Are men who have sex exclusively with men more vulnerable to HIV infection? Results of a cross-sectional behavioral and seroprevalence study with MSM in a Paraguayan border area
Background: HIV seroprevalence among MSM in Paraguay is 12%, but may be higher in border areas where riskier behaviors occur. A cross-sectional study was conducted to determine sexual behaviors, HIV and syphilis prevalence in MSM population at the border area with Brazil and Argentina.
Methods: From July-December 2006, 296 men or transsexuals who reported having sex with a man at least once past 12 months (>15 years old) were recruited through respondent-driven sampling, participated in an HIV-related behavioral questionnaire and were screened for syphilis (all) and HIV (optional).
Results: Only 10% of participants identified themselves as homosexuals, 54% as bisexuals and 34% as heterosexuals; 83% reported sex with both men and women in the last six months. Seventy four percent of men who had sex only with men (MSOM) and 75% of those who had sex with men and women (MSMW) reported having occasional male partners, but a higher proportion of MSOM than MSMW had sex with a permanent male partner (59% vs. 24%). MSOM were significantly more likely to have had receptive anal intercourse (RAI) with occasional partners (77% vs. 25%) and permanent partners (90% versus 49%). Consistent condom use in the last six months was low in both groups (<35%), regardless of the type of partner or sexual activity. While HIV seroprevalence was low (<1%), syphilis was high; MSOM (34%) were significantly more likely to test positive for syphilis than MSMW (8%). Despite that, MSOM (59%) and MSMW (64%) perceived themselves to be at low risk for HIV.
Conclusions: Despite low HIV seroprevalence, the low levels of condom use and self-perceived risk, and the high rate of syphilis create a ripe environment for a rapid expansion of HIV in this border area. MSOM are particularly vulnerable to HIV/STIs given the high levels of RAI with low condom use levels.
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