Is Involvement in Sex Work Associated with Engagement in HIV-Related Medical Care in Latin American Men Who Have Sex with Men? Results of a Large, Multinational Internet Survey

Men who have sex with men (MSM) who engage in transactional sex are at increased HIV risk, and face complex barriers to care seeking. Among 2,035 men recruited through an MSM social/sexual networking website in Latin America and who reported being HIV-infected, 186 (9.1%) reported being paid for sex with another man in the past year. Engagement in transactional sex was associated with decreased odds of receiving medical care for HIV (AOR=0.57, 95% CI=0.37–0.85). No significant differences were seen in being on antiretroviral therapy (ART) or ART adherence once in care. Interventions in this population should focus on reducing barriers to engagement in care.

...Results of this analysis suggest that there are disparities in receipt of HIV medical care associated with recent engagement in transactional sex among HIV-infected MSM in Latin America. The ability to access HIV-related medical care is related not only to availability of care facilities, but also barriers and facilitators to engagement and retention in care, and these factors may be compounded for MSM who engage in transactional sex. For example, stigma and discrimination may limit care seeking to a greater extent among men who engage in transactional sex, given multiple sources of stigma. Previous research suggests that MSM may face sexual stigma from multiple dimensions. Stigma from healthcare providers may limit disclosure of sexual orientation or sexual behaviors among MSM, if they anticipate discrimination following disclosure.¹⁶Among people living with HIV, HIV and healthcare stigma has been associated with decreased care-seeking behavior.^9,12 MSM who engage in transactional sex may experience additional stigma due to being involved in sex work, which is illegal and/or socially unacceptable across most of Latin America, and which has been described as a barrier to care seeking among female sex workers.^17,18 Although experienced and/or perceived stigma could act as a mechanism through which MSM who engage in transactional sex in Latin America have decreased engagement in HIV care, we were unable to quantify experiences of stigma in this study. Future work should consider the role of experienced and/or perceived stigma specifically as a barrier to engaging in care in this population.

...Interestingly, although participants who engaged in transactional sex were less likely to be engaged in HIV-related medical care, prior research by this team¹⁵ and by others in other regions²¹ indicates that MSM who engage in transactional sex are more likely to have a history of HIV testing and of HIV diagnosis.^22,23 This may indicate that men who engage in transactional sex are aware of their increased risk and thus are more likely to test for HIV, but that there are structural, interpersonal, and individual factors—including differential power dynamics due to social or economic position, physical or sexual violence, substance use, and/or psychological distress⁷—which are major barriers to linkage and continued engagement in care if diagnosed...

  

Full article at:  http://goo.gl/5RWUOC

By: Katie B. Biello, PhD, MPH, ^1,,2 Catherine E. Oldenburg, MPH,¹ Joshua Rosenberger, PhD,³ Kenneth H. Mayer, MD,^2,,4,,5 David Novak, MSW,⁶ and Matthew J. Mimiaga, ScD, MPH^1,,2,,7,,8

¹Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts.

²The Fenway Institute, Fenway Health, Boston, Massachusetts.

³Department of Global and Community Health, George Mason University, Fairfax, Virginia.

⁴Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, Massachusetts.

⁵Department of Global Health and Population, Harvard School of Public Health, Boston, Massachusetts.

⁶OLB Research Institute, Online Buddies, Inc., Cambridge, Massachusetts.

⁷Department of Psychiatry, Harvard Medical School, Boston, Massachusetts.

⁸Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts.

¹Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts.

²The Fenway Institute, Fenway Health, Boston, Massachusetts.

³Department of Global and Community Health, George Mason University, Fairfax, Virginia.

⁴Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, Massachusetts.

⁵Department of Global Health and Population, Harvard School of Public Health, Boston, Massachusetts.

⁶OLB Research Institute, Online Buddies, Inc., Cambridge, Massachusetts.

