Male sex workers among men who have sex with men in Lima, Peru
Background: HIV transmission in Peru primarily occurs among men who have sex with men (MSM). Despite knowledge of the increased risk for HIV infection of male sex workers, male sex work is illegal in Peru and data on this population is limited. We quantify and contextualize risk for HIV/STIs among male sex workers by providing additional information on their vulnerabilities.
Methods: A convenience sample of MSM was recruited from an inner-city STI clinic population in Lima, Peru. Participants completed a computer-assisted self-interview, including questions about compensated sex and sex work and provided a blood sample for laboratory testing of HIV ELISA (Vironostika), HIV WB (Genetic Systems), HSV-2 ELISA (Focus Diagnostics), RPR (RPRnosticon), with TPPA Serodia (Fujirebio).
Results: Among the 559 men enrolled, 169 (30%) reported having sex for compensation (money, alcohol, food, etc) in the past 6 months and 129/169 identified themselves as sex workers. Reporting compensated sex was associated with higher prevalence of HSV-2 (65% vs. 52%) and recent syphilis RPR³1:8 (14% vs. 8%) compared to men not reporting this behavior (all p<0.05) while there was no difference in HIV prevalence (24% vs. 21%). Among the 129 sex workers, condom use with clients was lower for insertive anal sex than for receptive anal sex (61% ever used a condom vs. 92%, respectively); additionally 92% reported that clients asked them not to use condoms for sex. Almost half of the sex workers reported police mistreatment, but only 9/56 informed authorities about this mistreatment.
Conclusions: Compensated sex and sex work was common among the population of men who have sex with men attending this clinic and sex work was associated with higher STI prevalence. These vulnerabilities and occupational related risks should be taken into account when planning interventions among this population, especially given HIV/STD prevalence among this health seeking population.
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