bisexual MSM, insertive role strain was more prevalent with insertive or versatile partners (reference: receptive), and less prevalent with casual partners (reference: primary). Our findings suggest TW and MSM experience different vulnerabilities during sexual role negotiation with different partner-types. Future studies should explore the impact of sexual role strain on condom use agency, HIV/STI risk, and discordances between public and private presentations of gender and sexual orientation. National Institutes of Health Revisión por pares

Background Social networks, norms, and discussions about sexual health may inform sexual practices, influencing risk of human immunodeficiency virus (HIV) or sexually transmitted infection (STI) acquisition. To better understand social networks of Peruvian men who have sex with men (MSM) and transgender women (trans women), we examined key social network members (SNMs), participant perceptions of these network members’ opinions toward sexual health behaviors, and associations between network member characteristics and condomless anal intercourse (CAI). Methods In a 2017 cross-sectional study, a convenience sample of 565 MSM and trans women with HIV-negative or unknown serostatus was asked to identify three close SNMs; describe discussions about HIV and STI prevention with each; and report perceived opinions of condom use, HIV/STI testing, and partner notification of STIs. Generalized estimating equations evaluated relationships between SNM characteristics, opinions, and discussions and participant-reported CAI. Results Among participants who identified as MSM, 42.3% of key SNMs were perceived to identify as gay. MSM “never” discussed HIV and STI prevention concerns with 42.4% of heterosexual SNMs, but discussed them “at least once weekly” with 16.9 and 16.6% of gay- and bisexual- identifying SNMs, respectively. Among participants who identified as trans women, 28.2% of key SNMs were perceived as heterosexual; 25.9%, as bisexual; 24.7%, as transgender; and 21.2%, as gay. Trans women discussed HIV/STI prevention least with cis-gender heterosexual network members (40.2% “never”) and most with transgender network members (27.1% “at least once weekly”). Participants perceived most of their close social network to be completely in favor of condom use (71.2% MSM SNMs, 61.5% trans women SNMs) and HIV/STI testing (73.1% MSM SNMs, 75.6% trans women SNMs), but described less support for partner STI notification (33.4% MSM SNMs, 37.4% trans women SNMs). Most participants reported CAI with at least one of their past three sexual partners (77.5% MSM, 62.8% trans women). SNM characteristics were not significantly associated with participant-reported frequency of CAI. Conclusions Findings compare social support, perceived social norms, and discussion patterns of Peruvian MSM and trans women, offering insight into social contexts and sexual behaviors. Trial registration The parent study from which this analysis was derived was registered at ClinicalTrials.gov (Identifier: NCT03010020) on January 4, 2017.

El texto completo de este trabajo no está disponible en el Repositorio Académico UPC por restricciones de la casa editorial donde ha sido publicado. OBJECTIVE: Determine the impact of HIV-1 seroconversion on inflammatory cytokines in the rectal mucosa. SETTING: Secondary analysis of data from men who have sex with men and transgender women who participated in a HIV prevention trial Lima, Peru. METHODS: From July to December 2017, 605 men who have sex with men and transgender women were screened for rectal gonorrhea/chlamydia (GC/CT). Fifty GC/CT-positive cases were randomly selected and matched with 52 GC/CT-negative controls by age and number of receptive anal intercourse partners in the last month. All participants were HIV-negative at baseline and those with GC/CT at baseline and/or follow-up received appropriate antibiotic therapy. Participants underwent sponge collection of rectal secretions for the measurement of inflammatory cytokines (IL-1β, IL-6, IL-8, and TNF-α) and were screened for rectal GC/CT and HIV at baseline, 3 months, and 6 months. Wilcoxon rank-sum tests compared inflammatory cytokine levels between participants diagnosed with HIV during follow-up and persons who remained HIV-negative. RESULTS: Eight participants were diagnosed with HIV at the 3-month (n = 6) or 6-month (n = 2) visit. The median number of receptive anal intercourse partners in the month before HIV diagnosis was the same for those who acquired HIV and those who did not. There were no significant differences in inflammatory cytokine levels in rectal mucosa between participants who did and did not experience HIV seroconversion at any time point. CONCLUSIONS: Despite a surge in viral replication during acute infection, findings from this study suggest that there is no prolonged effect of HIV-1 seroconversion on inflammatory cytokine levels in the rectal mucosa. Copyright National Institute of Allergy and Infectious Diseases Revisión por pares

