Sonia Morales-Miranda

High Rates of STD and Sexual Risk Behaviors Among Garífunas in Honduras

Background: Honduras has the highest concentration of HIV and AIDS cases in Central America, with an estimated adult HIV prevalence of 1.5%. Prevalence is higher among certain ethnic groups such as the Garífuna with a reported HIV prevalence of 8%. Methods: A biological and behavioral survey was conducted on a stratified random sample of the Garífuna population in Honduras, using computer-assisted interviews. Blood was tested for HIV, herpes simplex type 2 (HSV-2), and syphilis; urine was tested for Chlamydia trachomatis, Neisseria gonorrhoea, Trichomonas vaginalis, and Mycoplasma genitalum. Results: We enrolled a total of 817 participants, 41% female and 51% male. Estimated prevalences and 95% confidence intervals (CI) were: HIV, 4.5% (95% CI: 3.0 to 6.6), HSV-2, 51.1% (95% CI: 46.7 to 55.6), and syphilis seropositivity, 2.4% (95% CI: 1.4 to 4.0). Sexually transmitted infections in urine were: chlamydia, 6.8% (95% CI: 4.7 to 9.7), gonorrhea, 1.1% (95% CI: 0.4 to 2.9), trichomoniasis, 10.5% (95% CI: 8.1 to 13.6), and Mycoplasma genitalium, 7.1% (95% CI: 5.1 to 9.9). Consistent condom use was low with stable (10.6%) and casual (41.4%) partners. In multivariate analysis, HIV was associated with rural residence. HSV-2 was associated with female sex, older age, and syphilis seropositivity. Conclusions: We found a moderate prevalence of HIV and a high prevalence of HSV-2 among the Garífunas. HSV-2 may increase the vulnerability of these populations to HIV in the future. Intervention strategies should emphasize sexually transmitted infection control and condom promotion, specifically targeting the Garífuna population.

High prevalence of Mycoplasma genitalium among female sex workers in Honduras: implications for the spread of HIV and other sexually transmitted infections.

This study describes HIV, sexually transmitted infections (STI) and risk factors associated with Mycoplasma genitalium among female sex workers (FSWs) in four cities in Honduras. In 2006, 795 FSWs from Tegucigalpa, San Pedro Sula, La Ceiba and Comayagua were recruited using respondent-driven sampling (RDS) and tested for HIV prevalence and STI. HIV prevalence ranged from no infections in Comayagua to 5.4% in Tegucigalpa. With the exception of Comayagua, more than 20% of FSWs were infected with M. genitalium. M. genitalium in the aggregated cities was associated with HIV positivity, being aged ≤30 years old, drinking alcohol more than once weekly and always using condoms with regular clients in the past month. In comparison with a 2001 surveillance study we found lower rates of HIV infection. Interventions for HIV control and prevention among FSWs, including promotion of condom use, are needed in Honduras.

A single early introduction of HIV-1 subtype B into Central America accounts for most current cases.

ABSTRACT Human immunodeficiency virus type 1 (HIV-1) variants show considerable geographical separation across the world, but there is limited information from Central America. We provide the first detailed investigation of the genetic diversity and molecular epidemiology of HIV-1 in six Central American countries. Phylogenetic analysis was performed on 625 HIV-1 pol gene sequences collected between 2002 and 2010 in Honduras, El Salvador, Nicaragua, Costa Rica, Panama, and Belize. Published sequences from neighboring countries (n = 57) and the rest of the world (n = 740) were included as controls. Maximum likelihood methods were used to explore phylogenetic relationships. Bayesian coalescence-based methods were used to time HIV-1 introductions. Nearly all (98.9%) Central American sequences were of subtype B. Phylogenetic analysis revealed that 437 (70%) sequences clustered within five significantly supported monophyletic clades formed essentially by Central American sequences. One clade contained 386 (62%) sequences from all six countries; the other four clades were smaller and more country specific, suggesting discrete subepidemics. The existence of one large well-supported Central American clade provides evidence that a single introduction of HIV-1 subtype B in Central America accounts for most current cases. An introduction during the early phase of the HIV-1 pandemic may explain its epidemiological success. Moreover, the smaller clades suggest a subsequent regional spread related to specific transmission networks within each country.

