Background STI prevention and support services for MSM living with HIV in Guatemala are limited. The aim of this study was to collect information on STI risk among MSM living with HIV to inform the development of integrated prevention and care services for this population.
Methods As part of a qualitative study with MSM in Guatemala City, nine MSM living with HIV were purposely selected and interviewed in March 2010. Interviews addressed STI-related risk behaviours, experiences with HIV/STI services, social network characteristics and life after HIV diagnosis. Participants were recruited through referral from NGO representatives, key informants, clinic staff and other participants. In-depth interviews were recorded and transcribed and field notes were incorporated into the transcriptions. After multiple readings of the transcripts, key themes were identified and a codebook was developed. Codes were applied using the qualitative software Atlas.ti. Data was further analysed using analytic memos and discussions with research team.
Results Despite reporting HIV-related risk behaviours, including multiple, concurrent sexual partners, inconsistent condom use, and alcohol and drug use, most participants did not report an STI infection after their HIV diagnosis. Attitudes towards current HIV/AIDS treatment services tended to be favourable, especially among those who compared them to earlier treatment experiences, and participants described preferences for a one-stop venue for sexual health services. Participants were generally not familiar with STI services and identified several barriers to access including insufficient information on STI, lack of confidentiality and fear of stigma and discrimination from health workers. Many participants experienced a double burden of family rejection, first for their sexual orientation and then for their HIV diagnosis. In response to this alienation, participants created alternative networks of social support, frequently with other MSM or people with HIV, which provide moral support and motivation for treatment adherence.
Conclusions STI prevention, diagnosis and treatment services among MSM with HIV in Guatemala should be strengthened. Prevention interventions should contemplate using social support networks as an additional communication channel for STI prevention and antiretroviral adherence messages. Confidential STI prevention, diagnosis and treatment services should be integrated into existing HIV/AIDS services.
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