The incorporation of HIV self-testing as an exclusive option among men who have sex with men in Spain: results of an online cross-sectional study.

BACKGROUND: We assessed to what extent HIV self-testing would be incorporated by men who have sex with men (MSM) with previous testing history as their exclusive testing option and describe what actions they would take in the case of obtaining a reactive self-test. METHODS: We conducted an online survey among Spanish resident MSM recruited mainly in gay dating apps and analyze 6171 ever tested individuals. We used Poisson regression to estimate factors associated with the incorporation of self-testing as the exclusive testing option. Among those who would incorporate self-testing as their exclusive option, we described actions taken if obtaining a reactive self-test by number of tests in the past. RESULTS: Nearly half of the participants (48.3%) were > =35 years old, 84.6% were born in Spain, 57.9% had attained a university degree, 55.1% lived in a municipality of ≤500.000 and 86.4% self-identified as homosexual. For 37.2%, self-testing would become their exclusive testing option. The incorporation of self-testing as the exclusive option increased with age 25-34 (PR:1.1, 95%CI:1.0-1.3), 35-44 (PR:1.3, 95%CI:1.2-1.5), 45-49 (PR:1.5, 95%CI:1.3-1.7) and > 50 (PR:1.5, 95%CI:1.3-1.8) and in those who reported unprotected anal intercourse (PR:1.1, 95%CI:1.0-1.2) or having paid for sex (PR:1.2, 95%CI:1.0-1.3) in the last 12 months. It was also associated with having had < 10 HIV test in the past (2-9 tests (PR:1.3, 95%CI:1.1-1.4); 1 test (PR:1.5, 95%CI:1.3-1.7)), and having been tested ≥2 years (PR:1.4, 95%CI:1.3-1.5) or between 1 and 2 years ago (PR:1.1, 95%CI:1.0-1.2). Of participants who would use self-testing exclusively 76.6% would confirm their result in case of obtaining a reactive self-test and only 6.1% wouldn't know how to react. Only one individual expressed that he would do nothing at all. CONCLUSION: HIV self-testing could become the exclusive testing option for more than a third of our participants. It was chosen as the exclusive option especially by older, at risk and under-tested MSM. Self-testing strategies need to especially consider the linkage to care process. In this sense, only a small fraction would not know how to react and virtually nobody reported taking no action if obtaining a reactive result.

Knowledge, actual and potential use of HIV self-sampling testing kits among MSM recruited in eight European countries.

AIM: To describe the knowledge as well as current and potential use of self-sampling kits among men who have sex with men (MSM) and to analyse their preferred biological sample and result communication method. METHODS: We analyse data of MSM of HIV negative or unknown serostatus from an online survey conducted in eight countries (Belgium, Denmark, Germany, Greece, Portugal, Romania, Slovenia and Spain) between April and December 2016. It was advertised mainly in gay dating websites. We conduct a descriptive analysis of the main characteristics of the participants, and present data on indicators of knowledge, use and potential use of HIV self-sampling as well as their preferences regarding blood or saliva sample and face or non-face-to-face result communication by country of residence. RESULTS: A total of 8.226 participants of HIV negative or unknown serostatus were included in the analysis. Overall, 25.5% of participants knew about self-sampling (range: 18.8-47.2%) and 1.1% had used it in the past (range: 0.3-8.9%). Potential use was high, with 66.6% of all participants reporting that they would have already used it if available in the past (range: 62.1-82.1%). Most (78.6%) reported that they would prefer using a blood-based kit, and receiving the result of the test through a non-face-to-face-method (70.8%), even in the case of receiving a reactive result. CONCLUSION: The high potential use reported by MSM recruited in eight different European countries suggests that self-sampling kits are a highly acceptable testing methodology that could contribute to the promotion of HIV testing in this population.

Effect of country-of-origin contextual factors and length of stay on immigrants' substance use in Spain.

