Re to do so and I felt ashamed… and I never saw him again. [Later] I even became [the] active [partner]… because I didn’t want them touching my backside. (Gay man) Although most participants in discussion groups initially said they had never seen GW, some recognized them after seeing thePLOS ONE | www.plosone.orgHPV and Genital Warts in Peruvian MSM: Experiencesimages of GW presented in the study. Upon viewing the GW images, many participants visibly reacted (e.g. expressing repulsion): Right now that I see them [pictures of GW] on the screen, the truth is that I feel somewhat bad, um… a bit uncomfortable. The truth is, looking at the picture, I feel a bit tense. (Gay man) The pictures that were there were nasty [laughs]! Ick! Disgusting! Those [GW] look really nasty in those photos, I’ve never had that. (Man not identifying as ‘gay’ who reported having sex with men) The transgendered participants were less uncomfortable and notably most familiar with GW; they even referred to them using nicknames such as “grapes”, “earrings”, or “gizzards”: As a transgendered, usually the top guys pick me up… but when I was [sexually] versatile I saw the real “grape harvest” that they had there, the real “grapes”. (LY317615 supplier Transgender sex worker) Those [GW] are the “little earrings” they have. (Focus group with transgender sex workers) Among most transgendered people GW were seen as bothersome and a source of mockery, but for other groups GW were not a theme of conversation among peers, couples, or clients. Some participants reported that they had seen GW in their sexual partners, and mentioned having experienced astonishment and repulsion, Vasoactive Intestinal Peptide (human, rat, mouse, rabbit, canine, porcine) cost embarrassing situations, distrust and fear of becoming infected. In these cases, sex was frequently interrupted: I have seen it [GW] on some occasional partners… I’ve seen that they are like little warts in the anus; and I said: “I’m not getting close to that.” (Focus group with gay men) I was groping around and there was a wart and… I felt something ugly like a think mole, a meaty, raised mole… I lost all interest… it grossed me out. (Focus group with gay sex workers) A guy told me that he saw some little bumps in a queers ass and didn’t want to penetrate him and only let him give oral sex. He told me that he was disgusted but didn’t do anything with the other guy’s ass. (Man not identifying as ‘gay’ who reported having sex with men) People with GW tried to conceal them (e.g. by having sex in darkness) due to shame or denied having GW or justified their presence by saying they were “hemorrhoids”, “moles”, “scars” or “burns”: [A client] turned the lights off on me. I suspected that something wasn’t right, so I turned on the light and he… had removed the condom… I carefully checked him out and I saw a fleshy white growth… I didn’t know if it was papilloma… I asked him, “What do you have there?” “Nothing,” he said, “it is a burn” “That’s not a burn,” I said, “A burn doesn’t get like that.” immediately kicked him out. (Transgender sex worker)Management of genital wartsSelf-management of GW as an alternative to medical intervention was reported. Some transgendered participants discussed selfmanagement procedures aimed to excise GW by using “razor blades”, “scissors”, “pubic hairs” (to make “noose” around the GW and cut them) and “hands”: [One GW] moved like a little worm. I think [a friend] cut it off using his hand… (Another FG participant) Same here, I cut it.Re to do so and I felt ashamed… and I never saw him again. [Later] I even became [the] active [partner]… because I didn’t want them touching my backside. (Gay man) Although most participants in discussion groups initially said they had never seen GW, some recognized them after seeing thePLOS ONE | www.plosone.orgHPV and Genital Warts in Peruvian MSM: Experiencesimages of GW presented in the study. Upon viewing the GW images, many participants visibly reacted (e.g. expressing repulsion): Right now that I see them [pictures of GW] on the screen, the truth is that I feel somewhat bad, um… a bit uncomfortable. The truth is, looking at the picture, I feel a bit tense. (Gay man) The pictures that were there were nasty [laughs]! Ick! Disgusting! Those [GW] look really nasty in those photos, I’ve never had that. (Man not identifying as ‘gay’ who reported having sex with men) The transgendered participants were less uncomfortable and notably most familiar with GW; they even referred to them using nicknames such as “grapes”, “earrings”, or “gizzards”: As a transgendered, usually the top guys pick me up… but when I was [sexually] versatile I saw the real “grape harvest” that they had there, the real “grapes”. (Transgender sex worker) Those [GW] are the “little earrings” they have. (Focus group with transgender sex workers) Among most transgendered people GW were seen as bothersome and a source of mockery, but for other groups GW were not a theme of conversation among peers, couples, or clients. Some participants reported that they had seen GW in their sexual partners, and mentioned having experienced astonishment and repulsion, embarrassing situations, distrust and fear of becoming infected. In these cases, sex was frequently interrupted: I have seen it [GW] on some occasional partners… I’ve seen that they are like little warts in the anus; and I said: “I’m not getting close to that.” (Focus group with gay men) I was groping around and there was a wart and… I felt something ugly like a think mole, a meaty, raised mole… I lost all interest… it grossed me out. (Focus group with gay sex workers) A guy told me that he saw some little bumps in a queers ass and didn’t want to penetrate him and only let him give oral sex. He told me that he was disgusted but didn’t do anything with the other guy’s ass. (Man not identifying as ‘gay’ who reported having sex with men) People with GW tried to conceal them (e.g. by having sex in darkness) due to shame or denied having GW or justified their presence by saying they were “hemorrhoids”, “moles”, “scars” or “burns”: [A client] turned the lights off on me. I suspected that something wasn’t right, so I turned on the light and he… had removed the condom… I carefully checked him out and I saw a fleshy white growth… I didn’t know if it was papilloma… I asked him, “What do you have there?” “Nothing,” he said, “it is a burn” “That’s not a burn,” I said, “A burn doesn’t get like that.” immediately kicked him out. (Transgender sex worker)Management of genital wartsSelf-management of GW as an alternative to medical intervention was reported. Some transgendered participants discussed selfmanagement procedures aimed to excise GW by using “razor blades”, “scissors”, “pubic hairs” (to make “noose” around the GW and cut them) and “hands”: [One GW] moved like a little worm. I think [a friend] cut it off using his hand… (Another FG participant) Same here, I cut it.
