Web-based survey on sexual behavior and HIV prevention practices in gay men and men who have sex with men in Uruguay
DOI:
https://doi.org/10.29193/RMU.38.2.5Keywords:
HIV, HIV TESTING, CONDOMS, MEN WHO HAVE SEX WITH MEN, MSM, PRE-EXPOSURE PROPHYLAXIS, PrEPAbstract
Introduction: as gay men and men who have sex with men (MSM) constitute a population with a greater incidence of HIV, UNAIDS recommends regular surveillance by means of surveys that provide information that allows reporting prevention indicators. The implementation of these studies is limited in our context given the high complexity and costs of traditional methodologies.
Objectives: to generate updated information about HIV prevention, with an emphasis on condom use and to implement screening tests in gay/MSM population between 15 and 49 years old in Uruguay, using an innovative methodological strategy.
Method: transversal, analytical study by means of a web-based survey available between October and December 2019.
Results: 693 men were included in the study, 67% from Montevideo and 67% of which had university studies. 17% of them had been forced to have sex in the past, 20% had suffered abuse because of their sexual orientation and 68.4% concealed their sex-affective orientation to some extent. 57.2% used condoms in their last casual anal sexual relationship, what evidences a decrease with regard to 2012 (67.6%), whereas a growing tendency in the HIV test coverage (66%) was observed, when compared to previous studies. HIV positivity rate was 13.3%. The multivariate analysis revealed a lower probability of condom use was associated to: a stable partner in the last year, gay self-identification, HIV test in the last year and having the HPV vaccine. The greater likelihood of use was associated to: participating in informative activities, having sex with people with STD/HIV. The lowest probability of having an HIV test was associated to a stable partner and the highest was associated to knowing where they could get tested for HIV and also knowing about the post-exposure prophylaxis. When considering those who knew about the pre-exposure prophylaxis (375), 46.1% was willing to receive it and 1.3% had agreed to it.
Conclusions: the continuation of discrimination and violence towards gay men and MSM needs more effective right promoting actions. We need to integrate into prevention biomedical innovations that complement and leverage one another. The web-based survey was effective in terms of recruiting, although there were bias in the selection, what results challenging to improve the methodological strategy.
References
1) Global AIDS update 2020: seizing the moment. Tackling entrenched inequalities to end epidemics. Geneva: UNAIDS, 2020. Disponible en: https://www.unaids.org/sites/default/files/media_asset/2020_global-aids-report_en.pdf [Consulta: 15 set 2021].
2) Uruguay. Ministerio de Salud Pública. Ciudadanía y Salud. Acercándonos al conocimiento de dos poblaciones en condiciones de mayor vulnerabilidad para el VIH en Uruguay 2008/2009. Disponible en: https://www.gub.uy/ministerio-salud-publica/sites/ministerio-salud-publica/files/documentos/publicaciones/Ciudadania%20y% 20Salud%20Conocimiento%20del%20VIH%20en%20poblaciones%20vulnerables%20HSH%20y%20Trans%20HSH%20-%20Uruguay%202009_0.pdf [Consulta: 15 set 2021].
3) Uruguay. Ministerio de Salud Pública. Una ventana abierta al conocimiento de los desafíos existentes para el ejercicio al derecho a la salud de los hombres que tienen sexo con hombres en Uruguay 2013. Disponible en: https://www.gub.uy/ministerio-salud-publica/sites/ministerio-salud-publica/files/documentos/publicaciones/Conocimientos%20y%20desafios%20sobre%20la%20salud%20de%20HSH%20-%20MSP%202013_0_0.pdf [Consulta: 24 set 2021].
4) Monitoreo Global el SIDA 2022. Indicadores y preguntas para el seguimiento de los progresos de la Declaración Política sobre el VIH y el SIDA de 2021. ONUSIDA 2021, Orientación. Disponible en: https://www.unaids.org/sites/default/files/media_asset/global-aids-monitoring_es.pdf [Consulta: 24 set 2021].
5) Guidelines on surveillance among populations most at risk for HIV. Disponible en: https://www.unaids.org/sites/default/files/sub_landing/files/20110518_Surveillance_among_most_at_risk.pdf [Consulta: 15 set 2021].
