Sexual communication with partners informs risk assessment and sexual practices. We evaluated participant, partner, and network factors associated with communication about condom use and HIV serostatus and explored their relationships with condomless anal intercourse (CAI) among 446 men who have sex with men (MSM) and 122 transgender women (TW) in Lima, Peru. Generalized estimating equations assessed contextual influences on communication and practices with recent sexual partners. More frequent HIV communication was reported by MSM who: identified as heterosexual, compared to bisexual or gay; characterized partnerships as stable, compared to casual, anonymous, or commercial; or discussed HIV/STIs with close social contacts (p < 0.05). TW in concurrent partnerships discussed condom use more frequently than those in monogamous relationships (p < 0.05). Condom use discussions and alcohol use among MSM were associated with CAI (p < 0.05). Findings highlight complexity in sexual decision-making and call for further study of conversation content and practices to inform HIV prevention messaging.
La comunicación sexual entre parejas informa sobre la valoración de riesgos y las prácticas sexuales. Evaluamos los factores de participantes, sus parejas y sus redes en relación con la comunicación sobre el uso de condones y el serostatus del VIH, y exploramos sus asociaciones con el sexo anal sin condón (CAI) entre 446 hombres que tienen sexo con hombres (HSH) y 122 mujeres transgéneros (MT) en Lima, Perú. Usamos ecuaciones de estimación generalizadas para evaluar las influencias contextuales en la comunicación y las prácticas con parejas sexuales recientes. La comunicación sobre el VIH fue más frecuente entre los HSH: que se identificaron como heterosexuales, en comparación con bisexuales o gay; quienes reportaron sus relaciones de pareja como estables, en comparación a casuales, anónimas o comerciales; o quienes discutieron el VIH/ITS con contactos sociales cercanos (p < 0.05). Las MT con relaciones concurrentes discutieron el uso de condones con más frecuencia que las que reportaron relaciones monógamas (p < 0.05). Las discusiones sobre el uso de condones y el consumo de alcohol se asociaron con CAI entre los HSH (p < 0.05). Estos resultados resaltan la complejidad de las decisiones sexuales y ameritan un mayor estudio del contenido y las prácticas de conversación para informar los mensajes de prevención del VIH.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Price includes VAT (USA)
Tax calculation will be finalised during checkout.
The data that support the findings of this study are available upon reasonable request to the authors, pending approval from the UCLA IRB and Ethics Committee of Asociación Civil Vía Libre. Data utilized in this study are not publicly available due to restrictions on publication of human participant data without consent.
The code used in analysis of these findings is available upon reasonable request to the authors.
MINSA. Current situation of HIV-AIDS in Peru. 2018. http://www.digemidminsagobpe/UpLoad/UpLoaded/PDF/EAccMed/ReunionesTecnicas/PONENCIAS/2018/DIA3/SituacionActualVIH-SIDApdf. Accessed 15 April 2020.
Silva-Santisteban A, Raymond HF, Salazar X, Villayzan J, Leon S, McFarland W, et al. Understanding the HIV/AIDS epidemic in transgender women of Lima, Peru: results from a sero-epidemiologic study using respondent driven sampling. AIDS Behav. 2012;16(4):872–81.
UNAIDS. 2018 Peru Country Data. 2018. https://www.unaids.org/sites/default/files/media_asset/unaids-data-2018_en.pdf. Accessed 1 May 2020.
Sanchez J, Lama JR, Kusunoki L, Manrique H, Goicochea P, Lucchetti A, et al. HIV-1, sexually transmitted infections, and sexual behavior trends among men who have sex with men in Lima, Peru. JAIDS J Acquir Immune DeficSyndr. 2007;44(5):578–85.
Noar SM, Carlyle K, Cole C. Why communication is crucial: meta-analysis of the relationship between safer sexual communication and condom use. J Health Commun. 2006;11(4):365–90.
Grov C, Rendina HJ, Moody RL, Ventuneac A, Parsons JT. HIV serosorting, status disclosure, and strategic positioning among highly sexually active gay and bisexual men. AIDS Patient Care STDs. 2015;29(10):559–68.
Pinkerton SD, Galletly CL. Reducing HIV transmission risk by increasing serostatus disclosure: a mathematical modeling analysis. AIDS Behav. 2006;11(5):698.
