S L I D E 0 Being Unaware of Being HIV-Infected is Associated with Alcohol Use Disorders and High-Risk Sexual Risk Behaviors Among MSM in Peru Vagenas P, Ludford, KT, Gonzales P, Peinado P; Cabezas C; Gonzales F; Lama JR, Sanchez J, Altice FL

S L I D E 1 Background Peru Middle income country Low HIV prevalence: 0.2% in general population 1 Men who have sex with men (MSM) are disproportionately affected HIV prevalence (Lima): 18.5 – 22.3% 2-4 HIV epidemic concentrated among MSM, in Lima 1. Garcia PJ et al. Lancet Sanchez J et al.. JAIDS Tabet S et al. AIDS Silva-Santisteban A, et al. Int AIDS Conf 2010:Abstr# A

S L I D E 2 Other Findings from this Sample Alcohol Use Disorders (AUDs) are significantly and independently associated with: Unprotected sex >5 partners in last 3 months STI in last 6 months Sex work in last 6 months Sex with HIV+ partner in last 6 months Ludford KT et al., POSTER #WEPE554, Wed 12.30pm

S L I D E 3 Methods Bio-behavioral cross-sectional surveillance study (May-Oct, 2011) 5,148 biological men who reported sex with another male enrolled (convenience sampling), completed survey Lima (66%) + 4 representative provincial cities (Ica, Piura, Iquitos, Pucallpa) AUDs assessed using AUDIT (Alcohol Use Disorders Identification Test – developed by the W.H.O.) Testing for HIV Survey question: ‘have you ever tested positive for HIV?’

S L I D E 4 Methods LAB TESTSELF-REPORT + + OLD/KNOWN + NEW/UNKNOWN - LAB TESTSELF-REPORT

S L I D E 5 Relevant Characteristics Median Age: 27 ± 9 Transgender: 14% Education Primary or less: 16% Some secondary: 48% Some tertiary: 35% Self reported sexuality Gay: 57% Bisexual: 30% Straight: 13% 63% of participants had an AUD AUD No AUD

S L I D E 6 Results Overall, 8% were HIV+ (n=420) 89% of the 420 HIV+ men were UNAWARE of their HIV status

S L I D E 7 Correlates of Being Unaware of HIV+ Status: Risk Behaviors CovariatesBivariate AssociationsMultivariate Associations OR (95% CI) p-valueOR (95% CI) p-value Unprotected sex (last partner) 3.14 ( ) ( ) Unprotected sex (any of last 3 partners) 1.78 ( ) ( ) HIV+ partner (previous 3 months) 0.55 ( ) Sex work (previous 6 months) 1.05 ( ) >5 partners (previous 6 months) 0.90 ( ) STI (previous 6 months)1.17 ( )

S L I D E 8 Correlates of Being Unaware of HIV+ Status: Other Factors CovariatesBivariate AssociationsMultivariate Associations OR (95% CI) p-valueOR (95% CI) p-value Alcohol Use Disorder1.52 ( ) (1.01–4.54)0.048 Syphilis infection0.62 ( ) ( )0.135 Transgender1.52 ( ) Self-ID as gay0.98 ( ) Drug use (previous 6 months)1.60 ( ) Stable (male) partner (previous 3 partners) 0.70 ( ) Location in Lima (vs. outside)0.99 ( ) Age ( )0.087 Number of sexual partners (previous 3 months)

S L I D E 9 Conclusions AUDs are highly prevalent among MSM Most HIV+ MSM had not been previously HIV tested Having an AUD and reporting unprotected sex with the last sexual partners are independently correlated with being HIV+ and unaware of their HIV+ status

S L I D E 10 Recommendations Expansion of HIV testing and treatment strategies are urgently needed among MSM – especially given the low prevalence of previous HIV testing and high risk behaviors among those without previously undiagnosed HIV infection Further research into temporal relationship between AUDs and risky sexual behaviors –Treatment for AUDs –PrEP

S L I D E 11 Acknowledgements Peruvian Authorities Estrategia Nacional de Control de VIH/SIDA Dirección General de Epidemiologia Instituto Nacional de Salud del Peru Epicentro Hugo Sanchez Associación Civil Impacta Salud y Educación Anabeli Tataje (Study Coordinator) Patricia Segura: Recruitment & Retention Coordinator Carmela Ganoza (Lab Director) Cecilia Chang (Lab Supervisor) Ricardo Alfaro (Lab Manager) Robert de la Grecca (Program Manager) Lourdes Kusunoki (Independent Researcher) The Participants!!