BACKGROUND: Factors explaining disparities in risk of substance use between immigrants and natives and between immigrant subgroups are poorly understood. We aimed to describe such disparities and identify some explanatory factors in Spain. METHODS: Participants were residents aged 15-64 years from 2005 to 07 nationally representative surveys. Outcomes were prevalences of alcohol, tobacco, sedative-hypnotics, cannabis and other illegal substance use. Immigrants were recent if <5 years of Spanish stay and long term if ≥10 years. Country-of-origin income per capita and population level of substance use were taken from international databases. Adjusted prevalence ratios (aPRs) and percent change from Poisson regression with robust variance were used to estimate risk disparities and effects of immigration variables. RESULTS: Most immigrants had lower substance use than natives, although it generally increased with increasing Spanish stay, especially for illegal substances. This lower risk could be partially explained by country-of-origin contextual factors as a lower level of income or substance use and religious or cultural factors such as Islam. By origin, recent immigrant aPRs and convergence-divergence risk patterns were, respectively, as follows: lower aPRs with upward convergence (often incomplete) toward natives' risk in immigrants from Muslim area, Eastern-Europe and Latin-America excluding South-Cone, lower/similar aPRs with upward overtaking or divergent patterns in South-Cone Americans and similar/higher aPRs with stable or upward divergent patterns in Non-Eastern-Europeans. CONCLUSION: Spain is a host context that seems to facilitate increased substance use among immigrants, even those from countries with prevalences close to Spain. However, country-of-origin context is important in explaining disparities in substance use among immigrants.

Assessment of an outreach street-based HIV rapid testing programme as a strategy to promote early diagnosis: a comparison with two surveillance systems in Spain, 2008-2011.

We assess the added value of a multisite, street-based HIV rapid testing programme by comparing its results to pre-existing services and assessing its potential to reduce ongoing transmission. Between 2008 and 2011, 8,923 individuals underwent testing. We compare outcomes with those of a network of 20 sexually transmitted infections (STI)/HIV clinics (EPI-VIH) and the Spanish National HIV Surveillance System (SNHSS); evaluate whether good visibility prompts testing and assess whether it reaches under-tested populations. 89.2% of the new infections were in men who have sex with men (MSM) vs 78.0% in EPI-VIH and 56.0% in SNHSS. 83.6% of the MSM were linked to care and 20.9% had <350 CD4 HIV prevalence was substantially lower than in EPI-VIH. 56.5% of the HIV-positive MSM tested because they happened to see the programme, 18.4% were previously untested and 26.3% had their last test ≥2 years ago. The programme provided linkage to care and early diagnosis mainly to MSM but attendees presented a lower HIV prevalence than EPI-VIH. From a cost perspective it would benefit from being implemented in locations highly frequented by MSM. Conversely, its good visibility led to reduced periods of undiagnosed infection in a high proportion of MSM who were not testing with the recommended frequency.

The rapid test in Spanish pharmacies: a novel programme to reach heterosexual men?

OBJECTIVES: Spain has been a pioneer in the implementation of rapid HIV testing programmes in pharmacies to increase access to testing. However, no formal evaluation of the effectiveness of these programmes has been carried out to date. Our aim was to evaluate the ability of a novel in-pharmacy rapid HIV testing programme to promote diagnosis and reach vulnerable populations. METHODS: Between 2011 and 2012, 2168 people underwent testing in 16 urban pharmacies in 10 cities of a Spanish region with a low prevalence of HIV infection. The main outcomes of the programme were compared with those of the regional surveillance system for new HIV diagnoses (RHSS-CyL). RESULTS: Overall, 52.8% of those tested were heterosexual men, 15.8% were men who have sex with men (MSM) and 25.3% were women. Nine per cent were immigrants and 41.9% were < 30 years old. In total, 59.5% of the heterosexual men, 44.6% of the MSM and 65.3% of the women were previously untested. There were 23 positive results, representing 6% of all new regional diagnoses in 2011. The global prevalence was 1.1% (95% confidence interval 0.6-1.5%) and the prevalence in MSM was 3.8%. Of the reactive results, 60.9% were in MSM, 34.8% in heterosexual men and only 4.3% in women, vs. 35.4%, 37.5% and 15.0%, respectively, reported by the RHSS-CyL. The mean age of those testing positive was 32.7 years vs. 38.7 years in the RHSS-CyL. Fifty per cent of MSM and 75% of heterosexual men testing positive were previously untested. CONCLUSIONS: In Spain, this is the first programme not targeted at the most at-risk populations, and has been shown to be effective in reaching and diagnosing heterosexual men, who are the group most affected by delayed diagnoses. Heterosexual men accounted for over half of those tested and a third of those diagnosed, and most of them were previously untested. Young and previously untested MSM also greatly benefitted from the programme.