Lo SC, Reisen CA, Poppen PJ, Bianchi FT, Zea MC. Cultural beliefs, partner characteristics, communication, and sexual risk among Latino MSM. AIDS Behav. 2011;15(3):613–20.
Wilson PA, Díaz RM, Yoshikawa H, Shrout PE. Drug use, interpersonal attraction, and communication: situational factors as predictors of episodes of unprotected anal intercourse among Latino gay men. AIDS Behav. 2009;13(4):691–9.
Matser A, Heijman T, Geskus R, de Vries H, Kretzschmar M, Speksnijder A, et al. Perceived HIV status is a key determinant of unprotected anal intercourse within partnerships of men who have sex with men in Amsterdam. AIDS Behav. 2014;18(12):2442–56.
Santos-Hövener C, Zimmermann R, Kücherer C, Bätzing-Feigenbaum J, Wildner S, Hamouda O, et al. Conversation about Serostatus decreases risk of acquiring HIV: results from a case control study comparing MSM with recent HIV infection and HIV negative controls. BMC Public Health. 2014;14(1):453.
O’Connell AA, Reed SJ, Serovich JA. The efficacy of serostatus disclosure for HIV transmission risk reduction. AIDS Behav. 2015;19(2):283–90.
Simoni JM, Pantalone DW. Secrets and safety in the age of AIDS: does HIV disclosure lead to safer sex? Top HIV Med. 2004;12(4):109–18.
Eaton LA, Kalichman SC, O’Connell DA, Karchner WD. A strategy for selecting sexual partners believed to pose little/no risks for HIV: serosorting and its implications for HIV transmission. AIDS Care. 2009;21(10):1279–88.
Carballo-Diéguez A, Miner M, Dolezal C, Rosser BRS, Jacoby S. Sexual negotiation, HIV-status disclosure, and sexual risk behavior among Latino men who use the internet to seek sex with other men. Arch Sex Behav. 2006;35(4):473–81.
Marcus U, Schink SB, Sherriff N, Jones A-M, Gios L, Folch C, et al. HIV serostatus knowledge and serostatus disclosure with the most recent anal intercourse partner in a European MSM sample recruited in 13 cities: results from the Sialon-II study. BMC Infect Dis. 2017;17(1):730.
Rietmeijer CA, Lloyd LV, McLean C. Discussing HIV serostatus with prospective sex partners: a potential HIV prevention strategy among high-risk men who have sex with men. Sex Transm Dis. 2007;34(4):215–9.
Perez-Brumer AG, Passaro RC, Oldenburg CE, Garcia J, Sanchez J, Salvatierra HJ, et al. Homophobia and heteronormativity as dimensions of stigma that influence sexual risk behaviors among men who have sex with men (MSM) and women (MSMW) in Lima, Peru: a mixed-methods analysis. BMC Public Health. 2019;19(1):617.
Clark J, Salvatierra J, Segura E, Salazar X, Konda K, Perez-Brumer A, et al. Moderno love: sexual role-based identities and HIV/STI prevention among men who have sex with men in Lima. Peru AIDS Behav. 2013;17(4):1313–28.
Blair CS, Segura ER, Perez-Brumer AG, Sanchez J, Lama JR, Clark JL. Sexual orientation, gender identity and perceived source of infection among men who have sex with men (MSM) and transgender women (TW) recently diagnosed with HIV and/or STI in Lima. Peru AIDS Behav. 2016;20(10):2178–85.
Clark JL, Perez-Brumer AG, Segura ER, Salvatierra HJ, Sanchez J, Lama JR. Anticipated notification of sexual partners following STD diagnosis among men who have sex with men and transgender women in Lima, Peru: a mixed methods analysis. PLoS ONE. 2016;11(9):e0163905.
Kosenko KA. The safer sex communication of transgender adults: processes and problems. J Commun. 2011;61(3):476–95.
Long JE, Ulrich A, White E, Dasgupta S, Cabello R, Sanchez H, et al. Characterizing men who have sex with transgender women in Lima, Peru: sexual behavior and partnership profiles. AIDS Behav. 2020;24(3):914–24.
Satcher MF, Segura ER, Silva-Santisteban A, Sanchez J, Lama JR, Clark JL. Partner-level factors associated with insertive and receptive condomless anal intercourse among transgender women in Lima. Peru AIDS Behav. 2017;21(8):2439–51.
Pollock L, Silva-Santisteban A, Sevelius J, Salazar X. “You should build yourself up as a whole product”: transgender female identity in Lima. Peru Glob Public Health. 2016;11(7–8):981–93.