BACKGROUND: Reducing congenital syphilis has been the focus of Brazilian health programs for decades, yet the cases continue to increase. Although health interventions have targeted HIV screening and treatment, syphilis management continues to be challenging. Syphilis during pregnancy may enhance the HIV maternal seroconversion risk. The potential factors fueling the syphilis epidemic were evaluated in south Brazil, an area of high HIV or syphilis endemicity. OBJECTIVE: We hypothesized that ineffective treatment because of a lack of partner treatment, late presentation to care, and reinfection of previously treated mothers were potential drivers of syphilis mother-to-child transmission. STUDY DESIGN: Data on women diagnosed with syphilis during pregnancy between January 1, 2008 and December 31, 2018 were obtained from a large urban hospital in Porto Alegre, Brazil. The patients were stratified into effective vs ineffective treatment groups according to the World Health Organization guidelines. Crude and adjusted risk ratios for the prediction of congenital syphilis and adverse fetal or neonatal outcomes were computed using Poisson regression. RESULTS: Nearly 56,000 pregnant women delivered over the 11-year period; 1541 (2.8%) had confirmed syphilis during pregnancy, with 934 (61%) receiving ineffective syphilis treatment because of late presentation and diagnosis, delayed treatment initiation, and loss to follow-up with no treatment recorded. Ineffective treatment was associated with maternal education, prenatal care, timing of syphilis diagnosis, venereal diseases research laboratory titers, and maternal HIV coinfection. On multivariate regression analysis, ineffective treatment (adjusted risk ratio, 4.52; 95% confidence interval, 2.35–8.69), absence of prenatal care (adjusted risk ratio, 9.31; 95% confidence interval, 3.77–23.0), syphilis diagnosis at delivery (adjusted risk ratio, 3.08; 95% confidence interval, 2.07–4.58), and maternal nontreponemal titers ≥1:64 (1.09–1.93) were associated with an increased risk of fetal loss. Ineffective treatment (adjusted risk ratio, 1.71; 95% confidence interval, 1.59–1.84), year of diagnosis 2014 to 2016 (adjusted risk ratio, 1.07; 95% confidence interval, 1.02–1.13), absence of prenatal care (adjusted risk ratio, 1.44; 95% confidence interval, 1.17–1.76), and maternal nontreponemal titers >1:4 were associated with an increased risk of congenital syphilis. Although partner treatment reduced the congenital syphilis risk (adjusted risk ratio, 0.60; 95% confidence interval, 0.55–0.66), only 31.8% of partners received treatment. Maternal HIV coinfection was not associated with an increased risk of fetal loss, low birthweight, preterm birth, congenital syphilis, or symptomatic neonatal infection. CONCLUSION: Public health initiatives promoting effective syphilis treatment in pregnancy, increased access to high-quality prenatal care, and partner treatment should be considered to reduce congenital syphilis.

To improve understanding of factors associated with intimate partner violence (IPV) and explore its role in sexually transmitted infection (STI) acquisition, we analyzed partnership-level correlates of IPV among men who have sex with men (MSM) and transgender women (TW) in Peru. In a 2017 cross-sectional study of rectal STI screening and HIV prevention, MSM/TW completed a sociobehavioral survey addressing demographic characteristics, sexual risk behaviors, and substance use, and were tested for rectal gonorrhea and chlamydia, syphilis, and HIV. Generalized estimating equations estimated individual- and partner-level correlates of IPV. Of 576 participants (median age, 27 years), 7.9% (36/456) of MSM and 15.0% (18/120) of TW reported IPV with ≥ 1 of their last three partners. MSM/TW reporting IPV were more likely to meet criteria for an alcohol use disorder (74.1%) than participants reporting no IPV (56.7%; p

El texto completo de este trabajo no está disponible en el Repositorio Académico UPC por restricciones de la casa editorial donde ha sido publicado. Pre-exposure prophylaxis (PrEP) access is increasing in Latin America. We explored PrEP use among Spanish-speaking, Hornet geosocial networking application users from Latin American countries with limited PrEP data via an online survey completed between December 2018 and February 2019. A total of 718 Hornet users from 10 countries were included, of whom 72.1% reported PrEP awareness. Few (5.6%) were currently taking PrEP, though 32.1% intended to take PrEP in the subsequent 6 months. PrEP awareness was lower in 18–25 year olds compared to 26+ (62.4% vs. 75.6%, aOR 0.67, [95% CI 0.46–0.97]), and higher among those living in larger versus smaller cities (74.4% vs. 58.8%, aOR 1.96, [95% CI 1.25–3.07]) or countries with at least partial versus no PrEP policy adoption (79.1% vs. 60.8%, aOR 2.20, [95% CI 1.56–3.12]). Intention to use PrEP was higher among PrEP-eligible respondents (51.8% vs. 29.6%, aOR 2.26, [95% CI 1.26–4.07]) and those recently tested for a sexually transmitted infection (35.4% vs. 25.5%, aOR 1.58, [95% CI 1.01–2.48]). Efforts to expand PrEP use in Latin America should focus on national PrEP policy adoption, and research should explore barriers to awareness and use among young men who have sex with men. National Institute of Mental Health Revisión por pares