High HIV Burden in Men Who Have Sex with Men across Colombia’s Largest Cities: Findings from an Integrated Biological and Behavioral Surveillance Study

Background Among Latin America’s concentrated HIV epidemics, little is known about men who have sex with men (MSM) in Colombia, the region’s third largest country. To date, surveillance studies have been limited to Bogota, while 80% of HIV cases and deaths originate from Colombia’s other cities and departments. The extent to which interventions should prioritize MSM outside of Bogota is unknown. Methods We recruited 2603 MSM using respondent-driven sampling from seven of Colombia’s largest cities. HIV prevalence was estimated by site from dried blood spot samples. Behavioral data were collected through face-to-face interviews and risk factors for HIV infection analyzed using weighted, multi-level logistical regression models accounting for recruitment patterns. Results Across cities, HIV prevalence averaged 15%, varied from 6% to 24% and was highest in Cali, Bogota, and Barranquilla. In the past 12 months, 65% of MSM had ≥ 5 casual male partners and 23% had a female partner. Across partnerships (i.e., casual, stable, and commercial), the proportion of MSM engaging in unprotected sex was ≥ 52% with male partners and ≥ 66% with female partners. Self-reported history of STI (24%) and past-year illicit drug use (38%) were also common. In multivariate analysis, age ≥ 35 (adjusted odds ratio [AOR], 19.2) and 25–39 (AOR, 5.6) relative to ≤ 18–24 years, identifying as homosexual relative to heterosexual (AOR 0.1), meeting casual partners on the Internet (adjusted odds ratio [AOR], 3.1) and age of sexual debut of ≤ 13 years (AOR, 3.1) predicted HIV infection. HIV testing and prevention messaging reached just 24% of MSM in the past year. Conclusions Findings support consistently elevated HIV burden among MSM throughout Colombia’s largest cities and a need for enhanced behavioral prevention and HIV testing, emphasizing men who use the Internet as well as physical venues to meet sex partners.

Migration, violence, and safety among migrant sex workers: a qualitative study in two Guatemalan communities

Abstract Despite reports of high levels of violence among women migrants in Central America, limited evidence exists regarding the health and safety of migrant sex workers in Central America. This study is based on 16 months of field research (November 2012–February 2014), including ethnographic fieldwork, in-depth interviews, and focus groups conducted with 52 internal and international migrant female sex workers in Tecún Umán and Quetzaltenango, Guatemala, key transit and destination communities for both international and internal migrants. The analysis explored migration-related determinants of susceptibility to violence experienced by migrant sex workers across different phases of migration. Violence in home communities and economic considerations were key drivers of migration. Unsafe transit experiences (eg undocumented border crossings) and negative interactions with authorities in destination settings (eg extortion) contributed to migrant sex workers’ susceptibility to violence, while enhanced access to information on immigration policies and greater migration and sex work experience were found to enhance agency and resilience. Findings suggest the urgent need for actions that promote migrant sex workers’ safety in communities of origin, transit, and destination, and programmes aimed at preventing and addressing human rights violations within the context of migration and sex work.

Scale-Up, Retention and HIV/STI Prevalence Trends among Female Sex Workers Attending VICITS Clinics in Guatemala

Background Since 2007, Guatemala integrated STI clinical service with an HIV prevention model into four existing public health clinics to prevent HIV infection, known as the VICITS strategy. We present the first assessment of VICITS scale-up, retention, HIV and STI prevalence trends, and risk factors associated with HIV infection among Female Sex Workers (FSW) attending VICITS clinics in Guatemala. Methods Demographic, behavioral and clinical data were collected using a standardized form. Data was analyzed by year and health center. HIV and STI prevalence were estimated from routine visits. Retention was estimated as the percent of new users attending VICITS clinics who returned for at least one follow-up visit to any VICITS clinic within 12 months. Separate multivariate logistic regression models were conducted to investigate factors associated with HIV infection and program retention. Results During 2007–2011 5,682 FSW visited a VICITS clinic for the first-time. HIV prevalence varied from 0.4% to 5.8%, and chlamydia prevalence from 0% to 14.3%, across sites. Attending the Puerto Barrios clinic, having a current syphilis infection, working primarily on the street, and using the telephone or internet to contact clients were associated with HIV infection. The number of FSW accessing VICITS annually increased from 556 to 2,557 (361%) during the period. In 2011 retention varied across locations from 7.7% to 42.7%. Factors negatively impacting retention included current HIV diagnosis, having practiced sex work in another country, being born in Honduras, and attending Marco Antonio Foundation or Quetzaltenango clinic sites. Systematic time trends did not emerge, however 2008 and 2010 were characterized by reduced retention. Conclusions Our data show local differences in HIV prevalence and clinic attendance that can be used to prioritize prevention activities targeting FSW in Guatemala. VICITS achieved rapid scale-up; however, a better understanding of the causes of low return rates is urgently needed.