Awareness and use of nonoccupational HIV post-exposure prophylaxis among people receiving rapid HIV testing in Spain.

OBJECTIVES: This paper examines the awareness and use of nonoccupational HIV post-exposure prophylaxis (nPEP) in Spain, and the factors that influence this awareness. METHODS: Between June 2009 and July 2010, a mobile unit offered free, rapid HIV tests in a number of Spanish cities. A total of 2545 people were passively recruited and tested, and answered a self-administered questionnaire containing sociodemographic, behavioural and nPEP-related questions. Bivariate and multivariate analyses were performed, stratifying by gender/sexual behaviour. RESULTS: Some 34% of the responders were men who have sex with men (MSM), 30% were men who have sex exclusively with women (MSW), and 35% were women. Approximately 26% were foreigners, 46% had a university degree, and 51% had previously taken an HIV test. Overall, 22% were aware of nPEP. Only 2% had ever used it; 70% of these after high-risk sexual intercourse. Awareness was higher among MSM (34%) than women (16%) and MSW (15%). Multivariate analysis showed a lack of nPEP awareness to be associated with being born in Latin America, while awareness increased with the number of previous HIV tests among women and MSW. In MSM, awareness was also associated with having a university degree, the degree of interaction with gay culture, number of partners, and use of the internet as the main way of meeting partners. CONCLUSIONS: nPEP awareness in the studied population was unacceptably low. The promotion of its availability should be made a major objective of prevention programmes, as a complementary measure to condom use.

Increasing early diagnosis of HIV through rapid testing in a street outreach program in Spain.

Our goal was to analyze the results of a multicity program offering rapid HIV testing in a mobile unit in central locations. Between October 2006 and December 2007, 7138 persons were tested, providing a finger-prick blood sample and filling out a brief questionnaire while waiting for the results of the Determine((R)) test. Seventy people were classified as reactive and 3 as indeterminate. Confirmatory test results were obtained for 83.6%. Of the 56 reactive persons contacted, 2 were confirmed as negative, giving a positive predictive value of 96.6%. Those tested were primarily men (60.6%), persons with university education (47.4%), and included a large percentage of immigrants (26.2%), especially from Latin America, and 37.3% were men who have sex with men (MSM). Forty-seven percent had ever been tested for HIV. Global HIV prevalence was 0.98% (confidence interval [CI]: 0.75-1.21), 1.59%, (CI: 1.21-1.97) in men and 0.19%, (CI: 0.02-0.35) in women. In the tree analysis the high prevalence node included Latin Americans with only primary studies (study level finished at least at the age of 12). Of the 64% HIV-positive tests in 2007 with available CD4 counts, 18.75% had CD4 counts under 350. Street-based mobile units offering rapid HIV testing in selected sites, may diagnose HIV at an earlier stage of infection than clinic-based sites, and have a low rate of false-positives.

Human immunodeficiency virus testing uptake and risk behaviours in Spain.

BACKGROUND: The purpose of this study was to estimate the prevalence of human immunodeficiency (HIV) testing in the general population; to analyse factors related to voluntary testing; and to describe the main reasons for testing, the kinds of health services where testing takes place and the relations between self-risk perception and HIV testing. METHODS: A probability sample survey of health and sexual behaviour in men and women aged 18-49 years and resident in Spain in 2003 (n = 10 980) was used. A combination of face-to-face and computer-assisted self-interview was used, and bivariate and multivariate logistic regression analyses were performed. RESULTS: Some 39.4% (40.2% in men and 38.5% in women) had ever been tested, blood donation being the main reason for men and pregnancy for women. In the multivariate analysis, HIV testing was associated with foreign nationality, high educational level, having injected drugs and having a large number of sexual partners. In men, it was also associated with age 30-39 years, having had sex with other men and having paid for sex. About 29.3% of men and 32.8% of women had their last voluntary HIV test in primary healthcare centres, whereas only 3.4% of men and 3.6% of women had last been tested in sexually transmitted infection/HIV diagnostic centres. About 20.2% of men and 5.5% of women with risk behaviours had never been tested. CONCLUSION: The proportion of men with risk behaviours who have never had an HIV test is unacceptably high in Spain. Scaling up access to HIV testing in this population group remains a challenge for health policies and research.

