Evidence of Increased STI/HIV-Related Risk Behavior among Male Perpetrators of Intimate Partner Violence in Guatemala

Intimate partner violence (IPV) is a significant public health problem with a demonstrated link to increased sexually transmitted infection (STI)/HIV-related risk and vulnerability. While IPV is an important issue in Central America, the link to STI/HIV risk has not been explored in this region. 

In this study, the relationship between emotional and physical/sexual IPV and the STI/HIV-related risk behaviors of sex worker patronage and infidelity is assessed among male IPV perpetrators using data from a national survey conducted in 2009 in Guatemala (n = 4773 married/partnered men). Bivariate associations between background characteristics and emotional and physical IPV perpetration were explored. Logistic regression models were run to test associations between IPV for each sexual risk behavior. Perpetration of emotional and physical/sexual IPV was more common among married/partnered men who were older than 24, had more education, lived in urban areas, or were in common law versus married unions. Reports of past-year emotional IPV perpetration increased as wealth quintile increased. After adjusting for demographics and other characteristics, physical/sexual IPV perpetration was associated with past-year infidelity (AOR 1.9, 95% CI: 1.1-3.6). Lifetime emotional IPV (AOR 1.4, 95% CI: 1.1-1.7) and physical/sexual IPV 1.6 (95% CI 1.2-2.0) were positively associated with a history of sex worker patronage. Endorsement of traditional gender role norms showed a marginally positive association with past-year infidelity in the adjusted model (AOR 1.3, 95% CI 1.0-1.8). 

The study findings from Guatemala reinforce the growing evidence globally that male IPV perpetrators are more likely to engage in risky sexual behavior, including sex worker patronage and main partner infidelity. The concurrency of violence and increased STI/HIV risk may compound the health risks for female victims of IPV who also face injury and psychological trauma. Integration of prevention and screening of IPV and STI/HIV prevention services should be adopted in Guatemala and other similar contexts.

Purchase full article at:   http://goo.gl/U6p2V8

By:   Hembling J¹, Andrinopoulos K.

¹a Department of Global Health Systems and Development , Tulane School of Public Health and Tropical Medicine , New Orleans , LA , USA.

AIDS Care. 2014;26(11):1411-8. doi: 10.1080/09540121.2014.913766. Epub 2014 May 6.

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Ethnicity & HIV Risk Behaviour, Testing & Knowledge in Guatemala

OBJECTIVES:

To describe levels of risky sexual behaviour, HIV testing and HIV knowledge among men and women in Guatemala by ethnic group and to identify adjusted associations between ethnicity and these outcomes.

DESIGN:

Data on 16,205 women aged 15-49 and 6822 men aged 15-59 from the 2008-2009 Encuesta Nacional de Salud Materno Infantil were used to describe ethnic group differences in sexual behaviour, HIV knowledge and testing. We then controlled for age, education, wealth and other socio-demographic factors in a multivariate logistic regression model to examine the effects of ethnicity on outcomes related to age at sexual debut, number of lifetime sex partners, comprehensive HIV knowledge, HIV testing and lifetime sex worker patronage (men only).

RESULTS:

The data show low levels of risky sexual behaviour and low levels of HIV knowledge among indigenous women and men, compared to other respondents. Controlling for demographic factors, indigenous women were more likely than other women never to have been tested for HIV and to lack comprehensive HIV knowledge. They were less likely to report early sexual debut and three or more lifetime sexual partners. Indigenous men were more likely than other men to lack comprehensive HIV knowledge and demonstrated lower odds of early sexual debut, 10 or more lifetime sexual partners and sex worker patronage.

CONCLUSIONS:

The Mayan indigenous population in Guatemala, while broadly socially vulnerable, does not appear to be at elevated risk for HIV based on this analysis of selected risk factors. Nonetheless, low rates of HIV knowledge and testing may be cause for concern. Programmes working in indigenous communities should focus on HIV education and reducing barriers to testing. Further research into the factors that underlie ethnic self-identity and perceived ethnicity could help clarify the relative significance of these measures for HIV risk and other health outcomes.

Full article at:   http://goo.gl/Rxe4bb

By:   Taylor TM¹, Hembling J, Bertrand JT.

¹ Global Health Systems and Development , Tulane University , New Orleans , LA , USA.

Ethn Health. 2015;20(2):163-77. doi: 10.1080/13557858.2014.893562. Epub 2014 May 16.

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Scale-Up, Retention & HIV/STI Prevalence Trends among Female Sex Workers Attending VICITS Clinics in Guatemala

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: http://goo.gl/49AN6S

By: Morales-Miranda S1, Jacobson JO1, Loya-Montiel I1, Mendizabal-Burastero R1, Galindo-Arandi C1, Flores C2, Chen SY3.

• 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. 

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