Changing risk factors for HIV infection among men having sex with men in Manila, Philippines
L.M. Gangcuangco1, D.E. Sumalapao2, M.L. Tan3, R. Berba4
1University of the Philippines-Philippine General Hospital, Internal Medicine, Manila, Philippines, 2University of the Philippines Manila College of Arts and Sciences, Manila, Philippines, 3Social Hygiene Clinic of Manila, Manila, Philippines, 4UP-Philippine General Hospital, Internal Medicine, Manila, Philippines
Background: The steep rise of HIV infection among MSM in the Philippines is alarming. Reports suggest that most cases are MSM working as call center agents (CCA). This study aims to determine the prevalence and risk factors for HIV infection among MSM in Manila.
Methods: Legal-aged MSM were purposively sampled and interviewed from November 2009 to January 2010 from bars in Manila patronized by MSM clients. After counselling and psychological evaluation, rapid HIV screening was conducted using SD Bioline HIV 1/2 3.0. Rapid test positive samples were confirmed by Western blot.
Results: Out of 406 MSM study participants, 48 (11.82%) were rapid test positive; of whom 40 consented to proceed to Western blot, giving a prevalence of 9.85% confirmed HIV infection (95% CI 6.9%-13%). The mean age of participants was 26.2 years (SD 5.4). Among 385 who disclosed their occupation, 130 (34%) were CCA, 24 of which were confirmed HIV positive.
On logistic regression, two independent risk factors to acquiring HIV were identified: working as a CCA (OR 3.44; 95% CI 1.51-7.83) and having occasional unprotected sex (OUS) with a stranger as an anal receiver (OR 4.97; 95% CI 1.04-23.71). On the other hand, always using condoms when having sex with a significant partner as an anal inserter (ASP) is associated with reduced risk (OR 0.05; 95% CI 0.00-0.89). Age, educational attainment, age of first sexual contact, number of sex partners, and history of sexually transmitted infections are not significantly associated with HIV.
Conclusions: The prevalence of HIV among MSM in Manila is high. OUS and working as a CCA are independent risk factors to acquiring HIV. ASP has a significant protective effect. MSM who are CCA may be a novel vulnerable group in the Philippines. Studies and interventions to reduce risks should be initiated targeting MSM working as CCA.