Men who pay for sex in Spain and condom use: prevalence and correlates in a representative sample of the general population.

OBJECTIVE: To estimate the percentage of men who have paid for heterosexual sex in Spain and the percentage who used condoms. To identify the main factors associated with these behaviours and to describe opinions about condoms. METHODS: Sexual behaviour probability sample survey in men aged 18-49 years resident in Spain in 2003 (n = 5153). Computer-assisted face to face and self interview was used. Bivariate and multivariate logistic regression analyses were performed. RESULTS: 25.4% (n = 1306) of the men had paid for heterosexual sex at some time in their lives; 13.3% (n = 687) in the last 5 years and 5.7% (n = 295) in the last 12 months. In the logistic analysis this behaviour was associated with older age, lower education, being unmarried, foreign birth, being a practicing member of a religious group, unsatisfactory communication with parents about sex, age under 16 years at first sexual intercourse and having been drunk in the last 30 days. Of the men who had paid for sex in the previous 5 years, 95% (n = 653) had used a condom in the most recent paid contact. In the multivariate analysis, not using a condom was associated with age over 30 years and first sexual intercourse before age 16 years. Men who did not use condoms in the last commercial intercourse had more negative opinions about condoms. CONCLUSIONS: The prevalence of paying for heterosexual sex among Spanish men is the highest ever described in developed countries. The many variables associated with paying for sex and condom use permit the characterisation of male clients of prostitution and should facilitate targeting HIV prevention policies.

Influence of age and geographical origin in the prevalence of high risk human papillomavirus in migrant female sex workers in Spain.

OBJECTIVES: To estimate the prevalence and risk factors of high risk human papillomavirus (HPV) infection in migrant female sex workers (FSW) according to age and geographical origin. METHODS: Cross sectional study of migrant FSW attending a sexually transmitted infection (STI) clinic in Madrid during 2002. Information on sociodemographic characteristics, reproductive and sexual health, smoking, time in commercial sex work, history of STIs, HIV, hepatitis B, hepatitis C, syphilis, and genitourinary infections was collected. High risk HPV Infection was determined through the Digene HPV Test, Hybrid Capture II. Data were analysed through multiple logistic regression. RESULTS: 734 women were studied. Overall HPV prevalence was 39%; 61% in eastern Europeans, 42% in Ecuadorians, 39% in Colombians, 29% in sub-Saharan Africans, and 24% in Caribbeans (p = 0.057). HPV prevalence showed a decreasing trend by age; 49% under 20 years, 35% in 21-25 years,14% over 36 years% (p<0.005). In multivariate analyses, area of origin (p = 0.07), hormonal contraception in women not using condoms (OR 19.45 95% CI: 2.45 to 154.27), smoking, age, and an interaction between these last two variables (p = 0.039) had statistically significant associations with HPV prevalence. STI prevalence was 11% and was not related to age or geographical origin. CONCLUSIONS: High risk HPV prevalence in migrant FSW is elevated and related to age, area of origin, and use of oral contraceptives in women not using condoms. These data support the role of acquired immunity in the epidemiology of HPV infection and identifies migrant FSW as a priority group for sexual health promotion.

Risk of HIV infection among male sex workers in Spain.

