Objectives: Sex among men constitutes an important route of transmission for HIV type 1 (HIV-1) in Latin America. Seeking better understanding of risk behaviours in this region, we determined the seroprevalence, potential risk factors, and geographic distribution of HIV-1 among groups of men who have sex with men (MSM).
Methods: Seroepidemiological, cross sectional studies of 13 847 MSM were conducted in seven countries of South America during the years 1999–2002. Volunteers were recruited in city venues and streets where anonymous questionnaires and blood samples were obtained. HIV-1 infection was determined by enzyme linked immunosorbent assay (ELISA) screening and western blot (WB) confirmatory tests.
Results: HIV-1 seroprevalence varied widely (overall 12.3%, range 11.0%–20.6%). The highest HIV-1 seroprevalence was noted in Bolivia (20.6%) and the lowest in Peru (11.0%). Predictors of HIV-1 infection varied among countries; however, a history of previous sexually transmitted disease (STD) was associated with a consistent increased risk (ORs = 1.9–2.9, AORs = 1.8–2.7). Multiple weekly sexual contacts was found to represent a secondary risk factor in Ecuador, Peru, and Argentina (ORs = 1.6–2.9, AORs = 1.6–3.1), whereas use of drugs such as cocaine was found to increase risk in Bolivia, Uruguay, and Paraguay (ORs = 2.5–6.5, AORs = 2.6–6.1).
Conclusion: The results of this study illustrate an elevated HIV-1 seroprevalence among MSM participants from Andean countries. A previous STD history and multiple partners predicted HIV-1 infection in the seven countries of South America. In Southern Cone countries, HIV-1 infection was also associated with use of illegal drugs such as cocaine.
- ELISA, enzyme linked immunosorbent assay
- FCSW, female commercial sex workers
- IDU, injecting drug use
- MSM, men who have sex with men
- STDs, sexually transmitted diseases
- WB, western blot
- risk factors
- sexual behaviour
- South America
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Financial support: This study was supported by the US Military HIV Research Program (USMHRP) at the Walter Reed Army Institute of Research (WRAIR), and by the US Naval Medical Research Center (NMRC), Silver Spring, MD, USA. Work Unit Number (WUN) No 62787A S17 H B0002.
Disclaimer: The opinions and assertions made by the authors do not reflect the official position or opinion of the US Department of the Army or Navy, of the Henry M. Jackson Foundation for the Advancement of Military Medicine, or of the respective in-country national HIV/AIDS control programmes or non-governmental organisations (NGOs).
Human use statement: The study protocol was approved by the Naval Medical Research Center Institutional Review Board under Protocol # NMRCD.2000.0002 (DoD 31523), Protocol # NMRCD.1999.0002 (DoD 30590 and DoD 30583), Protocol # NMRCD.1999.0001 (DoD 30587), Protocol # NMRCD.2002.0006 (DoD 31590), and Protocol # NMRCD.1998.0001 (DoD 30578), in compliance with all federal regulations governing the protection of human subjects.
Partial results of this study were previously presented at the AIDS Vaccine 2003 Meeting, New York, 20 September 2003 (Abstract No 478).