⁷Department of Psychiatry, Harvard Medical School, Boston, Massachusetts.

⁸Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts.

LGBT Health. 2016 Jun 1; 3(3): 233–237. doi:  10.1089/lgbt.2015.0006

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HIV Testing Practices & the Potential Role of HIV Self-Testing among Men Who Have Sex with Men in Mexico

The objective of this study was to characterize HIV testing practices among men who have sex with men in Mexico and intention to use HIV self-testing. 

In 2012, members of one of the largest social/sexual networking websites for men who have sex with men in Latin America completed an anonymous online survey. This analysis was restricted to HIV-uninfected men who have sex with men residing in Mexico. Multivariable logistic regression models were fit to assess factors associated with HIV testing and intention to use a HIV self-test. 

Of 4537 respondents, 70.9% reported ever having a HIV test, of whom 75.5% reported testing at least yearly. The majority (94.3%) indicated that they would use a HIV home self-test if it were available. Participants identifying as bisexual less often reported ever HIV testing compared to those identifying as gay/homosexual (adjusted odds ratio = 0.52, 95% confidence interval: 0.44-0.62). Having a physical exam in the past year was associated with increased ever HIV testing (adjusted odds ratio = 4.35, 95% confidence interval: 3.73-5.07), but associated with decreased interest in HIV self-testing (adjusted odds ratio = 0.66, 95% confidence interval: 0.48-0.89). 

The high intention to use HIV home self-testing supports the use of this method as an acceptable alternative to clinic- or hospital-based HIV testing.

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By:  Oldenburg CE1, Biello KB2, Perez-Brumer AG3, Rosenberger J4, Novak DS5, Mayer KH6, Mimiaga MJ7.

• 1Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA ceo242@mail.harvard.edu.
• 2The Fenway Institute, Fenway Community Health, Boston, MA, USA Departments of Behavioral & Social Health Sciences and Epidemiology and the Institute for Community Health Promotion, Brown University School of Public Health, Providence, RI, USA.
• 3Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, NY, USA.
• 4Department of Biobehavioral Health, Penn State University, University Park, PA, USA.
• 5Online Buddies, Inc, OLB Research Institute, Cambridge, MA, USA.
• 6The Fenway Institute, Fenway Community Health, Boston, MA, USA Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
• 7Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA The Fenway Institute, Fenway Community Health, Boston, MA, USA Departments of Behavioral & Social Health Sciences and Epidemiology and the Institute for Community Health Promotion, Brown University School of Public Health, Providence, RI, USA. 
• Int J STD AIDS. 2016 Mar 27. pii: 0956462416641556.

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Reductions in Access to HIV Prevention & Care Services Are Associated with Arrest & Convictions in a Global Survey of Men Who Have Sex with Men

OBJECTIVES:

Men who have sex with men (MSM) are disproportionately impacted by HIV. Criminalisation of homosexuality may impede access to HIV services. We evaluated the effect of the enforcement of laws criminalising homosexuality on access to services.

METHODS:

Using data from a 2012 global online survey that was published in a prior paper, we conducted a secondary analysis evaluating differences in perceived accessibility to health services (ie, 'how accessible are ____' services) between MSM who responded 'yes'/'no' to: 'have you ever been arrested or convicted for being gay/MSM?'

RESULTS:

Of the 4020 participants who completed the study and were included in the analysis, 8% reported ever being arrested or convicted under laws relevant to being MSM. Arrests and convictions were most common in sub-Saharan Africa (23.6%), Eastern Europe/Central Asia (18.1%), the Caribbean (15%), Middle East/North Africa (13.2%) and Latin America (9.7%). Those arrested or convicted had significantly lower access to sexually transmitted infection treatment, condoms and medical care, compared with other MSM, while accounting for clustering by country and adjusting for age, HIV status, education and country-level income.

