Screening for Drug and Alcohol Use Disorders and Their Association with HIV-Related Sexual Risk Behaviors among Men Who Have Sex with Men in Peru

Background: Peru's HIV epidemic is concentrated among men who have sex with men (MSM). The contribution of alcohol use disorders (AUDs) to known high-risk behaviors associated with HIV transmission in this context has not been well characterized. Methods: Between June and October 2011, 5,148 sexually active MSM were recruited using convenience sampling in five cities to participate in a cross-sectional bio-behavioral survey. Five high-risk sexual criteria previously associated with incident HIV infection in this setting were selected a priori as the dependent outcomes. Screening for AUDs used the validated Alcohol Use Disorders Identification Test (AUDIT) and AUDS were stratified by severity. Unadjusted and adjusted odds ratios (AOR) were computed to establish the independent correlates of the five dependent outcomes. Results: The majority (62.8%) of participants met screening criteria for having an AUD, which were independently correlated with each of the following high-risk sexual risk behaviors in the previous 6 months: 1) >5 sexual partners [AOR = 1.76; (1.54-2.02)]; 2) sex with an HIV-infected partner [AOR = 1.29; (1.03-1.62)]; 3) having a sexually transmitted infection [AOR = 1.38; (1.13-1.68)]; 4) being a sex worker [AOR = 1.61; (1.40-1.87)]; and 5) unprotected sex during last encounter [AOR = 1.22; (1.09-1.38)]. Recent drug use was also correlated with having >5 sexual partners [AOR = 1.42 (1.19-1.71)], sex work [AOR = 1.97 (1.63-2.39)] and unprotected sex during last encounter [AOR = 1.31 (1.11-1.54)]. For each dependent variable, the association with AUDs significantly increased with increasing AUD severity. Conclusions: AUDs are highly prevalent among MSM in Peru and are associated with increased HIV risk-taking behaviors that are associated with HIV transmission. Strategies that target problematic drinking such as medication-assisted therapy, behavioral counseling and structural interventions could potentially reduce risky behaviors and ultimately reduce HIV transmission among MSM in Peru.