title: Unsafe sexual behaviors among HIV-positive men and women in Honduras: the role of discrimination, condom access, and gender.
abstract: BACKGROUND
  We conducted a study among HIV-positive men and women in Honduras to describe demographics, HIV risk behaviors and sexually transmitted infection prevalence, and identify correlates of unsafe sex.
  
  
  METHODS
  Participants were recruited from HIV clinics and nongovernmental organizations in Tegucigalpa and San Pedro Sula, Honduras in a cross-sectional study in 2006. We used audio-assisted computer interviews on demographics; behaviors in the past 12 months, 6 months, and 30 days; and access to care. Assays performed included herpes (HSV-2 Herpes Select), syphilis (rapid plasma reagin [RPR] and Treponema pallidum particle agglutination assay [TPPA]) serology, and other sexually transmitted infections by polymerase chain reaction (PCR). Bivariate and multivariate analyses were conducted to assess variables associated with unprotected sex across all partner types in the past 12 months.
  
  
  RESULTS
  Of 810 participants, 400 were from Tegucigalpa and 410 from San Pedro Sula; 367 (45%) were men. Mean age was 37 years (interquartile range: 31-43). Consistent condom use for men and women was below 60% for all partner types. In multivariate analysis, unprotected sex was more likely among women (odds ratio [OR]: 1.9, 95% confidence interval [CI]: 1.2-3.1, P = 0.007), those with HIV diagnoses within the past year (OR: 2.0, 95% CI: 1.1-3.7, P = 0.016), those reporting difficulty accessing condoms (OR: 2.6, 95% CI: 1.4-4.7, P = 0.003), and those reporting discrimination (OR: 1.8, 95% CI: 1.1-3.0, P = 0.016).
  
  
  CONCLUSIONS
  Programs targeting HIV-positive patients need to address gender-based disparities, improve condom access and use, and help establish a protective legal and policy environment free of stigma and discrimination.
authors.affiliation: Center for Health Studies, Del Valle University, Guatemala City, Guatemala. gmb5@cdc.gov
authors.forename: Gabriela
authors.initials: G
authors.lastname: Paz-Bailey
authors.forename: Virginia
authors.initials: V
authors.lastname: Isern Fernandez
authors.forename: Sonia
authors.initials: S
authors.lastname: Morales Miranda
authors.forename: Jerry O
authors.initials: JO
authors.lastname: Jacobson
authors.forename: Suyapa
authors.initials: S
authors.lastname: Mendoza
authors.forename: Mayte A
authors.initials: MA
authors.lastname: Paredes
authors.forename: Damien C
authors.initials: DC
authors.lastname: Danaval
authors.forename: David
authors.initials: D
authors.lastname: Mabey
authors.forename: Edgar
authors.initials: E
authors.lastname: Monterroso
mesh_terms: D000293:Adolescent; D000328:Adult; D017280:Condoms / Q000600:supply & distribution*; D003430:Cross-Sectional Studies; D003625:Data Collection; D003710:Demography; D005260:Female; D015658:HIV Infections / Q000453:epidemiology / Q000517:prevention & control* / Q000635:transmission; D006679:HIV Seropositivity; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006721:Honduras / Q000453:epidemiology; D006801:Humans; D008297:Male; D011287:Prejudice; D015995:Prevalence; D012309:Risk-Taking; D057566:Self Report; D012737:Sex Factors; D012725:Sexual Behavior / Q000706:statistics & numerical data*; D012749:Sexually Transmitted Diseases / Q000453:epidemiology / Q000517:prevention & control* / Q000635:transmission; D055815:Young Adult