FPP prevention for MSM in Ecuador: positive changes in behavior, but not so much on STI transmission
Background: The HIV epidemic in Latin-America, as in Ecuador, has been largely concentrated among MSM. The Frontiers Prevention Program is a major multi-country prevention program focused on a comprehensive set of interventions by and for key population groups.
Methods: The evaluation design consisted of a prospective randomized controlled community trial; 6 cities where allocated to intervention (3) or comparison, where existing programs continue. A mid 2003 baseline survey used a comprehensive multidisciplinary, questionnaire (demographics, socioeconomics and behaviors). Blood was collected for HSV 2 and syphilis. A mid 2007 follow-up survey was similar, plus variables measuring exposure to the interventions. Using these surveys cities we estimated the program effect on condom use and biomarkers.
Results: 2,026 MSM were interviewed at baseline and 1,676 at follow-up. In both, about 30% were in the comparison sites. Condom use with male partners increase from 35% in both groups to 55% in comparison cities and 77% in intervention cities (p=0.052 for the difference between intervention and comparison); condom use with female partners remained constant at 35% in comparison cities and increased from 22% to 53%. These changes are large and strongly suggestive of a large program impact. They are not statistically significant because of the small number of clusters. Including exposure measures suggests a positive association with condom use with both male & female partners. However, both syphilis and HSV 2 increased in both groups (although less than in the comparison group), suggesting that increased condom use was not enough to stop STI transmission.
Conclusions: Available data from MSM and SW are not able to explain the rapid increases in STIs in these sites. Comprehensive prevention activities seem to have a positive effect on increasing condom use and reduce, but don’t reverse, increases in STI prevalence that may be driven by increases in risk behavior in the broader population.
-Abstract available at link below-