HIV Risk Behaviors and Correlates of Inconsistent Condom Use Among Substance Using Migrants at the Mexico/Guatemala Border

This study assessed correlates of inconsistent condom use with casual partners and the prevalence of sexual risk behaviors and STIs in the Mexico/Guatemala border region using a sample of 392 migrants (303 men, 85 women) who reported current substance use or problem drinking. We ran separate univariate logistic regression models for men and women, and multivariate logistic regression models for men only. Prevalence of syphilis was 1.2% among women and 2.3% among men; HIV prevalence was 2.4% among women and 1.3% among men. Inconsistent condom use with casual partners was higher in women with greater education and lower among women who sold sex. In men, less access to free condoms, drug use with sexual partners, and drug use before sex were independently associated with inconsistent condom use with casual partners. Sexual and substance use risk behaviors were common, and HIV/STI prevention efforts should target both genders and expand beyond most-at risk populations.ResumenEn este estudio se evaluó la correlación del uso inconsistente de los preservativos con parejas ocasionales y la prevalencia de comportamientos sexuales de alto riesgo e ITS en la frontera entre México y Guatemala. Se utilizó una muestra de 392 migrantes (303 hombres, 85 mujeres), quienes reportaron consumir sustancias ilícitas o reportaron tener problemas con el consumo de alcohol. Realizamos modelos de regresión logística univariados para hombres y mujeres, de forma independiente, y modelos de regresión logística multivariantes sólo para los hombres. La prevalencia de sífilis fue de 1,2% entre las mujeres y 2,3% entre los hombres; la prevalencia de VIH fue de 2,4% entre las mujeres y de 1,3% entre los hombres. El uso inconsistente de condones con parejas ocasionales fue mayor en las mujeres con más educación y menor entre las mujeres que venden sexo. En los hombres, menos acceso a preservativos gratuitos, el uso de drogas con las parejas sexuales, y el uso de drogas antes de tener relaciones sexuales se asociaron independientemente con el uso inconsistente de condones con parejas ocasionales. Los comportamientos sexuales de riesgo y el uso de sustancias ilícitas son comunes entre esta población, son necesarios esfuerzos de prevención del VIH y las ITS que se dirijan a ambos sexos y que se expandan a otras poblaciones en riesgo.

Influence of peer support on HIV/STI prevention and safety amongst international migrant sex workers: A qualitative study at the Mexico-Guatemala border.

Background Migrant women engaged in precarious employment, such as sex work, frequently face pronounced social isolation alongside other barriers to health and human rights. Although peer support has been identified as a critical HIV and violence prevention intervention for sex workers, little is known about access to peer support or its role in shaping health and social outcomes for migrant sex workers. This article analyses the role of peer support in shaping vulnerability and resilience related to HIV/STI prevention and violence among international migrant sex workers at the Mexico-Guatemala border. Methods This qualitative study is based on 31 semi-structured interviews conducted with international migrant sex workers in the Mexico-Guatemala border communities of Tapachula, Mexico and Tecún Umán and Quetzaltenango, Guatemala. Results Peer support was found to be critical for reducing social isolation; improving access to HIV/STI knowledge, prevention and resources; and mitigating workplace violence, particularly at the initial stages of migration and sex work. Peer support was especially critical for countering social isolation, and peers represented a valuable source of HIV/STI prevention knowledge and resources (e.g., condoms), as well as essential safety supports in the workplace. However, challenges to accessing peer support were noted, including difficulties establishing long-lasting relationships and other forms of social participation due to frequent mobility, as well as tensions among peers within some work environments. Variations in access to peer support related to country of work, work environment, sex work and migration stage, and sex work experience were also identified. Conclusions Results indicate that peer-led and community empowerment interventions represent a promising strategy for promoting the health, safety and human rights of migrant sex workers. Tailored community empowerment interventions addressing the unique migration-related contexts and challenges faced by migrant sex workers should be a focus of future community-based research, alongside promotion of broader structural changes.

