Coverage of HIV prevention components among people with long-standing diagnosed HIV infection in El Salvador.
BACKGROUND
There is scarce information on prevention coverage and management of sexually transmitted infections (STIs) in people with HIV in resource-limited settings.


METHODS
Six hundred eighty nine sexually active people diagnosed with HIV ≥12 months before the study, including 110 men who have sex with men, 237 heterosexual men, and 342 women, were recruited from HIV support groups and hospitals in El Salvador and completed self-administered computer-assisted questionnaires and STI testing. Logistic models identified correlates of exposure to posttest counseling (POC) and subsequent prevention interventions (PIs).


RESULTS
Past-year transmission risk factors included unprotected sex with noncommercial partners (28.7%), having multiple sex partners (76.4%), a casual sex partner (31.4%), selling (3.5%) and purchasing sex (6.4%), herpes simplex virus type 2 (86.3%), and treatable STIs (18.6%). Men who have sex with men reported more recent casual partners, sex work, and alcohol and drug use than other subgroups. POC (22.8%), PIs (31.3%), and access to advice and information regarding HIV at the point of HIV care (24.1%) were limited. Of subjects with past-year STI symptoms (N = 267), 44.1% had sought medical attention. In multivariate analysis, POC was negatively associated with multiple partners. PI was associated with self-initiated testing, treatable STIs, and female sex. Both outcomes were associated with HIV-related discrimination outside of the health services context.


CONCLUSIONS
Coverage of POC, PIs, and treatment-seeking for STI symptoms was low among individuals with diagnosed HIV infection, although most were in regular contact with care and treatment. Prevention programs at testing and treatment sites should be intensified and should incorporate risk behavior screening to improve targeting.
Cra 8A N96-51, Bogota, Colombia. jerryojacobson@gmail.com
Jerry O
JO
Jacobson
Jacob
J
Creswell
Maria Elena
ME
Guardado
Janet C
JC
Lee
Ana
A
Isabel Nieto
Gabriela
G
Paz-Bailey
D000293:Adolescent; D000328:Adult; D000368:Aged; D002690:Chlamydia Infections / Q000453:epidemiology / Q000517:prevention & control* / Q000635:transmission; D017280:Condoms / Q000706:statistics & numerical data*; D004544:El Salvador / Q000453:epidemiology; D005260:Female; D006069:Gonorrhea / Q000453:epidemiology / Q000517:prevention & control* / Q000635:transmission; D006679:HIV Seropositivity / Q000453:epidemiology / Q000635:transmission; D007722:Health Knowledge, Attitudes, Practice; D054625:Healthcare Disparities; D018451:Homosexuality, Male / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance; D040242:Risk Reduction Behavior; D012725:Sexual Behavior / Q000706:statistics & numerical data*; D012747:Sexual Partners; D019966:Substance-Related Disorders / Q000453:epidemiology; D011795:Surveys and Questionnaires; D013997:Time Factors; D055815:Young Adult