High rates of STD and sexual risk behaviors among Garífunas in Honduras.

ABSTRACT

BACKGROUND: Honduras has the highest concentration of HIV and AIDS cases in Central America, with an estimated adult HIV prevalence of 1.5%. Prevalence is higher among certain ethnic groups such as the Garífuna with a reported HIV prevalence of 8%. METHODS: A biological and behavioral survey was conducted on a stratified random sample of the Garífuna population in Honduras, using computer-assisted interviews. Blood was tested for HIV, herpes simplex type 2 (HSV-2), and syphilis; urine was tested for Chlamydia trachomatis, Neisseria gonorrhoea, Trichomonas vaginalis, and Mycoplasma genitalum. RESULTS: We enrolled a total of 817 participants, 41% female and 51% male. Estimated prevalences and 95% confidence intervals (CI) were HIV, 4.5% (95% CI 3.0 to 6.6), HSV-2, 51.1% (95% CI 46.7 to 55.6), and syphilis seropositivity, 2.4% (95% CI 1.4 to 4.0). Sexually transmitted infections in urine were chlamydia, 6.8% (95% CI 4.7 to 9.7), gonorrhea, 1.1% (95% CI 0.4 to 2.9), trichomoniasis, 10.5% (95% CI 8.1 to 13.6), and Mycoplasma genitalium, 7.1% (95% CI 5.1 to 9.9). Consistent condom use was low with stable (10.6%) and casual (41.4%) partners. In multivariate analysis, HIV was associated with rural residence. HSV-2 was associated with female sex, older age, and syphilis seropositivity. CONCLUSIONS: We found a moderate prevalence of HIV and a high prevalence of HSV-2 among the Garífunas. HSV-2 may increase the vulnerability of these populations to HIV in the future. Intervention strategies should emphasize sexually transmitted infection control and condom promotion, specifically targeting the Garífuna population.