Background Condomless anal intercourse (CAI) appears to be increasing among men who have sex with men (MSM) globally, and is reported to be as high as 70% in recent studies in Peru. To improve understanding of the evolving context of CAI among MSM in Peru, we studied associations between partner type, substance use, and condomless anal intercourse (CAI) in locations where MSM commonly report having sexual encounters. Methods In a 2017 cross-sectional study of rectal STI screening and HIV prevention, a convenience sample of MSM recruited from community venues in Lima completed a survey of demographic characteristics and sexual risk behavior with their three most recent partners. Generalized estimating equations estimated correlations of CAI with location of last sexual contact, participant substance use prior to sex, and negotiation of condom use before or during sex. The network data integration application, Cytoscape, mapped intersections of partner type, sexual orientation, substance use, and CAI by four types of locations where sex occurred: 1) Home, 2) Hotel, 3) Sauna or Internet Cabin, and 4) Public Spaces. Results Of 447 MSM (median age 27 years), 76.9% reported CAI with ≥1 of their last three partners. Participants reported sex with casual partners most commonly in homes (64.6%) and hotels (60.4%), and with anonymous partners most often in saunas/Internet cabins (57.5%) and public spaces (52.6%). CAI was less commonly reported in hotels (aPR, 95% CI: 0.85, 0.75–0.97) compared to homes. Participants who used marijuana before sex at home were more likely to report CAI than MSM who did not use marijuana (1.36, 1.01–1.92). Partner alcohol use before sex was associated with CAI in saunas/Internet cabins (3.17, 1.45–6.91) and public spaces (2.65, 1.41–4.98). In the sexual network maps, almost all MSM who used drugs prior to their sexual encounters used drugs with more than one of their last three partners. Conclusions CAI was common and associated with different risk factors, like partner type and substance use, based on location where sex occurred. Novel combination HIV, STI, and substance use prevention interventions must consider how the social environments of MSM influence condom use and other sexual risk behaviors. Trial registration ClinicalTrials.gov Identifier NCT03010020, January 4, 2017.

Purpose: The purpose of this study was to explore risk factors for HIV and sexually transmitted infections (STIs) among transgender women (TW) in Lima, Peru. Methods: HIV-negative or serostatus unknown TW reporting recent condomless receptive anal intercourse underwent testing for STIs and HIV and completed a sociobehavioral survey. Results: Among 120 TW, 29.6% had rectal Neisseria gonorrhoeae (GC) or Chlamydia trachomatis (CT) and 12.6% had HIV. Age and migrant status were associated with rectal GC/CT, and rectal GC/CT predicted HIV infection. Conclusions: Further study is needed to understand individual and social factors that contribute to HIV/STI vulnerability among TW.

Male sex workers (MSW) in the Dominican Republic (DR) have multiple sexual partners, including personal and client-relationships, and are disproportionately affected by human immunodeficiency virus (HIV). We examined the prevalence of condomless anal and/or vaginal intercourse (CI) among MSW in the DR as a function of social network factors. Self-report surveys and social network interviews were administered to MSW recruited through venue-based sampling (N = 220). A generalized linear model was used to complete a Poisson Regression model and identify variables significantly associated with the outcome of interest. CI was more common with female (28.3%) than with male partners (4.9%). Factors associated with CI with the last female partner included older age of MSW, CI with the last male partner, having a stable female partner (a consistent or main partner), and having ≥1 family member in the participants’ social network. Partner and social network characteristics associated with CI among MSW suggest the utility of dyadic and network interventions to reduce HIV risk. National Institute of Mental Health Revisión por pares

Objectives: Rates of maternal syphilis have increased five-fold in Brazil in the past decade. While penicillin remains the only appropriate treatment for maternal syphilis, we hypothesized that low non-treponemal titers (

Pre-exposure prophylaxis (PrEP) has limited availability across Latin America, though access is increasing. We explored PrEP uptake in Mexico via an online survey completed by Spanish-speaking, Hornet geosocial networking application (GSN app) users without HIV (n = 2020). Most (81.3%) had heard of PrEP, 3.5% were current users, and 34.2% intended to take PrEP within six months. Current PrEP use was associated with PrEP eligibility (aOR 26.07 [95%CI 13.05-52.09], p0.001), recent STI testing (aOR 3.79 [95%CI 1.10-13.11], p = 0.035), and recent chemsex (aOR 3.02 [95%CI 1.02-8.93], p = 0.046). Recent STI testing was associated with hearing about PrEP from a doctor (aOR 3.26 [95%CI 1.98-5.36], p0.001), and those who lived in large cities were less likely to have learned about PrEP via Hornet (aOR 0.52 [95%CI 0.32-0.85], p = 0.009). Interventions to increase PrEP uptake in Mexico should build upon existing health networks and utilize GSN apps for PrEP information dissemination, particularly in less populated areas.La profilaxis pre-exposición (PrEP) tiene disponibilidad limitada en América Latina, aunque su acceso está aumentando. Exploramos el uso de PrEP en México a través de una encuesta en línea para sujetos hispanohablantes sin VIH usuarios de la aplicación de redes geosociales (GSN app) Hornet (n=2020). La mayoría (81,3%) había escuchado sobre PrEP, el 3,5% eran usuarios actuales, y el 34,2% tenían intención de tomar PrEP en seis meses o menos. El uso actual de PrEP estuvo asociado con la elegibilidad de tomar PrEP (aOR 26.07 [95%CI 13.05–52.09], p0.001), tener prueba reciente para ITS (aOR 3.79 [95%CI 1.10–13.11], p = 0.035), y chemsex reciente (aOR 3.02 [95%CI 1.02–8.93], p = 0.046). Tener prueba reciente para ITS se asoció con escuchar sobre PrEP de un médico (aOR 3.26 [95%CI 1.98–5.36], p0.001), y quienes vivían en ciudades grandes tenían menos probabilidad de conocer acerca de PrEP a través de Hornet (aOR 0.52 [95%CI 0.32–0.85], p = 0.009). Las intervenciones para aumentar el uso de PrEP en México deberían basarse en redes de salud existentes y usar las GSN apps para difundir información sobre PrEP, particularmente en áreas menos pobladas.

