Since 2007, Guatemala integrated STI clinical service with
an HIV prevention model into four existing public health clinics to prevent HIV
infection, known as the VICITS strategy. We present the first assessment of
VICITS scale-up, retention, HIV and STI prevalence trends, and risk factors
associated with HIV infection among Female Sex Workers (FSW) attending VICITS
clinics in Guatemala.
Demographic, behavioral and clinical data were collected
using a standardized form. Data was analyzed by year and health center. HIV and
STI prevalence were estimated from routine visits. Retention was estimated as
the percent of new users attending VICITS clinics who returned for at least one
follow-up visit to any VICITS clinic within 12 months. Separate multivariate
logistic regression models were conducted to investigate factors associated
with HIV infection and program retention.
During 2007-2011 5,682 FSW visited a VICITS clinic for the
first-time. HIV prevalence varied from 0.4% to 5.8%, and chlamydia prevalence
from 0% to 14.3%, across sites. Attending the Puerto Barrios clinic, having a
current syphilis infection, working primarily on the street, and using the
telephone or internet to contact clients were associated with HIV infection.
The number of FSW accessing VICITS annually increased from 556 to 2,557 (361%)
during the period. In 2011 retention varied across locations from 7.7% to
42.7%. Factors negatively impacting retention included current HIV diagnosis,
having practiced sex work in another country, being born in Honduras, and
attending Marco Antonio Foundation or Quetzaltenango clinic sites. Systematic
time trends did not emerge, however 2008 and 2010 were characterized by reduced
retention.
Our data show local differences in HIV prevalence and clinic
attendance that can be used to prioritize prevention activities targeting FSW
in Guatemala. VICITS achieved rapid scale-up; however, a better understanding
of the causes of low return rates is urgently needed.
Below: Number of active FSW attending VICITS clinics over time by clinic, Guatemala, 2007–2011
Risk factors associated with HIV infection among FSW attending VICITS clinics for the first time, Guatemala, 2007–2011 (N = 4,021).
| Variable | OR (95% CI) | AOR (95% CI) |
| Age | ||
| 18–24 | 1.00 | |
| 25–34 | 1.09 (0.61–1.95) | |
| ≥35 | 2.10 (1.04–4.24) | |
| Clinic | ||
| Zone 3 | 1.00 | 1.00 |
| FMA | 2.09 (1.06–4.10) | 0.73 (0.31–1.71) |
| Puerto Barrios | 4.58 (2.40–8.74) | 4.52 (2.09–9.78) |
| Quetzaltenango | 0.75 (0.18–3.15) | 1.11 (0.26–1.71) |
| Highest level of education completed | ||
| <Primary | 1.00 | 1.00 |
| Primary | 0.44 (0.24–0.81) | 0.51 (0.28–0.93) |
| ≥HS | 0.54 (0.26–1.11) | 0.73 (0.35–1.54) |
| Current syphilis infection | 6.13 (2.13–17.59) | 4.32 (1.46–12.81) |
| Sex work location | ||
| Strip club | 1.00 | 1.00 |
| Bar | 2.42 (1.17–5.02) | 1.37 (0.61–3.11) |
| Street | 3.69 (1.67–8.18) | 4.14 (1.60–10.69) |
| Brothels based at residential homes | 0.94 (0.33–2.72) | 1.01 (0.35–2.94) |
| Other (telephone or internet) | 3.13 (1.15–8.54) | 3.40 (1.11–10.38) |
Full article
at:
By:
- 1Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala.
- 2National STI/HIV/AIDS Program, Ministry of Public Health, Guatemala City, Guatemala.
- 3Division of Global HIV/AIDS, Centers for Disease Control and Prevention - Central America Regional Office, Guatemala City, Guatemala.