OBJECTIVE: To assess HIV prevalence and predictive factors for HIV among male sex workers in Spain. METHODS: In this study we analysed all male sex workers who visited HIV testing clinics in 19 Spanish cities between 2000 and 2002. The information was obtained during examination by means of a brief questionnaire. For repeating testers, only the last confirmed result was taken into account. RESULTS: 418 male sex workers were included in the analysis; 58% visited these clinics for the first time and 42% were repeating testers. 67% were of foreign origin, mostly from Latin America (91%). 96% had had sex with men, 18% were transvestites or transsexuals, and 3.3% had used injected drugs. HIV prevalence was 12.2% (95% CI, 9.3 to 15.8%), and rose to 16.9% among first time testers. No differences in HIV prevalence were found between injecting drug users, transvestites/transsexuals, and men from foreign countries. CONCLUSION: Because of the high risk of HIV infection, male sex workers should be the target of specific preventive activities. Preventive and healthcare strategies that are culturally adapted to migrants are required.

[Are we diagnosing people infected with HIV in time?]. / Estamos diagnosticando a tiempo a las personas infectadas por el VIH?

OBJECTIVE: To describe the number of AIDS cases who did not know of their HIV infection until they developed AIDS, and the factors relating to this situation. DESIGN: Descriptive study of data of the National AIDS Register.Setting. Spain.Patients. Cases of AIDS in the over-14s diagnosed between 1997 and 1999. RESULTS: Of the 6910 cases of AIDS studied, 35% (n = 2421) knew that they were HIV-positive at the same time as they were diagnosed with AIDS (in the same month or the previous one). The multi-variate analysis showed that this situation occurred less commonly in women (OR = 0.61; 95% CI, 0.53-0.71), in cases diagnosed in prison (OR = 0.19; 95% CI, 0.13-0.27), in cases diagnosed early (OR = 0.49; 95% CI, 0.41-0.60) and among residents in provinces with AIDS rates higher than the Spanish average (OR = 0.88; 95% CI, 0.78-0.99). Ignorance of HIV infection until the AIDS diagnosis was associated to ages of under 25 and over 34, homo/bisexual transmission (OR = 3.20; 95% CI, 2.69-3.80) and heterosexual transmission (OR = 4.88; 95% CI, 4.21-5.65) compared with intravenous drug users, and to the person coming from countries other than Spain, both developed (OR = 2.78; 95% CI, 1.89-4.08) and under-developed (OR = 1.85; 95% CI, 1.26-2.72) countries. CONCLUSIONS: A considerable number of people diagnosed with AIDS were unaware of their HIV infection, especially among people who had never injected drugs. HIV needs to be diagnosed earlier so as to improve prevention and treatments.

¿Estamos diagnosticando a tiempo a las personas infectadas por el VIH? / Are we diagnosing people infected by hiv in time?

Objetivo. Describir la proporción de casos de sida que no conocían su infección por el VIH hasta que desarrollaron sida y los factores asociados a esta situación. Diseño. Estudio descriptivo de datos del Registro Nacional de Sida. Emplazamiento. España. Pacientes. Casos de sida mayores de 14 años diagnosticados entre 1997 y 1999.Resultados. De los 6.910 casos de sida estudiados, un 35 por ciento (n = 2.421) supo que estaba infectado por el VIH coincidiendo con el diagnóstico de sida (en el mismo mes o en el anterior). En el análisis multivariante esta situación fue menos frecuente en mujeres (OR, 0,61; IC del 95 por ciento, 0,53-0,71); en los casos diagnosticados en prisión (OR, 0,19; IC del 95 por ciento, 0,13-0,27) o en los que habían estado presos con anterioridad (OR, 0,49; IC del 95 por ciento, 0,41-0,60) frente al resto, y los residentes en provincias con tasas de sida mayores que la española (OR, 0,88; IC del 95 por ciento, 0,78-0,99). Por el contrario, el desconocimiento de su infección por el VIH hasta el diagnóstico de sida se asoció a la edad menor de 25 o mayor de 34 años, a las categorías de transmisión homo/bisexual (OR, 3,20; IC del 95 por ciento, 2,69-3,80) y heterosexual (OR, 4,88; IC del 95 por ciento, 4,215,65) en comparación con los usuarios de drogas por vía parenteral, y a la procedencia de países distintos de España, tanto desarrollados (OR, 2,78; IC del 95 por ciento, 1,894,08) como en desarrollo (OR, 1,85; IC del 95 por ciento, 1,26-2,72).Conclusiones. Una proporción importante de las personas diagnosticadas de sida desconocía su infección por el VIH, especialmente aquellas que nunca habían usado drogas por vía patenteral. Se debe mejorar el diagnóstico precoz del VIH para conseguir un mayor impacto de la prevención y de los tratamientos (AU)

Sociodemographic characteristics and HIV risk behaviour patterns of male sex workers in Madrid, Spain.