CONCLUSIONS:

Arrests and convictions under laws relevant to being MSM have a strong negative association with access to HIV prevention and care services. Creating an enabling legal and policy environment, and increasing efforts to mitigate anti-homosexuality stigma to ensure equitable access to HIV services are needed, along with decriminalisation of homosexuality, to effectively address the public health needs of this population.

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By:  Santos GM1, Makofane K2, Arreola S2, Do T3, Ayala G2.

• 1San Francisco Department of Public Health, Center for Public Health Research, San Francisco, California, USA Department of Community Health Systems, University of California, San Francisco, San Francisco, California, USA.
• 2The Global Forum on MSM and HIV (MSMGF), Oakland, California, USA.
• 3Department of Community Health Systems, University of California, San Francisco, San Francisco, California, USA. 

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Clinical Outcomes of First-Line Antiretroviral Therapy in Latin America: Analysis from the LATINA Retrospective Cohort Study

Nearly 2 million people are infected with human immunodeficiency virus (HIV) in Latin America. However, information regarding population-scale outcomes from a regional perspective is scarce. 

We aimed to describe the baseline characteristics and therapeutic outcomes of newly-treated individuals with HIV infection in Latin America. A Retrospective cohort study was undertaken. 

The primary explanatory variable was combination antiretroviral therapy based on either a protease inhibitor (PI) or a non-nucleoside reverse transcriptase inhibitor (NNRTI). The main outcome was defined as the composite of all-cause mortality and the occurrence of an AIDS-defining clinical event or a serious non-AIDS-defining event during the first year of therapy. 

The secondary outcomes included the time to a change in treatment strategy. All analyses were performed according to the intention to treat principle. A total of 937 treatment-naive patients from four participating countries were included (228 patients with PI therapy and 709 with NNRTI-based treatment). At the time of treatment initiation, the patients had a mean age of 37 (SD: 10) years and a median CD4 + T-cell count of 133 cells/mm(3) (interquartile range: 47.5-216.0). Patients receiving PI-based regimens had a significantly lower CD4 + count, a higher AIDS prevalence at baseline and a shorter time from HIV diagnosis until the initiation of treatment. 

There was no difference in the hazard ratio for the primary outcome between groups. The only covariates associated with the latter were CD4 + cell count at baseline, study site and age. The estimated hazard ratio for the time to a change in treatment (NNRTI vs PI) was 0.61 (95% CI 0.47-0.80, p < 0.01). 

This study concluded that patients living with HIV in Latin America present with similar clinical outcomes regardless of the choice of initial therapy. Patients treated with PIs are more likely to require a treatment change during the first year of follow up.

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By:   Angriman F¹, Belloso WH¹, Sierra-Madero J², Sánchez J³, Moreira RI⁴, Kovalevski LO⁵, Orellana LC⁶, Cardoso SW⁴, Crabtree-Ramirez B², La Rosa A³, Losso MH⁷.

¹CICAL, Buenos Aires, Argentina Servicio de Clínica Médica, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.

²Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México DF, México.

³Asociación Civil Impacta Salud y Educación, Lima, Perú

⁴Instituto de Pesquisa Clinica Evandro Chagas-FIOCRUZ, Rio de Janeiro, Brazil.

⁵CICAL, Buenos Aires, Argentina.

⁶CICAL, Buenos Aires, Argentina Deakin University, Melbourne, Australia.

⁷CICAL, Buenos Aires, Argentina Hospital José M. Ramos Mejía, Buenos Aires, Argentina.

Int J STD AIDS. 2016 Feb;27(2):118-26. doi: 10.1177/0956462415575621. Epub 2015 Mar 3.

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'The Darkest Times Of My Life': Recollections of Child Abuse among Forced Migrants Persecuted Because of Their Sexual Orientation & Gender Identity

Numerous studies demonstrate that lesbian, gay, bisexual, and transgender (LGBT) children and youth are likely to experience abuse by peers, parents, and other adults and that these experiences correlate with a host of mental health problems. However, there is little understanding of the experiences of LGBT children and youth living in countries where social and legal protections for sexual and gender minorities are limited or nonexistent. 

