title: Human immunodeficiency virus, sexually transmitted infections, and risk behaviors among clients of sex workers in Guatemala: are they a bridge in human immunodeficiency virus transmission?
abstract: OBJECTIVE
  Clients of female sex workers (FSWs) are an important target group for human immunodeficiency virus/sexually transmitted infection (HIV/STI) prevention. This study aimed to estimate their HIV and other STI prevalence, examine their risk behaviors, and evaluate their role as a bridge population in the spread of HIV/STIs.
  
  
  METHODS
  A cross-sectional study was performed among 553 clients recruited in commercial sex sites in the province of Escuintla, Guatemala. They were interviewed and tested for HIV and other STIs.
  
  
  RESULTS
  Half of the clients who were approached refused participation. Median age was 28.9 years; 57.7% had a regular partner, of whom, 10.1% had concurrent noncommercial partnerships. Consistent condom use with FSWs and regular partners was 72.5% and 17.1%, respectively. Approximately 18% formed a bridge, and 40.0% a potential bridge. Among those who provided samples (70.5% provided a blood sample and 89.7%, urine sample), prevalence of HIV, syphilis, gonorrhea, chlamydia, and herpes simplex virus 2 was 1.5%, 1.0%, 0.8%, 5.5%, and 3.4%, respectively. Unprotected sex with FSWs and drug use just before sex were risk factors for having any STI (9.8% of participants). Bridge clients were significantly less educated, more employed, paid lower prices to the FSW just visited, and had a previous STI.
  
  
  CONCLUSIONS
  There is a relatively high prevalence of HIV in clients compared to national estimates, and a substantial proportion of them act as a bridge for HIV/STI transmission between FSWs and the general population in Escuintla. Given that this is fuelling the current HIV epidemic, preventive interventions addressing this hard-to-reach group are urgently required.
authors.affiliation: Department of Research and Epidemiology, Fundació Sida i Societat, Barcelona, Catalonia, Spain. msabido@sidaisocietat.org
authors.forename: Meritxell
authors.initials: M
authors.lastname: Sabidó
authors.forename: Maria
authors.initials: M
authors.lastname: Lahuerta
authors.forename: Alexandra
authors.initials: A
authors.lastname: Montoliu
authors.forename: Victoria
authors.initials: V
authors.lastname: Gonzalez
authors.forename: Gabriela
authors.initials: G
authors.lastname: Hernández
authors.forename: Federica
authors.initials: F
authors.lastname: Giardina
authors.forename: José Ernesto
authors.initials: JE
authors.lastname: Monzón
authors.forename: Maria Isabel
authors.initials: MI
authors.lastname: Pedroza
authors.forename: Jordi
authors.initials: J
authors.lastname: Casabona
mesh_terms: D000328:Adult; D017280:Condoms / Q000706:statistics & numerical data; D003430:Cross-Sectional Studies; D006166:Guatemala / Q000453:epidemiology; D006678:HIV; D015658:HIV Infections / Q000453:epidemiology* / Q000517:prevention & control / Q000635:transmission*; D006801:Humans; D008297:Male; D012307:Risk Factors; D011477:Sex Work / Q000706:statistics & numerical data; D060386:Sex Workers; D012749:Sexually Transmitted Diseases / Q000453:epidemiology* / Q000517:prevention & control* / Q000635:transmission*; D019966:Substance-Related Disorders; D047568:Unsafe Sex / Q000706:statistics & numerical data; D055815:Young Adult