Are men who have sex with men (MSM) involved in sex work at higher risk for HIV than the general population of MSM? Results of a population-based behavioral and seroprevalence study in Campinas, Sao Paulo, Brazil
Background: Information on MSM engaged in sex work (MSW) in Brazil is lacking. A cross-sectional study was conducted in Campinas, Brazil to compare population estimates of sexual risk behaviors and HIV seroprevalence of MSW to non-MSW.
Methods: MSM (N=658) were recruited through respondent-driven sampling. Audio-assisted computer self-interview was used to collect information on sexual behaviors, and HIV testing was performed. Estimates with 95% confidence intervals of characteristics and behaviors of MSW and non-MSW were calculated in RDSAT and compared. Non-overlapping CIs of the two group estimates were considered significantly different.
Results: The median age of MSM was 23, and 86% were unmarried. Twenty-eight percent reported ever receiving payment for sex, and 15% reported engaging in sex work in the past 2 months; the majority had exclusively male clients. MSWs and non-MSWs were similar in age and marital status; however, MSWs were significantly less likely to identify themselves as homosexual than non-MSWs (57% vs. 76%). MSWs were significantly more likely than non-MSWs to practice unprotected receptive (22% vs. 5%) and unprotected insertive (21% vs. 5%) anal intercourse with >1 male partner, and unprotected vaginal sex with women (23% vs. 6%). Although not statistically significant, HIV seroprevalence in MSWs was more than twice that in non-MSWs (14% vs. 6%). History of HIV testing was similar in both groups (about 60%). MSWs and MSWs experienced high levels of homophobic abuse, but MSWs experienced significantly greater rates of psychological abuse (81% vs. 58%) and physical abuse (48% vs. 15%). MSW used crack (25% vs. 2%) and cocaine (34% vs. 11%) significantly more frequently in the last 6 months than non-MSWs.
Conclusions: MSM engaged in sex work are at higher risk for HIV than the general population of MSM. It is crucial for HIV/STI prevention efforts to be targeted to this riskier subgroup.
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