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HIV among MSM in a large middle-income country

Kerr, Ligia R.F.S.a; Mota, Rosa S.b; Kendall, Carlc; Pinho, Adriana de A.d; Mello, Maeve B.e; Guimarães, Mark D.C.f; Dourado, Inêsg; de Brito, Ana M.h; Benzaken, Adelei; McFarland, Willij; Rutherford, Georgej; The HIVMSM Surveillance Group

doi: 10.1097/QAD.0b013e32835ad504
Epidemiology and Social

Objective: To conduct the first national biological and behavioral surveillance survey for HIV among MSM in Brazil.

Design: A cross-sectional surveillance study utilizing Respondent Driven Sampling (RDS) in 10 cities, following formative research. Planned sample: 350 MSM reporting sex with another man in the last 12 months, at least 18 years of age, and residing in the city of the study.

Methods: Conventional RDS recruitment. Results were calculated for each city using RDSAT 5.6. For the national estimate, a new individual weight using a novel method was calculated. The 10 cities were aggregated, treated as strata and analyzed using STATA11.0. Self-reported HIV status and logistic regression was used to impute missing values for serostatus, an important issue for RDSAT.

Results: A total of 3859 MSM were interviewed. Sample was diverse, most self-identified as mulatto or black, were social class C or below, and had relatively low levels of education. More than 80% reported more than one partner in the last 6 months. Only 49% had ever tested for HIV. HIV prevalence among MSM ranged from 5.2 to 23.7% in the 10 cities (3.7–16.5% without imputation) and was 14.2% for all cities combined with imputation. The overall prevalence was two and three times higher than that estimated for female sex workers and drug users, respectively, in Brazil. Half of those who tested HIV positive were not aware of their infection.

Conclusion: The AIDS epidemic in Brazil is disproportionately concentrated among MSM, as has been found in other countries. Renewed efforts to encourage testing, prevention and treatment are required.

aDepartamento de Saúde Comunitária, Universidade Federal do Ceará

bDepartamento de Estatistica e Matematica Aplicada, Universidade Federal do Ceará

cTulane University School of Public Health and Tropical Medicine, Center for Global Health Equity

dEscola Nacional de Saúde Pública, Fundação Oswaldo Cruz, (FIOCRUZ) Rio de Janeiro

eICIT, FIOCRUZ, Rio de Janeiro

fDepartamento de Medicina Preventiva e Social, Universidade Federal de Minas Gerais

gInstituto de Saúde Coletiva/Universidade Federal da Bahia

hCentro de Pesquisas Aggeu Magalhães, FIOCRUZ, Recife, Pernambuco

iFundação Alfredo da Mata, Manaus, Brazil

jInstitute of Global Health, University of California, San Francisco, USA.

Correspondence to Ligia Regina Franco Sansigolo Kerr, MD, PhD, Federal University of Ceara, Fortaleza, Ceara, Brazil. Tel: +55 85 9988 8866; fax: +55 85 3472 7544; e-mail:

Received 5 July, 2012

Revised 10 September, 2012

Accepted 27 September, 2012

© 2013 Lippincott Williams & Wilkins, Inc.