6) Rahman Q, Xu Y, Lippa RA, Vasey PL. Prevalence of sexual orientation across 28 nations and its association with gender equality, economic development, and individualism. Archiv Sex Behav 2020; 49:595-606.
7) Nemoto T, Xie H, Iwamoto M, Sakata M. High risk behaviors in relation to psychosocial factors and internet usage among Asian and Pacific islander (API) men who had sex with men (MSM) in California. AIDS Educ Prev 2020; 32(2):117-36.
8) Noble M, Jones AM, Bowles K, DiNenno EA, Tregear J. HIV testing among internet-using MSM in the United States: systematic review. AIDS Behav 2017; 21(2):561-75.
9) Brogan N, Paquette DM, Lachowsky NJ, Blais M, Brennan DJ, Hart TA, Adam B. Canadian results from the European Men-who-have-sex-with-men Internet survey (EMIS-2017). Can Commun Dis Rep 2019; 45(11):271-82.
10) Sanchez T, Smith A, Denson D, DiNenno E, Lansky A. Internet- based methods may reach higher-risk men who have sex with men not reached through venue-based sampling. Open AIDS J 2012; 6:83-9.
11) Saxton P, Dickson N, Hughes A. Who is omitted from repeated offline HIV behavioural surveillance among MSM? Implications for interpreting trends. AIDS Behav 2013; 17(9):3133–44.
12) Sanchez T, Smith A, Denson D, DiNenno E, Lansky A. Developing a web-based HIV behavioral surveillance pilot project among men who have sex with men. Open AIDS J 2012; 6:224-31.
13) Martinez O, Wu E, Shultz AZ, Capote J, López Rios J, Sandfort T, et al. Still a hard-to-reach population? Using social media to recruit Latino gay couples for an HIV intervention adaptation study. J Med Internet Res 2014; 16(4):e113.
14) Chen YT, Bowles K, An Q, DiNenno E, Finlayson T, Hoots B, et al. Surveillance among men who have sex with men in the United States: a comparision of web-based and venue-based samples. AIDS Behav 2018; 22(7):2104-12.
15) Chiasson MA, Hirshfield S, Rietmeijer C. HIV prevention and care in the digital age. J Acquir Immune Defic Syndr 2010; 55(Suppl 2):s94-7.
16) Zlotorzynska M, Cantu C, Rai R, Sullivan P, Sanchez T. The annual American Men’s Internet Survey of behaviors of men who have sex with men in the United States: 2017 key indicators report. JMIR Public Health Surveill 2020; 6(2):e16847.
17) EMIS-2017. The European Men-Who-Have-Sex-With-Men Internet Survey: key findings from 50 countries. Stockholm: ECDC, 2019. Disponible en: https://www.ecdc.europa.eu/sites/default/files/documents/European-MSM-internet-survey-2017-findings.pdf [Consulta: 24 set 2021].
18) Consumption of recreational drugs and their sexualized use in gay men, bisexual and other men-who-have-sex-with-men from Latin America: preliminary results of the Latin American MSM Internet Survey (LAMIS). En: 10th IAS Conference on HIV Science (City Mexico, 21-23 jul 2019). Disponible en: https://www.researchgate.net/publication/335967632_Consumption_of_recreational_drugs_and_their_sexualized_use_in_gay_men_bisexual_and_other_men-who-have-sex-with-men_from_Latin_America_Preliminary_results_of_the_Latin_American_MSM_Internet_Survey_LAMI [Consulta: 3 set 2021].
19) ONUAIDS. The key populations atlas. Disponible en: https://kpatlas.unaids.org/dashboard [Consulta: 24 set 2021].
20) Global HIV Strategic Information Working Group. Biobehavioural survey guidelines for populations at risk for HIV. Disponible en: https://www.fhi360.org/sites/default/files/media/documents/resource-bio-survey-guidelines.pdf [Consulta: 15 set 2021].
21) Family Health International. Implementing AIDS Prevention Care Project. Behavioral Surveillance Surveys. Guidelines for repeated behavioral surveys in populations at risk of HIV. Disponible en: https://www.who.int/hiv/strategic/en/bss_fhi2000.pdf [Consulta: 3 set 2021].
