HIV and STI control in El Salvador: results from an integrated behavioural survey among men who have sex with men.
OBJECTIVE
This cross-sectional study investigates HIV, other sexually transmitted infections (STI), and risk behaviours among men who have sex with men (MSM) in two cities in El Salvador.


METHODS
Respondent-driven sampling (RDS) was used to recruit MSM in the cities of San Salvador and San Miguel, El Salvador. Participants responded to questions about HIV risk behaviours; and blood, urine and anal swabs were collected. Blood samples were tested for herpes simplex type 2, syphilis and HIV infection. Urine and anal samples were tested by polymerase chain reaction (PCR) for Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis, and Mycoplasma genitalium. HIV-positive samples were tested with the BED capture enzyme immunoassay to distinguish recent from longstanding HIV infection. We estimated population-adjusted prevalence of behavioural variables, STI and HIV, and identified risk factors for HIV.


RESULTS
The final sample included 596 and 195 MSM in San Salvador and San Miguel, respectively. Consistent condom use was low across all partner types as was recent HIV testing. RDS-adjusted HIV prevalence was 10.8% (95% CI 7.4% to 14.7%) in San Salvador, and 8.8% (95% CI 4.2% to 14.5%) in San Miguel. The proportion of recent testing among HIV-positive samples was 20%. Prevalence of any bacterial STI by PRC testing was 12.7% (95% CI 8.2% to 17.5%) in San Salvador, and 9.6% (95% CI 4.9% to 15.4%) in San Miguel.


CONCLUSIONS
We found a high prevalence of HIV, high levels of recent infection, and low condom usage. In El Salvador, targeted interventions towards MSM are needed to promote condom use, as well as to diagnose, treat and prevent HIV and other STIs.
Centro de Estudios en Salud, Universidad del Valle de Guatemala, Guatemala City, Guatemala.
Jacob
J
Creswell
Maria Elena
ME
Guardado
Janet
J
Lee
Ana Isabel
AI
Nieto
Andrea A
AA
Kim
Edgar
E
Monterroso
Gabriela
G
Paz-Bailey
D000293:Adolescent; D000328:Adult; D001003:Anal Canal / Q000382:microbiology / Q000469:parasitology; D001769:Blood / Q000382:microbiology / Q000821:virology; D003140:Communicable Disease Control / Q000379:methods; D004544:El Salvador / Q000453:epidemiology; D018451:Homosexuality, Male; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012309:Risk-Taking; D012749:Sexually Transmitted Diseases / Q000453:epidemiology* / Q000517:prevention & control; D011795:Surveys and Questionnaires; D014556:Urine / Q000382:microbiology / Q000469:parasitology; D055815:Young Adult