Bridging behaviors among men who have sex with men in San Salvador, El Salvador
E. Kim1, M.E. Guardado2, F. Hernandez2, N. Shah1, S. Cienfuegos2, J. Creswell2, A. Kim1, E. Monterroso1, G. Paz Bailey2
1Centers for Disease Control and Prevention, Atlanta, United States, 2Centers for Disease Control and Prevention, Regional Office for Central America and Panama, Guatemala City, Guatemala
Background: The HIV epidemic in El Salvador is concentrated in high risk populations including men who have sex with men (MSM). Little is known about the bridging role of MSM in transmitting HIV and sexually transmitted infections (STIs) to the general population. This study assessed bisexual behaviors and associated factors in this MSM population.
Methods: In 2008, men in San Salvador aged ≥18 years reporting sex with men in the last year were recruited using respondent driven sampling (RDS). Participants completed behavioral surveys and tested for HIV, syphilis, and herpes simplex virus (HSV-2); results were returned at follow-up visits. MSM bridging behavior was based on bisexual behavior and condom use with female partners. Frequencies and 95% confidence intervals (CI) were calculated using RDS Analysis Tool (RDSAT). Multivariate analysis was performed using individualized weights exported from RDSAT.
Results: Among 624 participants, 49.6% ever had sex with women, and 34.1% (n=183) had sex with women in the last year. Of these, 43.1% reported using condoms during last sex with a woman. HIV, syphilis, and HSV-2 prevalence was 10.8% (CI: 7.1, 15.3), 9.6% (CI: 5.7, 13.4) and 42.4% (CI: 35.0, 49.0), respectively. HIV prevalence was 8.0% (CI: 3.5, 14.4) among MSM with female partners in the last year and 13.5% (CI: 9.1, 19.3) among MSM with no female partners. After adjusting for age and education, HIV prevalence was positively associated with having an HIV infected partner [Adjusted Odds Ratio (AOR)=2.8, CI: 1.4, 5.6] and HSV-2 infection (AOR=3.5, CI: 1.7, 7.0) and inversely associated with ever having sex with women (AOR=0.5, CI: 0.2, 0.9).
Conclusions: Levels of inconsistent condom use with female partners and HIV/STI rates demonstrate a significant role MSM may have in disseminating HIV and other STIs to the general population.
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