22) Encuesta de Vigilancia de Comportamiento Sexual y Prevalencia del VIH e ITS, en poblaciones vulnerables y en poblaciones clave (ECVC). Capítulo Guatemala. Guatemala, set 2013. Disponible en: https://mcr-comisca.org/actividades-regionales/febrero-2014-curso-de-malaria/encuestas-de-vigilancia-de-comportamiento-evc/83-encuesta-centroamerica-de-vigilancia-de-comportamiento-sexual-y-prevalancia-del-vih-its-en-poblaciones-vulnerables-y-en-poblaciones-claves-ecvc-capitulo-guatemala-2012-2013/file [Consulta: 15 set 2021].
23) Uruguay. Ministerio de Educación y Cultura. Logro y nivel educativo alcanzado por la población 2018. Disponible en: https://www.gub.uy/ministerio-educacion-cultura/datos-y-estadisticas/estadisticas/logro-nivel-educativo-alcanzado-poblacion-2018 [Consulta: 24 set 2021].
24) Encuesta Nacional de Comportamientos Reproductivos. Uruguay 2017. Disponible en: https://uruguay.unfpa.org/es/publications/encuesta-nacional-de-comportamientos-reproductivos [Consulta: 24 set 2021].
25) Informe IV Encuesta Nacional de Adolescencia y Juventud Uruguay, 2018. Disponible en: https://uruguay.unfpa.org/sites/default/files/pub-pdf/INJU-MIDES_ENAJ%20IV.pdf [Consulta: 15 set 2021].
26) Uurguay. Ministerio de Desarrollo Social. Convivencia y Discriminación en Educación Media. Resultados preliminares - agosto 2019. Disponible en: https://www.gub.uy/ministerio-desarrollo-social/sites/ministerio-desarrollo-social/files/documentos/publicaciones/Presentaci%C3%B3n%20de%20datos.pdf [Consulta: 3 set 2021].
27) Mongelli F, Perrone D, Balducci J, Sacchetti A, Ferrari S, Mattei G, et al. Minority stress and mental health among LGBT populations: an update on the evidence. Minerva Psichiatr 2019; 60(1):27-50.
28) Lelutiu-Weinberger C, Rendina HJ, Mirandola M, Gios L, Folch C, Rafila A, et al. The role of gay-related stigma in HIV-risk behavior among sexual minority men in Europe. AIDS Behav 2019; 23:684-94. doi: 10.1007/s10461-018-2306-z.
29) Ottaway Z, Finnerty F, Amlani A, Pinto-Sander N, Szanyi J, Richardson D. Men who have sex with men diagnosed with a sexually transmitted infection are significantly more likely to engage in sexualised drug use. Int J STD AIDS 2017; 28(1):91-3.
30) Guerras JM, Hoyos J, Agustí C, Casabona J, Sordo L, Pulido J, et al. Consumo sexualizado de drogas entre hombres que tienen sexo con hombres residentes en España. Adicciones 2022; 34(1):37-50. doi: 10.20882/adicciones.1371.
31) Organización Panamericana de la Salud; OMS. Epidemia del VIH y respuesta en América Latina y el Caribe. Noviembre 2020. Disponible en: https://www.paho.org/sites/default/files/2020-cde-world-aids-day-overview-es.pdf [Consulta: 15 set 2021].
32) ONUSIDA. Hoja de ruta de prevención del VIH para 2020. Disponible en: https://hivpreventioncoalition.unaids.org/wp-content/uploads/2018/03/JC2909_INCLUSION-GAP_002_ES.pdf [Consulta: 15 set 2021].
33) ONUSIDA. Comunidades en el centro. La respuesta al VIH en América Latina. Actualización de los datos globales sobre el Sida, 2019. Disponible en: http://onusidalac.org/1/images/2019-global-AIDS-update_latin-america_es.pdf [Consulta: 3 set 2021].
