title: Is the HIV epidemic stable among MSM in Mexico? HIV prevalence and risk behavior results from a nationally representative survey among men who have sex with men.
abstract: BACKGROUND
  Recent evidence points to the apparent increase of HIV prevalence among men who have sex with men (MSM) in different settings with concentrated epidemics, including the Latin American region. In 2011, Mexico implemented an ambitious HIV prevention program in all major cities, funded by the Global Fund to Fight Aids, Tuberculosis and Malaria. The program was intended to strengthen the prevention response for the most at risk populations: MSM and injecting drug users. This paper presents the HIV prevalence results of a nationally representative baseline survey in 24 Mexican cities throughout the 5 regions in the country and reports the socio-demographic and sexual risk behaviors that predict the probability of infection.
  
  
  METHODS
  The survey was implemented in two phases. We first identified and characterized places where MSM gather in each city and then conducted in a second phase, a seroprevalence survey that included rapid HIV testing and a self-administered questionnaire. The prevalence of HIV was estimated by adjusting for positive predicted value. We applied a probit model to estimate the probability of having a positive result from the HIV test as a function of socio-demographic characteristics and self-reported sexual risk behaviors.
  
  
  RESULTS
  We found an overall HIV prevalence among MSM gathering in meeting points of 16.9% [95% CI: 15.6-18.3], significantly higher than previously reported estimates. Our regression results suggest that the risk of infection increases with age, with the number of sexual partners, and among those who play a receptive sexual role, and the risk decreases with higher education.
  
  
  CONCLUSIONS
  Our findings suggest a higher HIV prevalence among MSM than previously acknowledged and that a significant regional variability exist throughout the country. These two findings combined, signal an important dynamic in the epidemic that should be better understood and promptly addressed with strong prevention efforts targeted at key populations.
authors.affiliation: National Institute of Public Health (INSP), Cuernavaca, Mexico.
authors.forename: Sergio
authors.initials: S
authors.lastname: Bautista-Arredondo
authors.forename: M Arantxa
authors.initials: MA
authors.lastname: Colchero
authors.forename: Martín
authors.initials: M
authors.lastname: Romero
authors.forename: Carlos J
authors.initials: CJ
authors.lastname: Conde-Glez
authors.forename: Sandra G
authors.initials: SG
authors.lastname: Sosa-Rubí
mesh_terms: D000328:Adult; D016000:Cluster Analysis; D058872:Epidemics; D062665:Epidemiological Monitoring; D015658:HIV Infections / Q000453:epidemiology* / Q000517:prevention & control; D015528:HIV Seroprevalence; D018451:Homosexuality, Male; D006801:Humans; D008297:Male; D008800:Mexico / Q000453:epidemiology; D015995:Prevalence; D012309:Risk-Taking; D021841:Safe Sex; D012680:Sensitivity and Specificity; D014505:Urban Population
references.citation: Eur J Health Econ. 2014 Jan;15(1):41-55
references.pmid: 23377757
references.citation: Curr Opin HIV AIDS. 2009 Jul;4(4):300-7
references.pmid: 19532068
references.citation: PLoS One. 2011;6(5):e20272
references.pmid: 21637802
references.citation: AIDS. 2003 Apr 11;17(6):895-903
references.pmid: 12660537
references.citation: BMC Infect Dis. 2009 Feb 18;9:19
references.pmid: 19226452
references.citation: Am Econ Rev. 2008 Dec 1;98(5):1829-1863
references.pmid: 21687831
references.citation: N Engl J Med. 2011 Aug 11;365(6):493-505
references.pmid: 21767103
references.citation: Salud Publica Mex. 2008;50 Suppl 4:S437-44
references.pmid: 19082254
references.citation: Salud Publica Mex. 2012 Oct;54(5):506-14
references.pmid: 23011502
references.citation: PLoS Med. 2007 Dec;4(12):e339
references.pmid: 18052602
references.citation: Health Educ Behav. 2009 Feb;36(1):182-94
references.pmid: 19188372
references.citation: Clin Vaccine Immunol. 2011 Sep;18(9):1480-5
references.pmid: 21752945
references.citation: J Acquir Immune Defic Syndr. 2008 Sep 1;49 Suppl 1:S52-8
references.pmid: 18724191