Murphy EC, Segura ER, Lake JE, Huerta L, Perez-Brumer AG, Mayer KH, et al. Intimate partner violence against transgender women: prevalence and correlates in Lima, Peru (2016–2018). AIDS Behav. 2019. https://doi.org/10.1007/s10461-019-02728-w.
Degtyar A, George PE, Mallma P, Diaz DA, Cárcamo C, Garcia PJ, et al. Sexual risk, behavior, and HIV testing and status among male and transgender women sex workers and their clients in Lima. Peru Int J Sex Health. 2018;30(1):81–91.
Ulrich AK, Sanchez J, Lama JR, Manhart LE, Goodreau SM, Duerr AC. Correlates of concurrent partnerships and patterns of condom use among men who have sex with men and transgender women in Peru. PLoS ONE. 2019;14(9):e0222114.
Passaro RC, Segura ER, Lama JR, Sanchez J, Lake JE, Shoptaw S, et al. High-risk, but hidden: binge drinking among men who have sex with men and transgender women in Lima, Peru, 2012–2014. Subst Use Misuse. 2020;55(3):399–404.
Konda KA, Castillo R, Leon SR, Silva-Santisteban A, Salazar X, Klausner JD, et al. HIV status communication with sex partners and associated factors among high-risk MSM and transgender women in Lima. Peru AIDS Behav. 2017;21(1):152–62.
Nagaraj S, Segura ER, Peinado J, Konda KA, Segura P, Casapia M, et al. A cross-sectional study of knowledge of sex partner serostatus among high-risk Peruvian men who have sex with men and transgender women: implications for HIV prevention. BMC Public Health. 2013;13:181.
Clark JL, Konda KA, Segura ER, Salvatierra HJ, Leon SR, Hall ER, et al. Risk factors for the spread of HIV and other sexually transmitted infections among men who have sex with men infected with HIV in Lima. Peru Sex Transm Infect. 2008;84(6):449–54.
Billings JD, Joseph Davey DL, Konda KA, Bristow CC, Chow J, Klausner JD, et al. Factors associated with previously undiagnosed human immunodeficiency virus infection in a population of men who have sex with men and male-to-female transgender women in Lima, Peru. Medicine (Baltimore). 2016;95(42):e5147.
Vagenas P, Ludford KT, Gonzales P, Peinado J, Cabezas C, Gonzales F, et al. Being unaware of being HIV-infected is associated with alcohol use disorders and high-risk sexual behaviors among men who have sex with men in Peru. AIDS Behav. 2014;18(1):120–7.
Perez-Brumer AG, Oldenburg CE, Segura ER, Sanchez J, Lama JR, Clark JL. Anonymous partnerships among MSM and transgender women (TW) recently diagnosed with HIV and other STIs in Lima, Peru: an individual-level and dyad-level analysis. Sex Transm Infect. 2016;92(7):554–7.
Garcia J, Perez-Brumer AG, Cabello R, Clark JL. “And then break the cliché”: understanding and addressing HIV vulnerability through development of an HIV prevention telenovela with men who have sex with men and transwomen in Lima. Peru Arch Sex Behav. 2018;47(7):1995–2005.
Passaro RC, Chávez-Gomez S, Castañeda-Huaripata A, Gonzales-Saavedra W, Beymer MR, Segura ER, et al. Personalized cognitive counseling reduces drinking expectancy among men who have sex with men and transgender women in Lima, Peru: a pilot randomized controlled trial. AIDS Behav. 2020. https://doi.org/10.1007/s10461-020-02882-6.
Workowski KA, Bolan GA, Centers for Disease C, Prevention. Sexually transmitted diseases treatment guidelines. MMWR Recomm Rep. 2015;64(RR-03):1–137.
Barros AJD, Hirakata VN. Alternatives for logistic regression in cross-sectional studies: an empirical comparison of models that directly estimate the prevalence ratio. BMC Med Res Methodol. 2003;3(1):21.
Coutinho LMS, Scazufca M, Menezes PR. Métodos para estimarrazão de prevalênciaemestudos de corte transversal. Revista de SaúdePública. 2008;42:992–8.
Delgado JR, Segura ER, Lake JE, Sanchez J, Lama JR, Clark JL. Event-level analysis of alcohol consumption and condom use in partnership contexts among men who have sex with men and transgender women in Lima. Peru Drug Alcohol Depend. 2017;170:17–24.
