In El Salvador, Guatemala, Honduras, Nicaragua, and Panama, we recruited 2466 female sex workers (FSWs) by probabilistic or comprehensive sampling and 1418 men who have sex with men (MSM) by convenience sampling to measure sociobehavioral risk and sexually transmitted infections. For MSM, HIV seroprevalence ranged from 7.6% in Nicaragua to 15.3% in El Salvador, and estimated HIV seroincidence per 100 person-years ranged from 2.7 in Panama to 14.4 in Nicaragua; 61% reported using condoms consistently with casual male partners, 29% reported exposure to behavioral interventions, and 22% reported recent sex with male and female partners. For FSWs, HIV seroprevalence ranged from 0.2% in Nicaragua and Panama to 9.6% in Honduras, where estimated HIV seroincidence was also highest (3.2 per 100 person-years); 77% and 72% of FSWs reported using condoms consistently with new and regular clients. Herpes simplex virus (HSV)-2 seroprevalence averaged 85.3% in FSWs and 48.2% in MSM, and syphilis seropositivity averaged 9.6% in FSWs and 8.3% in MSM. Chlamydia trachomatis and Neisseria gonorrhoeae prevalences in FSWs averaged 20.1% and 8.1%, and Trichomonas vaginalis and bacterial vaginosis prevalences averaged 11.0% and 54.8%. An ongoing HIV epidemic involves Central American MSM with potential bridging to women. In FSWs, HSV-2 infection was associated with HIV infection (odds ratio = 11.0, 95% confidence interval: 2.9 to 7.9). For these vulnerable populations, prevention must incorporate acceptable and effective sexual health services, including improved condom access and promotion.
From the *World Vision International, Regional Office for Latin America and the Caribbean, San José, Costa Rica; †Center for AIDS and Sexually Transmitted Disease, University of Washington, Seattle, WA; ‡Department of Epidemiology, University of Washington, Seattle, WA; §USAID Program for Strengthening the Central American Response to HIV (Proyecto de Acción en SIDA Centroamericano), Constella-Futures, Guatemala City, Guatemala; ∥Organización de Apoyo a una Sexualidad Integral frente al SIDA, Guatemala City, Guatemala; ¶Department of Biostatistics, University of Washington, Seattle, WA; #Fred Hutchinson Cancer Research Center, Seattle, WA; and the **Department of Medicine, University of Washington, Seattle, WA.
Received for publication December 14, 2006; accepted June 14, 2007.
The Estudio Multicéntrico was supported by the US Agency for International Development (50600-01), the World AIDS Foundation (WAF 264-01-067), GlaxoSmithKline Research and Development Limited (donation of HerpeSelect test kits), the US National Institute of Allergy and Infectious Diseases (University of Washington Center for AIDS Research, P30 AI 27757) and the University of Washington STD/AIDS Research Training Grant (T32 AI07140), the Joint United Nations Programme on AIDS and the World Health Organization and Pan American Health Organization, Roche Molecular Systems (donation of reagents for COBAS automated polymerase chain reaction testing), and the Spanish International Cooperation Agency.
Reprints: King K. Holmes, MD, PhD, Center for AIDS and Sexually Transmitted Disease, University of Washington, 325 9th Ave, PO Box 359931, Seattle, WA 98104 (e-mail: email@example.com).