MSM and male-to-female transwomen are an important target population for HIV/STI prevention due to high prevalence of HIV and syphilis infection, frequent asymptomatic disease, and the life-threatening consequences of untreated infection. This analysis explored the association of structural and social factors with unprotected anal intercourse (UAI) in a high-risk cohort of MSM/transwomen.
We recruited a clinic-based sample of self-identified MSM and transwomen, 18 years old or older, living in Lima, who were at high-risk for syphilis. Participants completed an interview-administered survey of socio-demographics and recent sexual risk behavior. We calculated the prevalence of UAI and used Poisson regression, adjusted for age and sexual identity, to calculate prevalence ratios (PRs) of the relationship between structural and social factors with an outcome of reported UAI in the past 3 months.
Among the 133 high-risk MSM and 38 transwomen, 91 (52.0%) reported any recent UAI. Of participants, 13 (7.6%) were unemployed, 92 (52.6%) and reported that they were unable to cover their basic needs for > 1 month in the last year. Unemployment (PR 1.72; 95% CI: 1.28, 2.32) and > 1 month of unmet basic needs over the past year (PR 1.34; 95% CI: 1.00, 1.79) were associated with UAI. Additionally, reporting sex with a sex worker in the past 3 months (PR 1.80; 95% CI: 1.25, 2.59) was associated with UAI. Among participants who reported sex work, sex with clients was moderately associated with UAI (PR 1.33; 95% CI: 0.98, 1.82).
Structural and social factors including being unemployed and reporting unmet basic needs were associated with UAI in the past three months. The relationship between HIV and structural factors such as financial hardship should be better understood, and appropriate strategies should be integrated as part of comprehensive HIV and syphilis prevention efforts for high-risk MSM and transwomen.