Sexual communication with partners informs risk assessment and sexual practices. We evaluated participant, partner, and network factors associated with communication about condom use and HIV serostatus and explored their relationships with condomless anal intercourse (CAI) among 446 men who have sex with men (MSM) and 122 transgender women (TW) in Lima, Peru. Generalized estimating equations assessed contextual influences on communication and practices with recent sexual partners. More frequent HIV communication was reported by MSM who: identified as heterosexual, compared to bisexual or gay; characterized partnerships as stable, compared to casual, anonymous, or commercial; or discussed HIV/STIs with close social contacts (p 0.05). TW in concurrent partnerships discussed condom use more frequently than those in monogamous relationships (p 0.05). Condom use discussions and alcohol use among MSM were associated with CAI (p 0.05). Findings highlight complexity in sexual decision-making and call for further study of conversation content and practices to inform HIV prevention messaging.La comunicación sexual entre parejas informa sobre la valoración de riesgos y las prácticas sexuales. Evaluamos los factores de participantes, sus parejas y sus redes en relación con la comunicación sobre el uso de condones y el serostatus del VIH, y exploramos sus asociaciones con el sexo anal sin condón (CAI) entre 446 hombres que tienen sexo con hombres (HSH) y 122 mujeres transgéneros (MT) en Lima, Perú. Usamos ecuaciones de estimación generalizadas para evaluar las influencias contextuales en la comunicación y las prácticas con parejas sexuales recientes. La comunicación sobre el VIH fue más frecuente entre los HSH: que se identificaron como heterosexuales, en comparación con bisexuales o gay; quienes reportaron sus relaciones de pareja como estables, en comparación a casuales, anónimas o comerciales; o quienes discutieron el VIH/ITS con contactos sociales cercanos (p 0.05). Las MT con relaciones concurrentes discutieron el uso de condones con más frecuencia que las que reportaron relaciones monógamas (p 0.05). Las discusiones sobre el uso de condones y el consumo de alcohol se asociaron con CAI entre los HSH (p 0.05). Estos resultados resaltan la complejidad de las decisiones sexuales y ameritan un mayor estudio del contenido y las prácticas de conversación para informar los mensajes de prevención del VIH.

La Revista Peruana de Ciencias de la Salud (RPCS) es editada y publicada por la Universidad de Huánuco a través de su Oficina Editorial y en colaboración con los miembros -tanto a nivel nacional e internacional- del comité editorial y científico (1). Durante su historia, la revista se ha caracterizado por su constante dedicación en fortalecer y promover su visibilidad en el entorno académico y científico. Esta editorial tiene como objetivo presentar un sumario de las acciones realizadas en este contexto y de los efectos e impactos esperados.

Personalized cognitive counseling (PCC) is an evidence-based intervention designed to modify HIV-related risk behavior. We assessed the impact of PCC on sexual behavior, drinking expectancy, and incidence of sexually transmitted infections (STIs) in a six-month randomized controlled trial among 153 HIV-uninfected men who have sex with men (MSM) and transgender women (TW) in Peru. Study retention was ≥90%, with three HIV infections (3 Control) and 19 cases of GC/CT (10 Control, 9 PCC) at six months. There was a decline in condomless receptive anal intercourse in the Control (0.74, 95% CI: 0.60–0.91; p

Limited data exists on intimate partner violence (IPV) among transgender women (TW), though global trends suggest IPV is associated with HIV risk in this population. We describe the prevalence of verbal, physical, and/or sexual violence as well as participant- and partner-level correlates of IPV among TW in Lima, Peru. Among 389 respondents, 15.2% reported IPV with one or more of their last three sexual partners: 9.2% verbal, 8.2% physical, and 2.3% sexual violence. Physical and verbal violence were more common with stable partners (aPR 3.46, 95% CI 1.17–10.25, aPR 2.46, 95% CI 1.14–5.28, respectively). Physical violence was associated with condomless receptive anal intercourse (cRAI) (aPR 2.22, 95% CI 1.19–4.13) and partner alcohol use (aPR 4.38, 95% CI 1.56–12.33) while verbal violence correlated with participant inebriation (aPR 4.86, 95% CI 1.63–14.46). Our results link IPV with stable partnerships, alcohol use, and cRAI, suggesting TW in Peru may benefit from multidimensional IPV prevention strategies to foster supportive relationships and reduce HIV transmission. amfAR, The Foundation for AIDS Research Revisión por pares