Verre MC, Peinado J, Segura ER, Clark J, Gonzales P, Benites C, et al. Socialization patterns and their associations with unprotected anal intercourse, HIV, and syphilis among high-risk men who have sex with men and transgender women in Peru. AIDS Behav. 2014;18(10):2030–9.
Lee SW, Deiss RG, Segura ER, Clark JL, Lake JE, Konda KA, et al. 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. BMC Public Health. 2015;15:408.
Vargas SK, Konda KA, Leon SR, Brown B, Klausner JD, Lindan C, et al. The relationship between risk perception and frequency of HIV testing among men who have sex with men and transgender women, Lima. Peru AIDS Behav. 2018;22(Suppl 1):26–34.
Maiorana A, Kegeles S, Salazar X, Konda K, Silva-Santisteban A, Cáceres C. “ProyectoOrgullo”, an HIV prevention, empowerment and community mobilisation intervention for gay men and transgender women in Callao/Lima. Peru Glob Public Health. 2016;11(7–8):1076–92.
Prevention Access Campaign. Undetectable=Untransmittable. 2016. https://www.preventionaccessorg/undetectable.
Okoli C, Van de Velde N, Richman B, Allan B, Castellanos E, Young B, et al. Undetectable equals untransmittable (U = U): awareness and associations with health outcomes among people living with HIV in 25 countries. Sex Transm Infect. 2020. https://doi.org/10.1136/sextrans-2020-054551.
Barrington C, Latkin C, Sweat MD, Moreno L, Ellen J, Kerrigan D. Talking the talk, walking the walk: social network norms, communication patterns, and condom use among the male partners of female sex workers in La Romana, Dominican Republic. SocSci Med. 2009;68(11):2037–44.
Cambou MC, Perez-Brumer AG, Segura ER, Salvatierra HJ, Lama JR, Sanchez J, et al. The risk of stable partnerships: associations between partnership characteristics and unprotected anal intercourse among men who have sex with men and transgender women recently diagnosed with HIV and/or STI in Lima, Peru. PLoS ONE. 2014;9(7):e102894.
Goodreau SM, Carnegie NB, Vittinghoff E, Lama JR, Sanchez J, Grinsztejn B, et al. What drives the US and Peruvian HIV epidemics in men who have sex with men (MSM)? PLoS ONE. 2012;7(11):e50522.
Morris M, Kretzschmar M. Concurrent partnerships and the spread of HIV. AIDS. 1997;11(5):641–8.
Chen MI, Ghani AC, Edmunds J. Mind the gap: the role of time between sex with two consecutive partners on the transmission dynamics of gonorrhea. Sex Transm Dis. 2008;35(5):435–44.
Kraut-Becher JR, Aral SO. Gap length: an important factor in sexually transmitted disease transmission. Sex Transm Dis. 2003;30(3):221–5.
Clark JL, Perez-Brumer AG, Reisner SL, Salazar X, McLean S, Huerta L, et al. Social network organization, structure, and patterns of influence within a community of transgender women in Lima, Peru: implications for biomedical HIV prevention. AIDS Behav. 2020;24(1):233–45.
We would like to thank the study participants for devoting their time and experiences to this project. We would also like to thank the research staff for their efforts to make this study possible.
The US National Institute of Health (NIH) provided funding for this work through Grants NIH R25 MH087222 (South American Program in HIV Prevention Research; PI: J. Clark) and NIH R34 MH105272 to J. Clark.
Conflict of interest
The authors have no relevant financial or non-financial interests to disclose.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the the Institutional Review Board at the University of California, Los Angeles and the Ethics Committee of Asociación Civil Vía Libre as well as the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The parent study was registered with ClinicalTrials.gov (Identifier: NCT03010020).
Informed consent was obtained from all individual participants included in the study.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
About this article
Cite this article
Ayer, A., Perez-Brumer, A., Segura, E.R. et al. Let’s Talk About Sex: The Impact of Partnership Contexts on Communication About HIV Serostatus and Condom Use Among Men Who Have Sex with Men (MSM) and Transgender Women (TW) in Lima, Peru. AIDS Behav 25, 2139–2153 (2021). https://doi.org/10.1007/s10461-020-03144-1
- HIV serostatus communication
- Condom negotiation
- Men who have sex with men
- Transgender women