This paper describes the sociodemographic and work characteristics, prevalence of HIV infection and associated risk behaviours among male sex workers (MSWs) in Madrid (Spain). Using an anonymous semi-structured questionnaire, educators attached to a mobile unit under a street-based prostitution programme surveyed 84 MSWs from several Madrid areas. Of the total surveyed: 35% were immigrants, mean age was 23 years, mean period in prostitution was four years; 21% had no primary education; 16% had injected drugs at some time; 11% reported private sexual relationships exclusively with women; 89% always used condoms in anal practices with clients; and 41% were in sexual relationships with their partners. Only 11% had ever used fortified condoms. In the preceding month, 37% had experienced condom failure, 82% without having used any lubricant. In all, 67% reported having undergone HIV testing, with a higher percentage of positive results among injecting (60%) versus non-injecting drug users (17%). Immigrants had a lower level of education, made less use of condoms, had more condom failures and, in their private lives, a greater proportion reported sexual relationships exclusively with women. In Spain, MSWs should be included in HIV prevention programmes, which ought to be specifically adapted to immigrants. Priority should be given to reducing the condom failure rate in anal intercourse, by improving access to fortified condoms.

Salud e inmigración; a propósito del sida / Health and inmigration; talking about aids

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Características sociales y conductas de riesgo para el VIH en un grupo de travestis y transexuales masculinos que ejercen la prostitución en la calle / Social characteristics and risk behaviour for HIV infection in male transgender street prostitutes

Objetivo: Describir las condiciones de vida y de trabajo, las prácticas asociadas a la transmisión del VIH, la cobertura y los resultados autoinformados de la prueba de VIH, en un grupo de travestis y transexuales que ejercen la prostitución en la calle. Métodos: Estudio descriptivo de serie de casos de travestis y transexuales masculinos que ejercían la prostitución en la calle, en Madrid, y que fueron atendidas por la unidad móvil de un programa de reducción de daños en 1998. Se recogieron datos sobre características sociodemográficas, condiciones de trabajo, consumo de drogas ilegales, conductas de riesgo sexual y estado serológico frente al VIH autoinformado. Resultados: Se entrevistaron 132 travestis y transexuales masculinos, de las cuales 56 por ciento eran españolas. La mediana de edad era de 30 años. El 50 por ciento tenía un nivel de estudios de EGB o inferior. El 11 por ciento se había inyectado drogas ilegales alguna vez. La mediana de años de prostitución era de 8 años y el 66 por ciento había ejercido sólo en la calle. En el último mes, todas dijeron utilizar el preservativo en las prácticas anales insertivas con los clientes, el 98 por ciento en las anales receptivas y el 49 por ciento lo utilizaron siempre con la pareja en el último año. El 39 por ciento tuvieron algún accidente con el preservativo en el último mes. El 73 por ciento se había realizado la prueba del VIH, siendo positivas el 22 por ciento (el 16 por ciento entre las que nunca se habían inyectado drogas y el 58 por ciento entre las que se habían inyectado alguna vez).Conclusiones: En travestis y transexuales que ejercen la prostitución la prevalencia de VIH es elevada, incluso entre las no inyectoras. El uso del preservativo en el medio laboral es alto, pero también su accidentabilidad. Los programas de prevención del VIH en prostitución deberían adaptarse más específicamente a los distintos grupos que la ejercen (AU)

[High-risk sex behavior and HIV prevalence among gay and bisexual men in the community of Madrid]. / Conductas sexuales de riesgo y prevalencia de infección por VIH en hombres con prácticas homosexuales y bisexuales en la Comunidad de Madrid.