The diagnosis of esophageal varices in cirrhotic patients is made by the upper gastrointestinal endoscopy. Multiple non-invasive predictors have been studied for the diag-nosis of esophageal varices. The objective of this study is to testthe FIB4 index as screening of esophageal varices in patients with liver cirrhosis.A cross-sectional analytic study was developed in four national hospital using hepatic cirrhosis patient's medi-cal files. We assessed the information using univariate and bivariate analysis, sensitivity, speci-ficity, predictive positive and negative value, the positive and negative likelihood ratio calcu-lation of the esophageal varices screening and its size. We built ROC curve for every analysis group.The study included 289 liver cirrhosis patients. Most of the patients were male (54.33%). 77.85% patients had esophageal varices. The distribution of varices was 19.03%, 35.99% and 22.84% for large, medium and small varices, respectively. In the FIB-4 index analysis for the presence of varices, it was found a sensitivity of 81.3%, specificity of 37.5% (AUC: 0.57). The calculation for variceal size showed a sensitivity of 81.8%, specificity of 23.9% (AUC: 0.50). In the analysis of FIB-4 index for prophylaxis groups was found a sensitivity of 81.8% and a specificity of 28.5% (AUC: 0.54).The FIB-4 index has no good performance in the screening for the presence of esophageal varices and its size in liver cirrhosis patients.

Introduccion: El diagnostico de varices esofagicas en pacientes cirroticos se realiza mediante la endoscopia digestiva alta. Se han estudiado predictores no invasivos para el diagnostico de estas. Objetivo: El objetivo de este estudio es evaluar el desempeno del indice FIB-4 en el despistaje de varices esofagicas en pacientes con diagnostico de cirrosis hepatica. Materiales y metodos: Se realizo un estudio transversal analitico en cuatro hospitales nacionales utilizando historias clinicas de pacientes cirroticos. Se realizo el analisis univariado y bivariado, calculo de sensibilidad, especificidad, valor predictivo positivo y negativo, razon de verosimilitud positiva y negativa del indice FIB-4 para el despistaje de varices esofagicas, tamano de estas y profilaxis. Se construyeron curvas ROC para cada grupo de analisis. Resultados: Se incluyo 289 pacientes con diagnostico de cirrosis hepatica, la mayor parte fueron de sexo masculino (54,33%). 77,85% presentaron varices esofagicas. La distribucion del tamano de varices fue de 19,03%, 35,99% y 22,84% para varices grandes, medianas y pequenas, respectivamente. En el analisis del indice FIB-4 con la presencia de varices se encontro una sensibilidad de 81,3% y una especificidad de 37,5% (AUC: 0,57). Para el tamano de varices se encontro una sensibilidad 81,8% y una especificidad de 23,9% (AUC: 0,50). En el analisis de FIB-4 para grupos de profilaxis se encontro una sensibilidad de 81,8% y una especificidad de 28,5% (AUC: 0,54). Conclusiones: El indice FIB-4 no tiene un buen desempeno en el despistaje de la presencia varices esofagicas y su tamano en pacientes con diagnostico de cirrosis hepatica.

Both hormone therapy (HT) and antiretroviral therapy (ART) can be lifesaving for transgender women (TW) living with HIV, but each has side effects and potential drug-drug interactions (DDI). We assessed how concerns about HT-ART interactions affect treatment adherence.This study used a cross-sectional survey of TW (n = 87) in Los Angeles, CA.Fifty-four percent were living with HIV; 64% used HT. Only 49% of TW living with HIV discussed ART-HT DDI with their provider; 40% reported not taking ART (12%), HT (12%), or both (16%) as directed due to DDI concerns.Imperfect HT/ART use and limited provider communication suggests a need for improved HT-ART integration.