34) Uruguay. Ministerio de Salud Pública. Recomendaciones de diagnóstico, tratamiento, prevención y vigilancia de las Infecciones de Transmisión Sexual. Disponible en: https://www.gub.uy/ministerio-salud-publica/comunicacion/publicaciones/recomendaciones-diagnostico-tratamiento-prevencion-vigilancia [Consulta: 15 set 2021].
35) Carballo-Diéguez A, Balan I, Marone R, Pando MA, Dolezal C, Barreda V, et al. Use of respondent driven sampling (RDS) generates a very diverse sample of men who have sex with men (MSM) in Buenos Aires, Argentina. PLoS One 2011; 6(11):e27447.
36) Bengtsson L, Lu X, Nguyen QC, Camitz M, Hoang NL, Nguyen TA, et al. Implementation of web-based respondent-driven sampling among men who have sex with men in Vietnam. PLoS One 2012; 7(11):e49417.
37) Strömdahl S, Lu X, Bengtsson L, Liljeros F, Thorson A. Implementation of web-based respondent driven sampling among men who have sex with men in Sweden. PLoS One 2015; 10(10):e0138599.
2) Uruguay. Ministerio de Salud Pública. Ciudadanía y Salud. Acercándonos al conocimiento de dos poblaciones en condiciones de mayor vulnerabilidad para el VIH en Uruguay 2008/2009. Disponible en: https://www.gub.uy/ministerio-salud-publica/sites/ministerio-salud-publica/files/documentos/publicaciones/Ciudadania%20y% 20Salud%20Conocimiento%20del%20VIH%20en%20poblaciones%20vulnerables%20HSH%20y%20Trans%20HSH%20-%20Uruguay%202009_0.pdf [Consulta: 15 set 2021].
3) Uruguay. Ministerio de Salud Pública. Una ventana abierta al conocimiento de los desafíos existentes para el ejercicio al derecho a la salud de los hombres que tienen sexo con hombres en Uruguay 2013. Disponible en: https://www.gub.uy/ministerio-salud-publica/sites/ministerio-salud-publica/files/documentos/publicaciones/Conocimientos%20y%20desafios%20sobre%20la%20salud%20de%20HSH%20-%20MSP%202013_0_0.pdf [Consulta: 24 set 2021].
4) Monitoreo Global el SIDA 2022. Indicadores y preguntas para el seguimiento de los progresos de la Declaración Política sobre el VIH y el SIDA de 2021. ONUSIDA 2021, Orientación. Disponible en: https://www.unaids.org/sites/default/files/media_asset/global-aids-monitoring_es.pdf [Consulta: 24 set 2021].
5) Guidelines on surveillance among populations most at risk for HIV. Disponible en: https://www.unaids.org/sites/default/files/sub_landing/files/20110518_Surveillance_among_most_at_risk.pdf [Consulta: 15 set 2021].
6) Rahman Q, Xu Y, Lippa RA, Vasey PL. Prevalence of sexual orientation across 28 nations and its association with gender equality, economic development, and individualism. Archiv Sex Behav 2020; 49:595-606.
7) Nemoto T, Xie H, Iwamoto M, Sakata M. High risk behaviors in relation to psychosocial factors and internet usage among Asian and Pacific islander (API) men who had sex with men (MSM) in California. AIDS Educ Prev 2020; 32(2):117-36.
8) Noble M, Jones AM, Bowles K, DiNenno EA, Tregear J. HIV testing among internet-using MSM in the United States: systematic review. AIDS Behav 2017; 21(2):561-75.
9) Brogan N, Paquette DM, Lachowsky NJ, Blais M, Brennan DJ, Hart TA, Adam B. Canadian results from the European Men-who-have-sex-with-men Internet survey (EMIS-2017). Can Commun Dis Rep 2019; 45(11):271-82.
10) Sanchez T, Smith A, Denson D, DiNenno E, Lansky A. Internet- based methods may reach higher-risk men who have sex with men not reached through venue-based sampling. Open AIDS J 2012; 6:83-9.
11) Saxton P, Dickson N, Hughes A. Who is omitted from repeated offline HIV behavioural surveillance among MSM? Implications for interpreting trends. AIDS Behav 2013; 17(9):3133–44.
