Risk behaviors and STI prevalence among people with HIV in El Salvador.

To date, there are no studies from El Salvador among people with HIV to inform prevention programs. We conducted a study in El Salvador in 2008 among people with HIV using audio computer-assisted interviews on risk behaviors and access to health care. Blood was tested for syphilis and herpes simplex type 2 (HSV-2). Active syphilis was defined as RPR titer ≥1:8. Genital specimens were tested for other sexually transmitted infections (STI) by PCR. We evaluated factors associated with unprotected sex with last stable partner of HIV-negative or unknown status among those reporting a stable partner. A total of 811 HIV-positive individuals participated: 413 men and 398 women. Prevalence of Chlamydia and gonorrhea was low (≤1%), while prevalence of other STI was high: Mycoplasma genitalium (14%), syphilis (15% seropositivity, active syphilis 3%) and HSV-2 (85%). In multivariate analysis, disclosing HIV status to partner (OR 0.2, 95% CI: 0.1-0.3, p<0.001), participation in HIV support groups (OR 0.3, 95% CI: 0.1-0.8, p=0.01), easy access to condoms (OR 0.4, 95% CI: 0.2-0.9, p=0.04) were protective factors for unprotected sex. Reporting a casual partner in the last 12 months (OR 3.6, 95% CI: 1.5-8.5, p=0.004). and having an STI (OR 2.6, 95% CI:1.3-5.5, p=0.02) were associated with an increased odds of unprotected sex. Prevention interventions among HIV-positives in El Salvador should focus on increasing condom access, promoting HIV disclosure and couples testing and reducing the number of partners. The positive role of support groups should be used to enhance behavioral change.

How many men who have sex with men and female sex workers live in El Salvador? Using respondent-driven sampling and capture-recapture to estimate population sizes.

OBJECTIVE: To estimate the numbers of female sex workers (FSW) and men who have sex with men (MSM) in San Salvador, El Salvador. DESIGN AND METHODS: A capture-recapture exercise was conducted among MSM and FSW in San Salvador in 2008. The first capture was done by distributing key chains to both MSM and FSW populations through local non-governmental organizations (NGO) that work with these groups. The second capture was done during the course of an integrated behavioural and biological survey (IBBS) using respondent-driven sampling (RDS). The proportion receiving a key chain estimated from the IBBS study was adjusted by RDS-derived weights. RESULTS: The first capture included 400 FSW and 400 MSM. Of the 624 MSM interviewed in the IBBS, 36 (5.8% crude; 3.2% adjusted RDS) had received the key chain. The estimated population size of MSM in San Salvador was 12 480 (95% CI 7235 to 17 725). Of the 663 FSW interviewed in the IBBS, 39 (5.9% crude; 6.9% adjusted RDS) had received the key chain. The estimated number of FSW was 5765 (95% CI 4253 to 7277). CONCLUSIONS: The capture-recapture exercise was successfully linked to an IBBS to obtain city-level population sizes for MSM and FSW, providing valuable information at a low cost. Size estimates are crucial for programme planning for national AIDS programmes, NGOs and stakeholders working with these populations and for HIV projection models.