This qualitative study used thematic analysis to explore the child and adolescent abuse experiences and their impact on the pre-migration mental health of LGBT forced migrants. We analyzed 26 interviews with individuals who obtained refugee or asylee status in the United States or Canada on the basis of sexual orientation or gender identity. Participants originated from countries in Asia, Africa, the Caribbean, Eastern Europe, Latin America, and the Middle East. 

Analysis revealed the following themes: abuse by parents and caregivers, abuse by peers and school personnel, having nowhere to turn, and dealing with psychological distress. Findings indicate that participants experienced severe verbal, physical, and sexual abuse throughout childhood and adolescence and that this abuse occurred at home, in school, and in the community. Furthermore, there were no resources or sources of protection available to them. 

Participants linked their abuse to subjective experiences of depression, anxiety, and traumatic stress, as well as suicidal ideation and suicide attempts. We conclude with implications for refugee adjudication practices, mental health care, and international policy.

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By:  Alessi EJ1, Kahn S2, Chatterji S3.

• 1School of Social Work, Rutgers, The State University of New Jersey, 360 Martin Luther King Jr. Blvd, Hill Hall, Room 401, Newark, NJ 07102, USA.
• 2School of Social Work, McGill University, 3506 University Street, Room 426, Montreal, QC, Canada H3A 2A7.
• 3School of Social Work, Rutgers, The State University of New Jersey, 536 George Street, New Brunswick, NJ 08901, USA. 

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Mortality in Migrants Living with HIV in Western Europe (1997-2013)

BACKGROUND:

Many migrants face adverse socioeconomic conditions and barriers to health services that can impair timely HIV diagnosis and access to life-saving treatments. We aimed to assess the differences in overall mortality by geographical origin in HIV-positive men and women using data from COHERE, a large European collaboration of HIV cohorts from 1997 to 2013.

METHODS:

In this observational cohort study, we included HIV-positive, antiretroviral-naive people accessing care in western Europe from COHERE. Individuals were eligible if enrolled in a cohort that collected information on geographical origin or ethnic origin from Jan 1, 1997, to March 19, 2013, aged 18-75 years, they had available information about sex, they were not infected perinatally or after the receipt of clotting factor concentrates, and were naive to combination antiretroviral therapy at cohort entry. Migrants' origins were grouped into seven regions: western Europe and similar countries (Australia, Canada, New Zealand, and the USA); eastern Europe; North Africa and the Middle East; sub-Saharan Africa; Latin America; the Caribbean; and Asia and the rest of Oceania (excluding Australia and New Zealand). Crude and adjusted mortality rate ratios were calculated by use of Poisson regression stratified by sex, comparing each group with the native population. Multiple imputation with chained equations was used to account for missing values.

FINDINGS:

Between Oct 25, 1979, and March 19, 2013, we recruited 279 659 individuals to the COHERE collaboration in EuroCoord. Of these 123 344 men and 45 877 women met the inclusion criteria. Our data suggested effect modification by transmission route (pinteraction=0·12 for men; pinteraction=0·002 for women). No significant difference in mortality was identified by geographical origin in men who have sex with men. In heterosexual populations, most migrant men had mortality lower than or equal to that of native men, whereas no group of migrant women had mortality lower than that in native women. High mortality was identified in heterosexual men from Latin America and heterosexual women from the Caribbean. Compared with that in the native population, mortality in injecting drug users was similar or low for all migrant groups.

INTERPRETATION:

Characteristics of and risks faced by migrant populations with HIV differ for men and women and for populations infected heterosexually, by sex between men, or by injecting drug use. Further research is needed to understand how inequalities are generated and maintained for the groups with higher mortality identified in this study.

Purchase full article at:  http://goo.gl/QltP0B

By:  Migrants Working Group on behalf of COHERE in EuroCoord.

