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Coverage of HIV Prevention Components Among People With Long-Standing Diagnosed HIV Infection in El Salvador

Jacobson, Jerry O. PhD*; Creswell, Jacob MPH; Guardado, Maria Elena MD, MPH; Lee, Janet C. MPH§; Isabel Nieto, Ana MD; Paz-Bailey, Gabriela MD, MSc, PhD§

doi: 10.1097/OLQ.0b013e3182593b33
Original Study

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.

From the *Cra 8A N96–51, Bogota, Colombia; Stop TB Department, World Health Organization, Geneva, Switzerland; Tephinet, Inc. Guatemala City, Guatemala; §Centre for Health Studies, Del Valle University, Guatemala City, Guatemala; and Ministry of Health, San Salvador, El Salvador

The authors thank the many individuals who participated in the study, El Salvador's health ministry, MC Estrada and others at the United States Agency for International Development office in El Salvador, the Central Laboratory in El Salvador and Centers for Disease Control and Prevention STD Laboratory for their support of this study, and two anonymous reviewers of previous versions of this manuscript.

Supported by funds from the United States Centers for Disease Control and Prevention, United States Agency for International Development, the Ministry of Health of El Salvador, the World Bank, and the Network for Research and Training in Tropical Diseases in Central America (NeTropica) under the project No 06-R-2010.

J.O.J. conceived of and designed the analysis, drafted the manuscript and conducted data analysis. J.C.L. conducted preliminary data analysis. J.C., M.E.G., and A.I.N. coordinated data collection. G.P.-B. designed and supervised the main study. J.C. and J.O.J. contributed to development of survey instruments and procedures. All authors helped to conceptualize ideas, interpret findings, and review drafts of the manuscript.

The findings and conclusions in this paper are those of the authors and do not necessarily represent those of the World Health Organization.

Correspondence: Jerry O. Jacobson, PhD, Cra. 8A No. 96–51, Apto. 604, Bogota, D.C., Colombia. E-mail:

Received for publication October 27, 2011, and accepted April 5, 2012.

© Copyright 2012 American Sexually Transmitted Diseases Association