BACKGROUND: To analyze high-risk sexual behavior as regards HIV, the use of preventive measures and the patient-reported prevalence of HIV infections among males belonging to one of the leading homosexual associations in the Region of Madrid. METHODS: Cross-sectional study conducted in 1997-1998 by way of mailed anonymous questionnaires. An analysis is made of the sociodemographic characteristics, how often condoms are used for different types of sexual intercourse with regular or casual partners, patient-reported prevalence of HIV and other related aspects. RESULTS: 157 questionnaires were returned by gay/bisexual males. These subjects averaged 32 years of age, 85% having a high school or college education, over the past 3 months, 56% had had intercourse with more than one man; 70.6% practiced insertive anal intercourse with a regular partner and 57.4% with casual partners, solely 32.5% and 61.1% of whom always used a condom. 69.7% had receptive anal intercourse with a regular partner and 39.4% with casual partners, 35.5% and 78.4% of whom respectively always used a condom. 86.6% had oral-genital intercourse, less than 10% having always used a condom. 137 were aware of their serological condition, and 15.2% were HIV positive. 10% had had some STD at some point during the previous year. CONCLUSIONS: A major percentage of those surveyed were involved in high-risk practices (several partners and unprotected high-risk sexual intercourse) which, in conjunction with the major prevalence of infection, can be said to be the same as a major seroconversion rate.

[Social characteristics and risk behaviors for HIV in a group of transvestites and male transsexuals engaging in street prostitution]. / Características sociales y conductas de riesgo para el VIH en un grupo de travestis y transexuales masculinos que ejercen la prostitución en la calle.

OBJECTIVE: To describe life and work conditions, practices associated with HIV transmission, self-informed HIV status and HIV test coverage in a group of male transgender street prostitutes. METHODS: Case descriptive study of male transgender street prostitutes who attended a mobile unit of a harm reduction programme in 1998 in Madrid, Spain Information on sociodemographic characteristics, work conditions, illegal drug use, sexual behaviours and self-informed HIV status was collected. RESULTS: 132 male transgenders were interviewed, of which 56% were Spanish. Median age was 30 years. 50% had primary school education or less. 11% had injected drugs sometime in their lives. Median time in prostitution was 8 years and 66% had worked only in the streets. In the last month, all of them said to use condoms in insertive anal sex with clients, 98% in receptive sex and 49% always used it with their partners in the previous year. 39% referred accidents with condoms within the previous month. 73% had had an HIV test, of which 22% said to be HIV positive (16% in those who had never injected drugs and 58% in the ones who had). CONCLUSIONS: HIV seroprevalence in male transgender street prostitutes is high, even in non-intravenous drug users. They nearly always use condoms with clients but have a high level of accidents. HIV prevention programmes in prostitution should be more specifically adapted to the different groups of commercial sex workers.

Drug and alcohol consumption and sexual risk behaviour among young adults: results from a national survey.

To study the association of the consumption of alcohol and other psychoactive drugs with sexual risk behaviour for HIV infection, data from a representative sample of the Spanish population aged 18-39 years were analysed. A national household survey was carried out in 1996 using a combination of face-to-face interviews and self-administered questionnaires. The survey included 5253 subjects aged 18-39 years who provided information on alcohol and drug consumption, number of sexual partners and condom use with the steady partner and with casual partners in the 12 months before the survey. Of those surveyed, 27.4% had been drunk at least once and 20.5% had consumed drugs. Both behaviours were associated with male sex, younger age, higher educational level, being single and having had more than one sexual partner. In the logistic regression analysis adjusting for the sociodemographic variables, the greater frequency of drunkenness and cannabis use were associated with having more than one sexual partner. Regular condom use was significantly less frequent among cocaine users and more frequent among opiate users, but was not associated with the use of other drugs. Sexual risk behaviour (i.e. more than one partner and failure to use a condom regularly) was more frequent among persons who had been drunk or used cannabis or cocaine. Excessive consumption of alcohol, and cannabis and cocaine use are independently associated with sexual behaviour involving greater risk of HIV infection or transmission.