title: Sexual role and transmission of HIV Type 1 among men who have sex with men, in Peru.
abstract: In Latin America, men who have sex with men (MSM) have traditionally practiced role segregation--that is, the adoption of a fixed role (insertive or receptive) rather than a versatile role (both practices) during anal sex. Previous modeling has shown that role segregation may yield a lower incidence of human immunodeficiency virus (HIV) type 1 infection, compared with role versatility; however, the modeling assumed no risk of acquiring HIV-1 during insertive sex, which is now recognized as unlikely. We reexamine the issue by use of a deterministic model incorporating bidirectional transmission and data from a cohort study of MSM in Lima, Peru, to demonstrate the potential effects of role segregation on the trajectory of the HIV-1 epidemic. In Lima, 67% of MSM reported segregated roles in their recent male partnerships. A population of MSM with identical contact rates but complete role versatility would have twice the prevalence of HIV-1 infection throughout the epidemic's first 3 decades. Preferential mixing among versatile MSM does not change overall prevalence but affects which individuals become infected.
authors.affiliation: Center for AIDS and STD and Center for Statistics and the Social Sciences, University of Washington, Seattle, WA 98195, USA. goodreau@u.washington.edu
authors.forename: Steven M
authors.initials: SM
authors.lastname: Goodreau
authors.forename: L Pedro
authors.initials: LP
authors.lastname: Goicochea
authors.forename: Jorge
authors.initials: J
authors.lastname: Sanchez
mesh_terms: D000465:Algorithms; D015331:Cohort Studies; D015658:HIV Infections / Q000453:epidemiology / Q000635:transmission*; D015497:HIV-1; D018451:Homosexuality, Male; D006801:Humans; D008297:Male; D010568:Peru / Q000453:epidemiology; D015995:Prevalence; D012380:Role; D012725:Sexual Behavior; D012747:Sexual Partners; D011795:Surveys and Questionnaires