12) Sanchez T, Smith A, Denson D, DiNenno E, Lansky A. Developing a web-based HIV behavioral surveillance pilot project among men who have sex with men. Open AIDS J 2012; 6:224-31.
13) Martinez O, Wu E, Shultz AZ, Capote J, López Rios J, Sandfort T, et al. Still a hard-to-reach population? Using social media to recruit Latino gay couples for an HIV intervention adaptation study. J Med Internet Res 2014; 16(4):e113.
14) Chen YT, Bowles K, An Q, DiNenno E, Finlayson T, Hoots B, et al. Surveillance among men who have sex with men in the United States: a comparision of web-based and venue-based samples. AIDS Behav 2018; 22(7):2104-12.
15) Chiasson MA, Hirshfield S, Rietmeijer C. HIV prevention and care in the digital age. J Acquir Immune Defic Syndr 2010; 55(Suppl 2):s94-7.
16) Zlotorzynska M, Cantu C, Rai R, Sullivan P, Sanchez T. The annual American Men’s Internet Survey of behaviors of men who have sex with men in the United States: 2017 key indicators report. JMIR Public Health Surveill 2020; 6(2):e16847.
17) EMIS-2017. The European Men-Who-Have-Sex-With-Men Internet Survey: key findings from 50 countries. Stockholm: ECDC, 2019. Disponible en: https://www.ecdc.europa.eu/sites/default/files/documents/European-MSM-internet-survey-2017-findings.pdf [Consulta: 24 set 2021].
18) Consumption of recreational drugs and their sexualized use in gay men, bisexual and other men-who-have-sex-with-men from Latin America: preliminary results of the Latin American MSM Internet Survey (LAMIS). En: 10th IAS Conference on HIV Science (City Mexico, 21-23 jul 2019). Disponible en: https://www.researchgate.net/publication/335967632_Consumption_of_recreational_drugs_and_their_sexualized_use_in_gay_men_bisexual_and_other_men-who-have-sex-with-men_from_Latin_America_Preliminary_results_of_the_Latin_American_MSM_Internet_Survey_LAMI [Consulta: 3 set 2021].
19) ONUAIDS. The key populations atlas. Disponible en: https://kpatlas.unaids.org/dashboard [Consulta: 24 set 2021].
20) Global HIV Strategic Information Working Group. Biobehavioural survey guidelines for populations at risk for HIV. Disponible en: https://www.fhi360.org/sites/default/files/media/documents/resource-bio-survey-guidelines.pdf [Consulta: 15 set 2021].
21) Family Health International. Implementing AIDS Prevention Care Project. Behavioral Surveillance Surveys. Guidelines for repeated behavioral surveys in populations at risk of HIV. Disponible en: https://www.who.int/hiv/strategic/en/bss_fhi2000.pdf [Consulta: 3 set 2021].
22) Encuesta de Vigilancia de Comportamiento Sexual y Prevalencia del VIH e ITS, en poblaciones vulnerables y en poblaciones clave (ECVC). Capítulo Guatemala. Guatemala, set 2013. Disponible en: https://mcr-comisca.org/actividades-regionales/febrero-2014-curso-de-malaria/encuestas-de-vigilancia-de-comportamiento-evc/83-encuesta-centroamerica-de-vigilancia-de-comportamiento-sexual-y-prevalancia-del-vih-its-en-poblaciones-vulnerables-y-en-poblaciones-claves-ecvc-capitulo-guatemala-2012-2013/file [Consulta: 15 set 2021].
23) Uruguay. Ministerio de Educación y Cultura. Logro y nivel educativo alcanzado por la población 2018. Disponible en: https://www.gub.uy/ministerio-educacion-cultura/datos-y-estadisticas/estadisticas/logro-nivel-educativo-alcanzado-poblacion-2018 [Consulta: 24 set 2021].
24) Encuesta Nacional de Comportamientos Reproductivos. Uruguay 2017. Disponible en: https://uruguay.unfpa.org/es/publications/encuesta-nacional-de-comportamientos-reproductivos [Consulta: 24 set 2021].
