TP 161 Factors Associated with HIV Among Men Who Have Sex with Men in 2 Cities in El Salvador: The Importance of Other STIs

Tuesday, June 10, 2014
Exhibit Hall
Cal Ham, MD, MPH1, Maria Guardado, MD2, Ana Nieto, MD, MPH3, Sanny Northbrook, PhD, MHS4 and Mary Kamb, MD, MPH1, 1Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA, 2Central America Technical Director, TEPHINET, Guatemala City, Guatemala, 3El Salvador National AIDS Program, El Salvador National AIDS Program, San Salvador, El Salvador, 4CDC Central America, CDC Central America, Guatemala City, Guatemala

Background:  In Central America, men who have sex with men (MSM) have the highest HIV prevalence of any high-risk population.    We sought to understand factors associated with HIV infection among MSM using results of the most recent behavioral and biologic survey conducted in El Salvador.

Methods:  We used 2008 data from the “Survey of Sexual Behavior and HIV/STI Prevalence among Vulnerable Populations” conducted in San Salvador and San Miguel. Investigators used respondent-driven sampling to recruit MSM, conducting interviews using audio computer-assisted self-interviews and collecting blood for HIV (EIA), genital herpes (HSV-2 EIA), and syphilis (RPR/TPPA) and urine for gonorrhea and chlamydia (NAATS).  We conducted univariate and multivariate analyses using crude data to identify factors associated with prevalent HIV infection. 

Results:  Among 710 MSM tested for HIV, 96 (13.5%) had positive tests.  HIV-infected men were young (47% <25 years), reported early sexual debut (mean=13.2 years), history of forced sex (43.9%), and selling sex for money (36.5% past year).  Compared to uninfected MSM, HIV-infected men had higher prevalence of laboratory-defined gonorrhea (11.0% vs. 3.3%; p=.009), syphilis (27.1% vs. 11.2%; p<.0001), and HSV-2 (80.2% vs. 42.1%; p<.0001), and similar chlamydia prevalence (5.5% vs. 5.6%; p=1.0).  HIV prevalence was higher in San Salvador than San Miguel (14.7% vs. 10.3%; p=.133); overall bacterial STI (gonorrhea, chlamydia, syphilis) prevalence was similar (17.0% vs. 16.0%, p=.751).  Adjusting for age, location, and age of sexual debut, HIV-infected men were more likely to have had forced sex (Adjusted Odds Ratio [AOR= 2.3; p=.007); a positive gonorrhea test (AOR = 3.7; p=.033); a positive HSV-2 serology (AOR= 4.3; p<.0001); and recent STI-related symptoms (AOR=1.8; p=.004).

Conclusions:  HIV-infection and STIs were common among MSM in San Salvador and San Miguel.  These results highlight the importance of targeted efforts among both HIV-infected and uninfected MSM to reduce risk for HIV acquisition and transmission.