P16.31 Improving timely hiv results in key populations: rapid test antibody evaluation for hiv diagnosis in guatemala, 2012–2013

Introduction Guatemala has a concentrated HIV epidemic among key populations; in 2003, the first rapid test validation in Central America was performed. A national HIV testing algorithm with a rapid test and a second test using an enzyme immunoassay (EIA) was developed (average turnaround time of 2 weeks). Given the changes in the market since 2003, we present results of a second rapid test validation to update the Guatemalan algorithm. Methods Validation was performed in 2012–2013, evaluating a total of 10 rapid tests in two phases: 1) with serum, HIV-negative samples were obtained from blood banks, and positive samples from HIV care units; 2) with whole blood, negative samples were obtained from antenatal care services and positive samples from HIV care units. We tested 452 serum samples [244 HIV+, 208 HIV-] and 432 whole blood samples (10 HIV positive, 422 HIV negative) using two EIA (Roche ELECSYS HIV Combi and Abbott AXSYM HIV Ag/Ab Combo). Discordant results were evaluated with HIV-1 Western Blot. For fourth generation rapid tests, only antibody was evaluated. Data was analysed using OpenEpi. Results Six HIV rapid tests were included for both phases. All tests (except Double Check Gold) reported sensitivity higher than 99% and specificity higher than 95%. Determine HIV 1/2 and HIV Ag/Ab reported the highest results for sensitivity (100%). Hexagon HIV (100%) and Accu-Tell (99.5%) reported the highest results for specificity. All rapid tests that also included HIV-2 detection, showed cross-reactivity, ranging from 37% of HIV cases for Anarapid HIV 1/2/O Tri-line to 15% for Rapid HIV 1/2/O Tri-Line. Conclusion Our results show that Determine HIV½ and HIV Ag/Ab should be recommended as a screening test while Hexagon HIV and Accu-Tell should be recommended as second test. Rapid test validation provides valuable information for on-site confirmation of reactive results improving diagnosis turnaround time. Disclosure of interest statement We declare that we have no conflicts of interest.

P09.39 Hiv/syphilis prevalence and risk behaviours among transgender women and men who have sex with men in nicaragua: sentinel surveillance and sti control (vicits), 2014

Background Nicaragua has a HIV concentrated epidemic, with 9.7% among men who have sex with men and transgender women (MSM/TGW). Since 2011, Sentinel Surveillance and STI Control (VICITS) strategy has been implemented in public health clinics for key populations to provide STI diagnosis/treatment and behavioural change interventions. We describe risk sexual behaviours and HIV/syphilis prevalence among MSM/TGW who attended at least one of two VICITS clinics. Methods We included in the analysis: Men, ≥18 years old (yo), who reported having sex with men in the last year, who attended one of the two selected VICITS clinics in Managua (Pedro Altamirano Hospital) or Granada (Sinforoso Bravo Hospital), from 1 January 2014 through 31 December 2014. Blood samples were collected for HIV and syphilis testing according to national guidelines. Data analysis was performed using Stata v13. Results A total of 712 MSM/TGW attended a VICITS clinic (91.4% MSM, 8.6% TGW) with 545 in Managua (484 MSM, 61 TGW) and 167 MSM in Granada. Median age was 21 yo, median age at first sexual intercourse was 15 yo in both cities; 94.6% of MSM in Granada and 71.8% of MSM/TGW in Managua reported receptive anal sex in the last 30 days. Granada reported highest alcohol use in the last month (75.5%). Condom use in the last sex was reported by 71.3% MSM/TGW in Managua and 93.8% MSM in Granada. HIV prevalence was 4.9% in Managua and 0.6% in Granada. Syphilis prevalence was 4.6% Managua and 0.6% in Granada. Conclusion Managua showed higher prevalence of HIV and Syphilis and sexual risk behaviours in MSM/TGW than Granada. Our results show young people getting infected in both cities, underscoring the need to implement additional efforts to control HIV epidemic among this young key population in Managua and Granada. Disclosure of interest statement We declare that we have no conflicts of interest.