Background Although syphilis remains a central public health problem, disease estimates for men who have sex with men (MSM) and transwomen (TW) in the Americas are incomplete. The purpose of this study was to compare the syphilis epidemics of North America (NA) and Latin America/Caribbean (LAC). Methods We conducted a systematic review of ten databases for studies of syphilis in MSM/TW in the Americas between 1980–2017. Regional and country-specific prevalences were calculated from 2000–17 using 3 analytic frameworks: 1) All MSM/TW; 2) MSM/TW with versus without HIV; and 3) MSM and TW separately. Pooled prevalence estimates were calculated utilizing random effects meta-analysis. Results 167 studies (NA=84, LAC=83) representing 368,587 subjects were included. Almost no data was available from LAC prior to 2000 and only 8% of studies from either region reported stage of infection (Primary, Secondary, Latent). For syphilis diagnosis, 42% of studies used RPR, 24% used VDRL, and 18% used FTA-Abs. From 2000–2017, syphilis prevalence among MSM/TW in NA was 6.6% (95% CI: 5.7–7.4%) and 13.3% (95% CI: 11.7–14.9%) in LAC. For TW alone, prevalence was 7.1% (95% CI: 2.3–11.9%) in NA and 31.7% (95% CI: 19.1–44.4%) in LAC. Among MSM/TW with HIV in NA, prevalence was 10.5% (95% CI: 7.4–13.3%) versus 4.0% (95% CI: 1.8–6.1%) in those without HIV. In LAC, syphilis was diagnosed in 15.1% (95% CI: 0–30.3%) of MSM/TW with HIV and 12.9% (95% CI: 9.5–16.2%) without HIV. Conclusion From 2000–2017, the burden of syphilis in MSM/TW was greater in LAC than NA. Prevalence estimates were higher in certain subgroups, including TW in LAC and MSM/TW with HIV in NA, though these data were limited. Our results suggest a need for additional data on syphilis epidemiology with stratification by key subgroups, classification by stage of disease, and uniform diagnostic criteria to target public health strategies in the Americas. Disclosure No significant relationships.

Background Rectal gonorrhea (GC) and chlamydia (CT) infection are associated with mucosal inflammation and HIV transmission. To determine the impact of GC/CT infection and treatment on rectal tissue inflammation, we assessed levels of inflammatory cytokines in MSM with and without rectal GC/CT in Lima, Peru. Methods We screened 605 behaviorally high-risk MSM for rectal GC/CT using Hologic TMA between July-December, 2017. We identified 101 GC/CT(+) cases among 469 HIV-uninfected candidates (101/469; 21.5%). Prior to antibiotic treatment, we randomly selected 50 GC/CT(+) cases and matched 52 GC/CT(-) controls according to age and number of receptive anal intercourse partners during the prior 30 day period. Participants underwent anoscopy and sponge collection of rectal secretions for inflammatory cytokine quantification (IL-1b, IL-6, IL-8, and TNF-a) via Luminex multiplex assays. HIV and rectal GC/CT testing, and mucosal cytokine assessments were repeated at 3- and 6-month Follow-up Visits. Pre- and post-treatment cytokine levels in cases were compared against levels in uninfected controls using Wilcoxon Rank-Sum tests for non-parametric data. Results At baseline, MSM with GC/CT had elevated levels of all inflammatory cytokines in rectal mucosa compared with uninfected controls (all p-values 0.05). Conclusion Rectal tissue inflammation and cytokine recruitment is associated with GC/CT infection and resolves following antibiotic treatment. Our data provides ‘proof of concept’ for use of rectal STI screening as part of an integrated bio-behavioral HIV prevention program for MSM. Disclosure No significant relationships.

ObjectivesA detailed understanding of intentions and practices related to partner notification (PN) following STI diagnosis can improve control strategies. We assessed participant-level and partner-level factors guiding notification behaviour among men who have sex with men and/or with transgender women (MSM-TW) in Lima, Peru, including discordances between anticipated and actual notification.MethodsMen newly diagnosed with gonorrhoea, chlamydia and/or syphilis between 2012 and 2014 reported recent partners’ characteristics, anticipated PN practices, and actual PN outcomes following diagnosis. Generalised estimating equation Poisson regression analyses assessed factors guiding PN outcomes.ResultsParticipants (n=150) predominantly identified as homosexual (70%) and moderno (versatile sexual role, 55%); 55% of partners (n=402) were casual. Among all sexual partners, 35% were notified of the STI diagnosis, though only 51% of predicted PN occurred and 26% of actual notifications were unanticipated. 47% of participants notified no partners, while 24% notified all partners. PN was more common with stable versus casual (adjusted prevalence ratio (aPR), 95% CI: 0.53, 0.39 to 0.73) or commercial (aPR, 95% CI: 0.38, 0.12 to 1.21) partners, and among participants who perceived PN as normative among their peers (aPR, 95% CI: 1.96, 1.37 to 2.82). A trend towards greater notification following condom-protected intercourse was observed (aPR, 95% CI: 1.33, 0.98 to 1.81). PN frequency did not differ by type of STI diagnosed.Anticipated notification predicted actual notification (aPR, 95% CI: 1.67, 1.19 to 2.33) only imperfectly: 81 (54%) participants’ PN practices did not match their anticipated behaviour. Successful notification despite anticipated silence (40 participants, 63 partners) was associated with stable partnerships and a normative perception of PN. Non-notification despite intention (43 participants, 73 partners) frequently occurred among participants reporting exclusively oral sex with the partner or with partners identified as activo (insertive role).ConclusionsAnticipated notification imperfectly reflects actual PN behaviour. Future interventions to improve PN among MSM-TW in Peru need to acknowledge partnership contexts.

