HIV, STD and risk behaviors among female sex worker in El Salvador
J. Creswell1, M.E. Guardado Escobar2, J. Armero3, G. Paz-Bailey1,4
1Universidad del Valle de Guatemala, Guatemala, Guatemala, 2Tephinet, El Salvador, El Salvador, 3Ministerio de Salud de El Salvador, San Salvador, El Salvador, 4Tephinet, Guatemala, Guatemala
Background: A behavioral surveillance survey done in 2002 in El Salvador, surveyed a convenience sample of female sex workers (FSW). It reported an HIV prevalence of 3.2%. We present findings from the second behavioral surveillance survey done in 2008 using different sample methodology.
We used audio computer assisted interviews to survey FSW participants in San Salvador. Respondent Driven Sampling (RDS) was used to recruit participants. The target sample size was 600 FSW. Blood was tested for HIV (Determine and Oraquick), syphilis (Rapid Plasma Reagin and Treponema Pallidum Aglutination Particles) and herpes serology (HSV-2 Herpes Select). Data collection was conducted from March through September 2008. The BED IgG capture-ezyme immunoassay was used among HIV positive specimens to distinguish recent HIV infections (infection ≤6 months). Annualized HIV incidence rates and 95% confidence intervals were calculated, assuming a window period for the assay of 155 days, and was corrected for assay misclassification using a local correction factor for derived assay misclassification from this study.
Results: We enrolled a total of 663 FSW participants. The HIV prevalence was 5.7% (95% CI: 3.5-7.9) and estimated annual incidence per 100 people was 0% 95% IC (0, 2.2). Active syphilis prevalence was 2.7% (95% CI: 1.3-4.3). HSV-2 sero-prevalence was 82.6% (95% CI: 78.6-86.3). Reported condom use by FSW during the last sexual encounter was 74.5% (95% CI: 69.8 -78.7) while 91.0% (95% CI: 87.2-94.2) reported using a condom with the last frequent client and 89.9% (95% CI: 86.5-93.2) with the last new client.
Conclusions: This is the first survey using RDS and ACASI in El Salvador. HIV prevalence was moderate. We found high rates of HSV-2 seropositivity and active syphilis, this may increase the vulnerability of this population to HIV in the future. New intervention strategies should include condom promotion programs.
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