Risk Behaviors and STI Prevalence Among People with HIV in El Salvador



G Paz-Bailey*, 1, 2, 3, N Shah3, J Creswell1, 2, ME Guardado1, AI Nieto4, MC Estrada5, R Cedillos6, JM Pascale7, E Monterroso3
1 Training Programs in Epidemiology and Public Health Interventions Network (TEPHINET) Central American office, Guatemala City, Guatemala
2 Centre for Health Studies, Del Valle University, Guatemala City, Guatemala
3 Centers for Disease Control and Prevention, Atlanta, GA, USA
4 Ministry of Health, San Salvador, El Salvador
5 United States Agency for International Development, San Salvador, El Salvador
6 Hospital Rosales, San Salvador, El Salvador
7 Gorgas Memorial Institute for Health Studies, Panama City, Panama


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© Paz-Bailey et al.; Licensee Bentham Open.

open-access license: This is an open access article licensed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.

* Address correspondence to this author at the 1600 Clifton Road, Atlanta Georgia 303333 MS E-46, USA; Tel: +1 4046394451; Fax: +4046398640; E-mail: gmb5@cdc.gov


Abstract

To date, there are no studies from El Salvador among people with HIV to inform prevention programs. We conducted a study in El Salvador in 2008 among people with HIV using audio computer-assisted interviews on risk behaviors and access to health care. Blood was tested for syphilis and herpes simplex type 2 (HSV-2). Active syphilis was defined as RPR titer ≥1:8. Genital specimens were tested for other sexually transmitted infections (STI) by PCR. We evaluated factors associated with unprotected sex with last stable partner of HIV-negative or unknown status among those reporting a stable partner. A total of 811 HIV-positive individuals participated: 413 men and 398 women. Prevalence of Chlamydia and gonorrhea was low (≤1%), while prevalence of other STI was high: Mycoplasma genitalium (14%), syphilis (15% seropositivity, active syphilis 3%) and HSV-2 (85%). In multivariate analysis, disclosing HIV status to partner (OR 0.2, 95% CI: 0.1-0.3, p<0.001), participation in HIV support groups (OR 0.3, 95% CI: 0.1-0.8, p=0.01), easy access to condoms (OR 0.4, 95% CI: 0.2-0.9, p=0.04) were protective factors for unprotected sex. Reporting a casual partner in the last 12 months (OR 3.6, 95% CI: 1.5-8.5, p=0.004). and having an STI (OR 2.6, 95% CI:1.3-5.5, p=0.02) were associated with an increased odds of unprotected sex. Prevention interventions among HIV-positives in El Salvador should focus on increasing condom access, promoting HIV disclosure and couples testing and reducing the number of partners. The positive role of support groups should be used to enhance behavioral change.

Keywords:: El Salvador, HIV, AIDS, Prevention, People living with HIV, Condoms, Sexually transmitted infections..