Summary Background Peru is an upper-middle-income country with wide social and regional disparities. In recent years, sustained multisectoral antipoverty programmes involving governments, political parties, and civil society have included explicit health and nutrition goals and spending increased sharply. We did a country case study with the aim of documenting Peru's progress in reproductive, maternal, neonatal, and child health from 2000–13, and explored the potential determinants. Methods We examined the outcomes of health interventions coverage, under-5 mortality, neonatal mortality, and prevalence of under-5 stunting. We obtained data from interviews with key informants, a literature review of published and unpublished data, national censuses, and governmental reports. We obtained information on social determinants of health, including economic growth, poverty, unmet basic needs, urbanisation, women's education, water supply, fertility rates, and child nutrition from the annual national households surveys and the Peruvian Demographic and Health Surveys. We obtained national mortality data from the Interagency Group for Child Mortality Estimation, and calculated subnational rates from 11 surveys. Analyses were stratified by region, wealth quintiles, and urban or rural residence. We calculated coverage indicators for the years 2000–13, and we used the Lives Saved Tool (LiST) to estimate the effect of changes in intervention coverage and in nutritional status on mortality. Findings From 2000 to 2013, under-5 mortality fell by 58% from 39·8 deaths per 1000 livebirths to 16·7. LiST, which was used to predict the decline in mortality arising from changes in fertility rates, water and sanitation, undernutrition, and coverage of indicators of reproductive, maternal, neonatal, and child health predicted that the under-5 mortality rate would fall from 39·8 to 28·4 per 1000 livebirths, accounting for 49·2% of the reported reduction. Neonatal mortality fell by 51% from 16·2 deaths per 1000 livebirths to 8·0. Stunting prevalence remained stable at around 30% until 2007, decreasing to 17·5% by 2013, and the composite coverage index for essential health interventions increased from 75·1% to 82·6%, with faster increases among the poor, in rural areas, and in the Andean region. Socioeconomic, urban–rural, and regional inequalities in coverage, mortality, and stunting were substantially reduced. The proportion of the population living below the poverty line reduced from 47·8% to 23·9%, women with fewer than 4 years of schooling reduced from 11·5% to 6·9%, urbanisation increased from 68·1% to 75·6%, and the total fertility rate decreased from 3·0 children per woman to 2·4. We interviewed 175 key informants and they raised the following issues: economic growth, improvement of social determinants, civil society empowerment and advocacy, out-of-health and within-health-sector changes, and sustained implementation of evidence-based, pro-poor reproductive, maternal, neonatal, and child health interventions. Interpretation Peru has made substantial progress in reducing neonatal and under-5 mortality, and child stunting. This country is a good example of how a combination of political will, economic growth, broad societal participation, strategies focused on poor people, and increased spending in health and related sectors can achieve significant progress in reproductive, maternal, neonatal, and child health. The remaining challenges include continuing to address inequalities in wealth distribution, poverty, and access to basic services, especially in the Amazon and Andean rural areas. Funding Bill & Melinda Gates Foundation.

Objectives Partner notification (PN) following sexually transmitted disease (STI) diagnosis is a key strategy for controlling HIV/STI transmission. Anonymous partnerships are an important barrier to PN and often associated with high-risk sexual behaviour. Limited research has examined the profile of men who have sex with men (MSM) and transgender women (TW) who engage in anonymous sex. To better understand anonymous partnership practices in Lima, Peru, we assessed participant-level and partnership-level characteristics associated with anonymous sex among a sample of MSM and TW recently diagnosed with HIV/STI. Methods MSM and TW diagnosed with HIV/STI within the past month completed a cross-sectional survey regarding anticipated PN practices. Participants reported sexual partnership types and characteristics of up to three of their most recent partners. Using a Poisson generalised estimating equation model, we assessed participant-level and partnership-level characteristics associated with anonymous partnerships. Results Among 395 MSM and TW with HIV/STI, 36.0% reported at least one anonymous sexual partner in the past 3 months (mean of 8.6 anonymous partners per participant; SD 17.0). Of the 971 partnerships reported, 118 (12.2%) were anonymous and the majority (84.8%) were with male partners, followed by 11.0% with female partners and 4.2% with transgender/ travesti partners. Partner-level characteristics associated with increased likelihood of having an anonymous partner included female (adjusted prevalence ratio (aPR) 2.28, 95% CI 1.05 to 4.95, p=0.04) or transgender/ travesti (aPR 4.03, 95% CI 1.51 to 10.78, p=0.006) partner gender. Conclusions By assessing both individual-level and dyadic-level factors, these results represent an important step in understanding the complexity of partnership interactions and developing alternative PN strategies for Latin America.

ObjectiveWhile 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.MethodsWe 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.ResultsApproximately 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.ConclusionsNetwork 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.

