Mixed-methods exploration of fear as a multi-level barrier to voluntary partner notification among men who have sex with men (MSM) recently diagnosed with HIV/STI in lima, Peru (2011)

BACKGROUND: Partner management strategies in Peru depend on first-party notification following HIV/STI diagnosis. We explored the relationship between “fear” and anticipated HIV/STI disclosure among recently diagnosed MSM in low-income, urban Peru. METHODS: Through behavioral surveys and in-depth interviews, we assessed anticipated partner notification among MSM diagnosed with HIV/STIs in the past month. A subset of participants (n=30) were selected for semi-structured interviews. Quantitative and qualitative analysis assessed different types of “Fear”, and differentiated between individual- and partner-level factors. RESULTS: Study participants (n=396) reported 1069 sex partnerships in 6 months and 46.3% did not anticipate notifying a recent partnership. In 46.0% of partnerships, “Fear” was reported as a reason for non-disclosure. Specific pathways included partner-level factors like fear of rejection (27.3%), fear of violence (24.1%), and social-level factors like fear of community awareness of their diagnosis (21.1%). Among participants (n=207) who cited fear as a barrier to notifying one or more partners, 70.9% cited partner-level factors and 42.8% cited social-level factors. Interviews also suggested that fear functioned as a barrier on multiple levels. Interpersonal barriers included fear of rejection or violence from recent partners and social barriers included anticipated violence, discrimination or rejection by peers and community members. CONCLUSIONS: Anticipated negative sentiments on both partnership and societal levels influenced willingness of Peruvian MSM to notify their recent sex partners of recent HIV/STI diagnosis. Further research is needed to explore the multiple pathways in which fear may influence partner notification to inform future interventions to control secondary HIV/STI transmission.