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Age and Intimate Partner Violence: An Analysis of Global Trends among Women Experiencing Victimization in 30 Developing Countries

Purpose

Young women are at elevated risk of violence victimization, yet generalizable evidence on age at which abuse first occurs is lacking. This analysis provides new descriptive evidence on age and duration into partnership of women's first intimate partner violence (IPV) victimization.

Methods

Data come from ever married women ages of 15–49 years in nationally representative Demographic and Health Surveys in 30 countries collected from 2005 to 2014 in Africa, Asia, Eastern Europe, and Latin America and the Caribbean. Descriptive analysis is performed.

Results

Approximately 29.0% of women reported any physical or sexual IPV. Among ever married women who first experienced violence post-union, abuse began, on average, 3.5 years, after union formation. Approximately 38.5% and 67.5% of those ever experiencing abuse did so within 1 year and 3 years, respectively, of union formation. Regionally, average years into union of abuse initiation showed little variation and average age at first abuse among once married women is 22.1 years.

Conclusions

Results imply that primary prevention for IPV must take place on average before first union before age 19 years, to capture the most relevant and at risk target population. Resources allocated toward risk factors in childhood and adolescence may be most effective in combating initiation of IPV globally. Despite this finding, there remains a lack of evidence on effective interventions for primary prevention of abuse during women's early years in developing settings.

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By:  Amber Peterman, Ph.D., Jennifer Bleck, Ph.D., M.P.H., Tia Palermo, Ph.D.

• Social and Economic Policy Unit, UNICEF Office of Research—Innocenti, Florence, Italy

Correspondence

• Address correspondence to: Amber Peterman, Ph.D., UNICEF Office of Research—Innocenti, Piazza SS. Annunziata 12, 50122 Florence, Italy.

  

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Improving Empathy in the Prevention of Sexual Abuse Against Children and Youngsters

The aim of this research is to study the improvement of empathy in child-care professionals (i.e., teachers, psychologists, social workers) involved in the prevention of sexual abuse against children and youngsters. An E-Learning training pilot program was conducted with pre- and post-measures (T1 = at the beginning and T2 = after 6 months) using the program's standardized questionnaires of Situational Empathy and the Interpersonal Reactivity Index (IRI) as a Dispositional Empathy measure. 

A sample of 42 experienced professionals involved in activities with children and youngsters was obtained from the International Movement of Popular Education in Latin America called "Fe y Alegría." Significant progress was found in the scales of Situational Empathy and in some Coping subscales. The final outcomes seem to indicate that the prevention program elicits important changes in the cognitive sphere and that these changes are more intense when the implication level for the situation is greater. 

This research shows that empathy can be improved through professional experience and careful situational involvement.

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By: Man-Ging CI1, Böhm B2, Fuchs KA3, Witte S2, Frick E4.

• 1a Department of Palliative Medicine , Ludwig-Maximilian University of Munich , Munich , Germany.
• 2b Department of Child and Adolescent Psychiatry and Psychotherapy , Ulm University Medical Center , Ulm , Germany.
• 3c Centre for Child Protection , Pontifical Gregorian University , Rome , Italy.
• 4d Spiritual Care Research Center, Department of Psychosomatic Medicine and Psychotherapy , Medical School, Technical University of Munich , Munich , Germany.  

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Transactional Sex and the HIV Epidemic among Men Who have Sex with Men (MSM): Results from a Systematic Review and Meta-analysis

Engagement in transactional sex has been hypothesized to increase risk of HIV among MSM, however conflicting evidence exists. 

We conducted a systematic review and meta-analysis comparing HIV prevalence among MSM who engaged in transactional sex to those who did not (33 studies in 17 countries; n = 78,112 MSM). 