Gonorrhea (Neisseria gonorrhoeae [GC]) and chlamydia (Chlamydia trachomatis [CT]) disproportionately affect men who have sex with men (MSM), and public health implications vary by anatomic site and bacterial agent. Urethral and rectal GC and CT can increase risk of HIV transmission, whereas pharyngeal GC may be a reservoir for antimicrobial resistance. To define screening priorities in Latin America, we compare differences in the prevalence and correlates of urethral, pharyngeal, and rectal GC and CT among MSM in Peru.A cross-sectional sample of 787 MSM from Lima was screened between 2012 and 2014. We described prevalence of urethral, pharyngeal, and rectal GC and CT infection and conducted bivariate analyses of associations with social, behavioral, and biological characteristics. Poisson regression analyses assessed the correlates of each infection at each anatomic site.The most commonly symptomatic infection (urethral GC; 42.1%) was the least prevalent (2.4%). The most prevalent infections were rectal CT (15.8%) and pharyngeal GC (9.9%). Rectal CT was the least commonly symptomatic (2.4%) infection, and was associated with younger age (adjusted prevalence ratio [95% confidence interval], 0.96 [0.94-0.98]), HIV infection (1.46 [1.06-2.02]), and pasivo (receptive; 3.59 [1.62-7.95]) and moderno (versatile; 2.63 [1.23-5.60]) sexual roles.Results highlight limitations of current syndromic screening strategies for sexually transmitted diseases in Peru, wherein urethral CT and rectal GC and CT may be missed due to their frequently asymptomatic presentations. Successful management of GC and CT infections among MSM in low-resource settings requires differentiating between bacterial agent, symptomatic presentation, associated risk factors, and public health implications of untreated infection at different anatomic sites.

Background Syphilis incidence worldwide has rebounded since 2000, particularly among men who have sex with men (MSM). A predictive model for syphilis infection may inform prevention counselling and use of chemoprophylaxis. Methods: Data from a longitudinal cohort study of MSM and transgender women meeting high-risk criteria for syphilis who were followed quarterly for 2 years were analysed. Incidence was defined as a four-fold increase in rapid plasma reagin (RPR) titres or new RPR reactivity if two prior titres were non-reactive. Generalised estimating equations were used to calculate rate ratios (RR) and develop a predictive model for 70% of the dataset, which was then validated in the remaining 30%. An online risk calculator for the prediction of future syphilis was also developed. Results: Among 361 participants, 22.0% were transgender women and 34.6% were HIV-infected at baseline. Syphilis incidence was 19.9 cases per 100-person years (95% confidence interval (CI) 16.3–24.3). HIV infection (RR 2.22; 95% CI 1.54–3.21) and history of syphilis infection (RR 2.23; 95% 1.62–3.64) were significantly associated with incident infection. The final predictive model for syphilis incidence in the next 3 months included HIV infection, history of syphilis, number of male sex partners and sex role for anal sex in the past 3 months, and had an area under the curve of 69%. The online syphilis risk calculator based on those results is available at: www.syphrisk.net. Conclusions: Using data from a longitudinal cohort study among a population at high risk for syphilis infection in Peru, we developed a predictive model and online risk calculator for future syphilis infection. The predictive model for future syphilis developed in this study has a moderate predictive accuracy and may serve as the foundation for future studies.

Background To better characterize mortality among methamphetamine users, we estimated rates of all-cause mortality by HIV serostatus and smoking history in gay and bisexual men (GBM) treated for methamphetamine dependence, and explored associated clinical and socio-behavioral characteristics. Methods We searched public records to identify deaths among men screened between 1998–2000 for a trial of outpatient therapy for GBM with methamphetamine dependence. Crude mortality rates (CMRs) were calculated, and standardized mortality ratios (SMRs) estimated, comparing data with historical information from CDC WONDER. Associations of mortality with HIV infection, tobacco use, and other factors were explored using Kaplan-Meier survival analysis and Cox proportional hazards models. Results Of 191 methamphetamine-dependent GBM (median age 35 years; majority Caucasian), 62.8% had HIV infection, and 31.4% smoked tobacco at baseline. During the 20-year follow-up period, 12.6% died. Relative to controls, methamphetamine-dependent GBM had a three-fold higher 20-year SMR: 3.39, 95% CI: 2.69-4.09. Especially high mortality was observed among participants reporting tobacco use (adjusted HR 3.48, 95% CI: 1.54–7.89), club drug use prior to starting methamphetamine (2.63, 1.15–6.00), or other clinical diagnoses at baseline (3.89, 1.15–13.22). At 20 years, the CMR for HIV infected participants (7.7 per 1000 PY) was 1.5 times that for men without HIV (5.2 per 1000 PY; p = 0.22) and there was a 5-fold difference in CMRs for HIV infected tobacco smokers (16.9 per 1000 PY) compared to non-smokers (3.4 per 1000 PY; p Conclusion In our sample of methamphetamine-dependent GBM, concomitant HIV infection and tobacco use were associated with dramatic increases in mortality.