Recorded elsewhere, as this would have provided identifiable data of participants. Once the Investigator and participant reviewed the verbal consent, and all participant questions and doubts were addressed, the investigator signed the consent form in the presence of the participant. A copy of the verbal consent was provided to the participant. The verbal consent procedure was approved by the ethics committee on February 9, 2011 prior to any participant contact.Data AnalysisFocus groups and interviews were audio recorded and transcribed order Pyrvinium embonate verbatim. A Peruvian anthropologist experienced in sexuality and STI research (CRN) applied systematic comparative and descriptive content analysis that consisted of grouping and coding the information in thematic categories, and identifying recurring issues and differences in the narratives. A second reviewer (JG) Pyrvinium pamoate supplier confirmed the analysis and discrepancies were resolved. Representative quotes were extracted and translated into English.Results DemographicsWe recruited 36 participants comprised of three focus groups (of 6? participants in each sub-group) and 15 in-depth interviews. The mean participant age was 26 (range 18?0). We did not ask participants if they personally had GW; nevertheless, 4/15 of the in-depth interview participants spontaneously reported having HPV, and the results presented on personal experiences of having GW are based on the information provided by these subjects.Focus Groups and In-depth InterviewsThree main themes emerged across the focus group and indepth interviews: 1) Knowledge of HPV and genital warts; 2) Genital wart-related attitudes and experiences; and 3) Management of genital warts. Each theme is presented below with representative quotes.PLOS ONE | www.plosone.orgHPV and Genital Warts in Peruvian MSM: ExperiencesKnowledge of HPV and genital wartsUnfamiliarity with HPV was common though a few participants recognized that HPV affects both men and women or linked GW to HPV. Some participants had heard of the term “papilloma”, a few reported that HPV was a transmissible and incurable infection, and others had little knowledge of HPV and associated it with women’s health problems: What I’ve heard [about papilloma] had to do with a case that happened to a female Brazilian model whose entire [sex] organ was infected and there were complications; that was the case that surprised me and was how I came to know about the issue. (man not identifying as ‘gay’ who reported having sex with men) [It is] a virus that has no cure, it is an illness… that has no remedy, treatment, right? I think that it appears through outbreaks on the hands, like blisters. (Gay sex worker) I have a cousin that is with papilloma… it is like little bumps that grow… she does not know if it is cancer or papilloma, but they ended up operating on her due to the outbreak… they say it has no cure. (Focus group with gay sex workers) In contrast, GW were familiar to most participants. Some had seen GW at least once on their sexual partners or clients, while others heard comments about people who had GW: I have a close friend who this happened to. I believe that they are like warts? Small, skin fragments that stick out. Something like that. (Focus group with gay men) However, many confused GW with visible or ulcerative STIs, “pimples”, “scars”, “wounds”, and other health problems affecting the anogenital zone, particularly “hemorrhoids”: When I penetrated a guy he had them, but they were small… o.Recorded elsewhere, as this would have provided identifiable data of participants. Once the Investigator and participant reviewed the verbal consent, and all participant questions and doubts were addressed, the investigator signed the consent form in the presence of the participant. A copy of the verbal consent was provided to the participant. The verbal consent procedure was approved by the ethics committee on February 9, 2011 prior to any participant contact.Data AnalysisFocus groups and interviews were audio recorded and transcribed verbatim. A Peruvian anthropologist experienced in sexuality and STI research (CRN) applied systematic comparative and descriptive content analysis that consisted of grouping and coding the information in thematic categories, and identifying recurring issues and differences in the narratives. A second reviewer (JG) confirmed the analysis and discrepancies were resolved. Representative quotes were extracted and translated into English.Results DemographicsWe recruited 36 participants comprised of three focus groups (of 6? participants in each sub-group) and 15 in-depth interviews. The mean participant age was 26 (range 18?0). We did not ask participants if they personally had GW; nevertheless, 4/15 of the in-depth interview participants spontaneously reported having HPV, and the results presented on personal experiences of having GW are based on the information provided by these subjects.Focus Groups and In-depth InterviewsThree main themes emerged across the focus group and indepth interviews: 1) Knowledge of HPV and genital warts; 2) Genital wart-related attitudes and experiences; and 3) Management of genital warts. Each theme is presented below with representative quotes.PLOS ONE | www.plosone.orgHPV and Genital Warts in Peruvian MSM: ExperiencesKnowledge of HPV and genital wartsUnfamiliarity with HPV was common though a few participants recognized that HPV affects both men and women or linked GW to HPV. Some participants had heard of the term “papilloma”, a few reported that HPV was a transmissible and incurable infection, and others had little knowledge of HPV and associated it with women’s health problems: What I’ve heard [about papilloma] had to do with a case that happened to a female Brazilian model whose entire [sex] organ was infected and there were complications; that was the case that surprised me and was how I came to know about the issue. (man not identifying as ‘gay’ who reported having sex with men) [It is] a virus that has no cure, it is an illness… that has no remedy, treatment, right? I think that it appears through outbreaks on the hands, like blisters. (Gay sex worker) I have a cousin that is with papilloma… it is like little bumps that grow… she does not know if it is cancer or papilloma, but they ended up operating on her due to the outbreak… they say it has no cure. (Focus group with gay sex workers) In contrast, GW were familiar to most participants. Some had seen GW at least once on their sexual partners or clients, while others heard comments about people who had GW: I have a close friend who this happened to. I believe that they are like warts? Small, skin fragments that stick out. Something like that. (Focus group with gay men) However, many confused GW with visible or ulcerative STIs, “pimples”, “scars”, “wounds”, and other health problems affecting the anogenital zone, particularly “hemorrhoids”: When I penetrated a guy he had them, but they were small… o.
