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.