title: A cross-sectional study of low HIV testing frequency and high-risk behaviour among men who have sex with men and transgender women in Lima, Peru.
abstract: BACKGROUND
  Increased HIV testing frequency among high-risk populations such as men who have sex with men (MSM) and male-to-female transgender women (TW) can lead to earlier treatment and potentially reduce HIV transmission.
  
  
  METHODS
  We analyzed baseline survey data from 718 high-risk, young (median age 29 [interquartile range 23-35]) MSM/TW enrolled in a community-based HIV prevention trial between 2008-2009. Participants were recruited from 24 neighborhoods in and around Lima, Peru. We assessed HIV testing frequency, testing behaviour, and motivations and barriers to testing. Multivariate analysis identified correlates to prior HIV testing.
  
  
  RESULTS
  Overall, 79.6% reported HIV testing within their lifetimes, however, only 6.2% reported an average of two tests per year, as per Peruvian Ministry of Health guidelines. The most commonly reported motivators for testing were to check one's health (23.3%), lack of condom use (19.7%), and availability of free testing (14.0%), while low self-perceived risk for HIV (46.9%), fear of a positive result (42.0%), and lack of access to testing services (35.7%) were the most frequently reported barriers. In multivariate analysis, factors independently associated with HIV testing included age [adjusted prevalence ratio (APR) 1.00, 95% CI (1.00-1.01)], transgender-identification vs. gay-identification [APR 1.11, 95% CI (1.03-1.20)], history of transactional sex [APR 1.16, 95% CI (1.07-1.27)], and prior sexually transmitted infection diagnosis [APR 1.15, 95% CI (1.07-1.24)].
  
  
  CONCLUSIONS
  An overwhelming majority of participants did not meet the standard-of-care for testing frequency. The reported motivations and barriers to testing highlight issues of risk perception and accessibility. Our findings suggest utilizing non-traditional outreach methods and promoting HIV testing as a routine part of healthcare in Peru to encourage testing and knowledge of HIV serostatus.
authors.affiliation: Division of Infectious Diseases, University of California, Los Angeles, California, USA. sky.w.lee@gmail.com.
authors.forename: Sky W
authors.initials: SW
authors.lastname: Lee
authors.affiliation: Division of Global Public Health, University of California, La Jolla, San Diego, California, USA. rgdeiss@yahoo.com.
authors.forename: Robert G
authors.initials: RG
authors.lastname: Deiss
authors.affiliation: Division of Infectious Diseases, University of California, Los Angeles, California, USA. eddysegura@gmail.com.
authors.forename: Eddy R
authors.initials: ER
authors.lastname: Segura
authors.affiliation: Division of Infectious Diseases, University of California, Los Angeles, California, USA. jlclark@mednet.ucla.edu.
authors.forename: Jesse L
authors.initials: JL
authors.lastname: Clark
authors.affiliation: Division of Infectious Diseases, University of California, Los Angeles, California, USA. jlake@mednet.ucla.edu.
authors.forename: Jordan E
authors.initials: JE
authors.lastname: Lake
authors.affiliation: Division of Infectious Diseases, University of California, Los Angeles, California, USA. kkonda@jhsph.edu.
authors.forename: Kelika A
authors.initials: KA
authors.lastname: Konda
authors.affiliation: Division of Infectious Diseases, University of California, Los Angeles, California, USA. tcoates@mednet.ucla.edu.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Coates
authors.affiliation: Unidad de Salud Sexualidad y Desarrollo Humano, Universidad Peruana Cayetano Heredia, Lima, Peru. carlos.caceres@upch.pe.
authors.forename: Carlos F
authors.initials: CF
authors.lastname: Caceres
mesh_terms: D015492:AIDS Serodiagnosis / Q000706:statistics & numerical data*; D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000175:diagnosis* / Q000523:psychology; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D018451:Homosexuality, Male / Q000523:psychology / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000706:statistics & numerical data; D015999:Multivariate Analysis; D010568:Peru / Q000453:epidemiology; D015995:Prevalence; D012749:Sexually Transmitted Diseases / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology; D011795:Surveys and Questionnaires; D063106:Transgender Persons / Q000523:psychology / Q000706:statistics & numerical data*; D047568:Unsafe Sex / Q000706:statistics & numerical data*; D055815:Young Adult