Attitudes towards HIV/STI prevention, diagnosis and treatment among male clients of female sex workers in Escuintla, Guatemala
M. Lahuerta1,2, M. Torrens1, M. Sabidó1,3, I. Pedroza4, E. Cabrera5, V.H. Fernández5, J. Casabona1,3,6
1Fundació Sida i Societat, Barcelona, Spain, 2Columbia University, International Center for AIDS Care and Treatment Programs, New York, United States, 3CIBER Epidemiología y Salud Pública, Ciberesp, Spain, 4Escuintla Health Center, Escuintla, Guatemala, 5Fundació Sida i Societat, Escuintla, Guatemala, 6Centre for Epidemiological Studies on HIV/AIDS and STI of Catalonia (CEEISCAT), Institut Catala d'Oncologia/Health Department, Generalitat de Catalunya, Badalona, Spain
Background: Clients of female sex workers (FSW) play a critical role in the decision-making to prevent HIV and sexually transmitted infections (STI), although most interventions in Central America have mainly targeted FSW. Our aim was to explore attitudes of clients of FSW towards HIV/STI prevention, diagnosis and treatment in Escuintla, Guatemala.
Methods: Semi-structured interviews were conducted with clients of FSW on attitudes towards prevention of HIV/STIs, barriers to condom use and behavior towards HIV/STI treatment. Gender issues and socioeconomic factors that could influence their sexual behavior were also evaluated.
Results: Between September-November 2008, 30 clients of FSW were interviewed (11 (37%) recruited at sex establishments, 7(23%) at show bars and 12(40%) in public places were commercial sex took place).
Despite high knowledge of condoms as an HIV/STI preventive measure, the decision to use them was often based on the client moral judgment of the woman´s sexual conduct (distinguishing between “house women” versus “street women”). Regular clients reported lower condom use. Interestingly, the periodical medical checks that FSW are required to take gave clients a sense of protection towards infections. In terms of HIV/STI testing and treatment, most preferred private clinics to increase confidentiality, but ended up self-medicating for lack of money and to avoid embarrassment. Most were reluctant to take the HIV test for fear of a positive result and those already HIV-positive hided their status to avoid stigmatization.
Conclusions: The socio-cultural context regarding sexuality and gender is a clear obstacle for the prevention, diagnosis and treatment of HIV/STIs in Guatemala. A multilevel intervention (UALE Project) has proven to be effective with FSW in this setting, but according to our results new approaches are needed to reach male clients. Outreach programs offering HIV counseling and testing could increase test uptake, health-seeking behaviour and care and eventually reduce transmissions to the general population.
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