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Unpacking "High-Risk": A Latent Class Analysis of Sexual Partnership Patterns and HIV Transmission Risk Among Gay,
Reni Forer1,2, Jesse L Clark3, Jessica Gutierrez4
1University of Michigan Medical School, Ann Arbor, MI.
Insights
Gay, bisexual, and other men who have sex with men (GBMSM) are diverse. Differentiating subgroups by last sexual partner reveals varied HIV risks, informing targeted prevention strategies in Lima, Perú.
Area of Science:
- Public Health
- Epidemiology
- Social and Behavioral Sciences
Background:
- Gay, bisexual, and other men who have sex with men (GBMSM) are often viewed as a uniform group at high risk for HIV.
- Understanding behavioral diversity within this population is crucial for effective HIV prevention.
Purpose of the Study:
- To differentiate subgroups of GBMSM based on their last sexual partner (LSP).
- To explore associations between these subgroups and HIV transmission risk factors in Lima, Perú.
Main Methods:
- Cross-sectional data from 2,119 GBMSM in Lima, Perú (June 2022-March 2023).
- Latent class analysis using LSP characteristics (partner type, sexual role, condomless anal sex position).
- Multinomial logistic regression to identify HIV risk factors (drug use, transactional sex, STI, sexual identity, alcohol use, anonymous partners).
Main Results:
- Five distinct latent classes of GBMSM were identified based on LSP.
- Each class exhibited unique patterns of HIV transmission risk factors.
- Specific 'moderno partner' classes were linked to substance use and larger sexual networks, especially for those not living with HIV, compared to the 'pasivo partner' class.
Conclusions:
- GBMSM in Lima exhibit significant behavioral diversity influencing HIV risk.
- Sexual roles, partnership types, and network structures are key determinants of HIV risk.
- Culturally tailored prevention strategies, like role-specific partner notification, are vital for reducing HIV transmission.
Background:
Gay, bisexual, and other men who have sex with men (GBMSM) are often considered a homogenous "high-risk" group. We aimed to differentiate subgroups based on participants' last sexual partner and explore associations with HIV transmission risk factors.
Setting:
We utilized cross-sectional data (06/2022 to 03/2023) from "high-risk" GBMSM in Lima, Perú.
Methods:
Participants included cisgender men and gender nonconforming adults assigned male at birth reporting condomless anal sex with ≥1 serodiscordant or unknown serostatus cisgender man or transgender woman in the past 6 months. Latent class analysis was performed using the last sexual partner characteristics, including partner type, sexual role, and condomless anal sex position. Multinomial logistic regression examined HIV risk factors associated with latent classes, including drug use, transactional sex, sexually transmitted infection diagnosis, sexual identity, hazardous alcohol use, and number of anonymous partners.
Results:
From 2119 participants (47.1% living with HIV), 5 latent classes were identified: "pasivo partner" (26.1%); " one-time activo partner" (20.2%); " recurring activo partner" (16.6%); " one-time moderno partner" (13.3%); and "recurring moderno partner" (23.8%). Class memberships were each associated with different groupings of HIV transmission risk factors. Certain moderno partner classes were associated with substance use and larger anonymous sexual networks, particularly among GBMSM not living with HIV, compared with the "pasivo partner" class.
Conclusions:
Our findings demonstrate that GBMSM in Lima represent a behaviorally diverse population whose HIV risk is shaped by sexual roles, partnership types, and network structures. Culturally informed prevention strategies that incorporate these dynamics-such as role-specific partner-notification methods-are essential to more effectively address HIV transmission in the region.
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