25) Informe IV Encuesta Nacional de Adolescencia y Juventud Uruguay, 2018. Disponible en: https://uruguay.unfpa.org/sites/default/files/pub-pdf/INJU-MIDES_ENAJ%20IV.pdf [Consulta: 15 set 2021].
26) Uurguay. Ministerio de Desarrollo Social. Convivencia y Discriminación en Educación Media. Resultados preliminares - agosto 2019. Disponible en: https://www.gub.uy/ministerio-desarrollo-social/sites/ministerio-desarrollo-social/files/documentos/publicaciones/Presentaci%C3%B3n%20de%20datos.pdf [Consulta: 3 set 2021].
27) Mongelli F, Perrone D, Balducci J, Sacchetti A, Ferrari S, Mattei G, et al. Minority stress and mental health among LGBT populations: an update on the evidence. Minerva Psichiatr 2019; 60(1):27-50.
28) Lelutiu-Weinberger C, Rendina HJ, Mirandola M, Gios L, Folch C, Rafila A, et al. The role of gay-related stigma in HIV-risk behavior among sexual minority men in Europe. AIDS Behav 2019; 23:684-94. doi: 10.1007/s10461-018-2306-z.
29) Ottaway Z, Finnerty F, Amlani A, Pinto-Sander N, Szanyi J, Richardson D. Men who have sex with men diagnosed with a sexually transmitted infection are significantly more likely to engage in sexualised drug use. Int J STD AIDS 2017; 28(1):91-3.
30) Guerras JM, Hoyos J, Agustí C, Casabona J, Sordo L, Pulido J, et al. Consumo sexualizado de drogas entre hombres que tienen sexo con hombres residentes en España. Adicciones 2022; 34(1):37-50. doi: 10.20882/adicciones.1371.
31) Organización Panamericana de la Salud; OMS. Epidemia del VIH y respuesta en América Latina y el Caribe. Noviembre 2020. Disponible en: https://www.paho.org/sites/default/files/2020-cde-world-aids-day-overview-es.pdf [Consulta: 15 set 2021].
32) ONUSIDA. Hoja de ruta de prevención del VIH para 2020. Disponible en: https://hivpreventioncoalition.unaids.org/wp-content/uploads/2018/03/JC2909_INCLUSION-GAP_002_ES.pdf [Consulta: 15 set 2021].
33) ONUSIDA. Comunidades en el centro. La respuesta al VIH en América Latina. Actualización de los datos globales sobre el Sida, 2019. Disponible en: http://onusidalac.org/1/images/2019-global-AIDS-update_latin-america_es.pdf [Consulta: 3 set 2021].
34) Uruguay. Ministerio de Salud Pública. Recomendaciones de diagnóstico, tratamiento, prevención y vigilancia de las Infecciones de Transmisión Sexual. Disponible en: https://www.gub.uy/ministerio-salud-publica/comunicacion/publicaciones/recomendaciones-diagnostico-tratamiento-prevencion-vigilancia [Consulta: 15 set 2021].
35) Carballo-Diéguez A, Balan I, Marone R, Pando MA, Dolezal C, Barreda V, et al. Use of respondent driven sampling (RDS) generates a very diverse sample of men who have sex with men (MSM) in Buenos Aires, Argentina. PLoS One 2011; 6(11):e27447.
36) Bengtsson L, Lu X, Nguyen QC, Camitz M, Hoang NL, Nguyen TA, et al. Implementation of web-based respondent-driven sampling among men who have sex with men in Vietnam. PLoS One 2012; 7(11):e49417.
37) Strömdahl S, Lu X, Bengtsson L, Liljeros F, Thorson A. Implementation of web-based respondent driven sampling among men who have sex with men in Sweden. PLoS One 2015; 10(10):e0138599.
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2022-06-08
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Cabrera S, Pérez L, Meré JJ, Pérez D, Miranda C, Cavallieri F. Web-based survey on sexual behavior and HIV prevention practices in gay men and men who have sex with men in Uruguay. Rev. Méd. Urug. [Internet]. 2022 Jun. 8 [cited 2024 Sep. 7];38(2):e38206. Available from: https://revista.rmu.org.uy/index.php/rmu/article/view/884
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