Overall, transactional sex was associated with a significant elevation in HIV prevalence (OR 1.34, 95 % CI 1.11-1.62). Latin America (OR 2.28, 95 % CI 1.87-2.78) and Sub-Saharan Africa (OR 1.72, 95 % CI 1.02-2.91) were the only regions where this elevation was noted. 

Further research is needed to understand factors associated with sex work and subsequent HIV risk in Latin America and Sub-Saharan Africa.

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By: Oldenburg CE1, Perez-Brumer AG2, Reisner SL3,4, Mimiaga MJ3,4,5.

• 1Department of Epidemiology, Harvard School of Public Health, 677 Huntington Ave, Boston, MA, 02115, USA. ceo242@mail.harvard.edu.
• 2Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA.
• 3Department of Epidemiology, Harvard School of Public Health, 677 Huntington Ave, Boston, MA, 02115, USA.
• 4The Fenway Institute, Fenway Community Health, Boston, MA, USA.
• 5Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.

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HIV Infection in Migrant Populations in the European Union and European Economic Area in 2007-2012: An Epidemic on the Move

Migrants are considered a key group at risk for HIV infection. This study describes the epidemiology of HIV and the distribution of late HIV presentation among migrants within the European Union/European Economic Area during 2007-2012.

HIV cases reported to European Surveillance System (TESSy) were analyzed. Migrants were defined as people whose geographical origin was different than the reporting country. Multiple logistic regression was used to model late HIV presentation.

Overall, 156,817 HIV cases were reported, of which 60,446 (38%) were migrants. Of these, 

• 53% were from Sub-Saharan Africa, 
• 12% from Latin America, 
• 9% from Western Europe, 
• 7% from Central Europe, 
• 5% from South and Southeast Asia, 
• 4% from East Europe, 
• 4% from Caribbean, and 
• 3% from North Africa and Middle East. 

Male and female migrants from Sub-Saharan Africa and Latin America had higher odds of late HIV presentation than native men and women. Migrants accounted for 40% of all HIV notifications in 2007 versus 35% in 2012. HIV cases in women from Sub-Saharan Africa decreased from 3725 in 2007 to 2354 in 2012. The number of HIV cases from Latin America peaked in 2010 to decrease thereafter. HIV diagnoses in migrant men who have sex with men increased from 1927 in 2007 to 2459 in 2012.

Migrants represent two-fifths of the HIV cases reported and had higher late HIV presentation. HIV epidemic in migrant populations in European Union/European Economic Area member states is changing, probably reflecting the global changes in the HIV pandemic, the impact of large-scale ART implementation, and migration fluctuations secondary to the economic crisis in Europe.

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By: Hernando V1, Alvárez-Del Arco D, Alejos B, Monge S, Amato-Gauci AJ, Noori T, Pharris A, Del Amo J.

• 1*Red de Investigación en Sida, Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, Spain; †CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; ‡Department of Surgery, Medical and Social Sciences, Universidad Alcalá, Alcalá de Henares, Spain; and §Surveillance and Response Section, European Centre for Disease Prevention and Control, Stockholm, Sweden.  

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Transactional Sex among Men Who Have Sex with Men in Latin America: Economic, Sociodemographic & Psychosocial Factors

We assessed factors associated with engagement in transactional sex among men who have sex with men recruited from one of the largest Internet sites for men seeking social or sexual interactions with other men in Latin America.

We constructed multilevel logistic regression models to analyze factors associated with engagement in transactional sex in 17 Latin American countries in 2012.

Of 24 051 respondents, 1732 (7.2%) reported being paid for sexual intercourse in the past 12 months. In a multivariable model, 

• higher country-level unemployment was associated with increased odds of transactional sex (adjusted odds ratio [AOR] = 1.07 per 1% increase in unemployment). 
• Individual or interpersonal factors associated with increased odds of engagement in transactional sex included self-reported HIV or sexually transmitted infection
• childhood sexual abuse history
• intimate partner violence 
• and sexual compulsivity 

Structural-level economic interventions and those that address individual and interpersonal factors may improve HIV prevention efforts among men who have sex with men who engage in transactional sex.

