HIV Prevention and Care for Peruvian MSM and Transgender Women
Despite the existence of a government-led HIV prevention program focused on men who have sex with men and transgender women (MSM/TW) for nearly two decades in Peru, HIV incidence among them remains high at 5%, and most (70-75%) HIV+ MSM/TW are unaware of their HIV status. This is similar to the rest of Latin America, where sexual transmission among MSM/TW drives the HIV epidemic. HIV prevention efforts for MSM/TW in Peru are ineffective, in part, because this population remains exposed to high levels of societal discrimination, homophobia and transphobia, because of social norms favoring silence about HIV and sexual risk, and because of lack of cultural competent health services. Moreover, HIV+ MSM/TW face substantial HIV stigma, which affects disclosure of HIV status, willingness to obtain HIV testing and care, and social support. A multilevel intervention approach is needed that addresses factors at the individual, social/community, and health system levels, to facilitate earlier detection of HIV infection; linking, retaining, and re-engagin HIV+ people in care and treatment to achieve viral suppression; sexual risk reduction among both HIV- and HIV+ people; and community mobilization around these issues to provide support for and change social norms and engagement in HIV prevention and treatment. A multilevel approach stressing prevention-care links in the Continuum of Prevention and Care (CPC), is likely to reduce barriers to HIV prevention and care through integrated activities involving both community and health facilities, while creating synergy across the intervention elements. We have developed and piloted Proyecto Orgullo (PO), a multilevel, theory-based intervention that diffuses support for and creates positive social norms around HIV prevention by building a mobilized, empowered MSM/TW community to reduce unsafe sex and promote biannual HIV testing. PO has shown to be acceptable, feasible and potentially effective. In collaboration with the Peruvian Ministry of Health (MoH) and local healthcare facilities, we now propose to develop, implement and test the efficacy of PO+, an extension of PO that will facilitate full engagement in the CPC, and strengthen the linkage between the community and the health system. If shown effective, PO+ can be scaled up throughout Peru with the support of the MoH, and used as a model elsewhere in the Americas, including the US. The project aims are:
(1) to create Proyecto Orgullo+ (PO+), a comprehensive, integrated, multilevel intervention that will focus on the CPC;
(2) to implement PO+ for 3 years in Lima South, in collaboration with the Peruvian MoH, hospitals that provide HIV care, and HIV testing sites;
(3) to evaluate the efficacy of PO+ in affecting the CPC by using: (a) data on the CPC, including sexual risk behavior, HIV testing frequency; incidence of anal Chlamydia and gonorrhea, and engagement in care among HIV+ people, collected through longitudinal cohorts of MSM/TW in Lima South and Lima East (the control area), recruited independently of the intervention, oversampling HIV+ MSM/TW; and (b) CD4 and VL data for HIV patients, collected and provided by the MoH.