Via:  http://goo.gl/nrMoTr Purchase full article at: http://goo.gl/V5zOmK

By: Oldenburg CE1, Perez-Brumer AG, Biello KB, Landers SJ, Rosenberger JG, Novak DS, Mayer KH, Mimiaga MJ.

• 1Catherine E. Oldenburg is with the Department of Epidemiology, Harvard School of Public Health, Boston, MA. Amaya G. Perez-Brumer is with the Department of Sociomedical Sciences, Columbia University, New York, NY. Katie B. Biello and Kenneth H. Mayer are with the Fenway Institute, Fenway Health, Boston, MA. Stewart J. Landers is with John Snow, Inc., Boston, MA. Joshua G. Rosenberger is with the Department of Global and Community Health, George Mason University, Fairfax, VA. David S. Novak is with the OLB Research Institute, Online Buddies, Inc., Cambridge, MA. Matthew J. Mimiaga is with the Department of Psychiatry, Massachusetts General Hospital, Boston. 

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A Cross-Sectional Study to Evaluate Factors Related to Condom Use with Commercial Sexual Partners in Workers from Ecuadorian Companies

Below: New HIV infections in Latin America, 2013

Background

Unprotected intercourse with sex workers is one of the major risk factors for HIV infection. Consistent condom use is a prerequisite to lower the incidence of HIV.

Methods

We assessed the prevalence of condom use and its determinants among company workers engaged with commercial sexual partners in Ecuador. The study was based on a random sample of 115 companies and 1,732 workers stratified by province and working sector and utilized the “Behavioral Surveillance Surveys – Adult questionnaire” developed by Family Health International.

Results

Of the 1,561 sexually active workers, 311 (19.9 %) reported having intercourse with sex workers. Among them 25.9 % did not use a condom at the last sexual intercourse. As for condom use frequency over the last 12 months, 29/208 (13.9 %) reported never, 23 (11.1 %) sometimes, 24 (11.5 %) almost every time and 132 (63.5 %) every time. Factors adversely affecting condom use frequency over the last 12 months were female gender (OR = 4.56, 95 % CI: 1.45-14.4), older age (OR = 1.07, 95 % CI: 1.03-1.10), low educational level (OR = 4.69, 95 % CI: 1.95-11.3) and married workers living with spouse (OR = 7.66, 95 % CI: 3.08-19.1). By contrast, factors such as age at first sexual intercourse, job category, HIV transmission and prevention measure knowledge, single workers, previous exposure to HIV intervention programs and having a casual sexual partner were not affecting condom use frequency. When considering condom use during the last sexual intercourse or during the past 12 months with commercial sexual partners, results were similar.

Conclusions

Workers with low education, older age, female gender and those married living with their spouse should be targeted for specific educational interventions.

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Family Planning for Strangers: An Experiment on the Validity of Reported Contraceptive Use

Below:  Scatterplot for Reported Sterilization and TFR in Urban Latin American DHS data, 42 surveys from 15 countries, including OLS Regression Prediction Line (R2 = 0.14; p = 0.015).

Sterilization levels reported in the Dominican Republic appear well above what we would normally expect given prevailing patterns in the region. We suspect that the use of strangers as interviewers—the normative approach in data collection in both developed and developing country settings—may be partly responsible for this result, and may underlie a long history of bias in family planning data. We present findings from a field experiment conducted in a Dominican town in 2010, where interviewer assignment was randomized by level of preexisting level of familiarity between interviewer and respondent. In our data, sterilization use is higher when the interviewer is an outsider, as opposed to someone known to the respondent or from the same community. In addition, high sterilization use is correlated with a propensity of respondents to present themselves in a positive light to interviewers. These results call into question the routine use of strangers and outsiders as interviewers in demographic and health surveys.

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