Notification for sexually transmitted infections and HIV among sex workers in Guatemala: acceptability, barriers, and preferences.

Partner notification for HIV and other sexually transmitted infections is acceptable and feasible among female sex workers attending sexually transmitted infection clinics in Guatemala, especially for regular partners. Intention to refer the sexual partner was best predicted by attitude followed by social norms and baby's protection. Women preferred notification via patient-based referral.

Human immunodeficiency virus, sexually transmitted infections, and risk behaviors among clients of sex workers in Guatemala: are they a bridge in human immunodeficiency virus transmission?

OBJECTIVES: Clients of female sex workers (FSWs) are an important target group for human immunodeficiency virus/sexually transmitted infection (HIV/STI) prevention. This study aimed to estimate their HIV and other STI prevalence, examine their risk behaviors, and evaluate their role as a bridge population in the spread of HIV/STIs. METHODS: A cross-sectional study was performed among 553 clients recruited in commercial sex sites in the province of Escuintla, Guatemala. They were interviewed and tested for HIV and other STIs. RESULTS: Half of the clients who were approached refused participation. Median age was 28.9 years; 57.7% had a regular partner, of whom, 10.1% had concurrent noncommercial partnerships. Consistent condom use with FSWs and regular partners was 72.5% and 17.1%, respectively. Approximately 18% formed a bridge, and 40.0% a potential bridge. Among those who provided samples (70.5% provided a blood sample and 89.7%, urine sample), prevalence of HIV, syphilis, gonorrhea, chlamydia, and herpes simplex virus 2 was 1.5%, 1.0%, 0.8%, 5.5%, and 3.4%, respectively. Unprotected sex with FSWs and drug use just before sex were risk factors for having any STI (9.8% of participants). Bridge clients were significantly less educated, more employed, paid lower prices to the FSW just visited, and had a previous STI. CONCLUSIONS: There is a relatively high prevalence of HIV in clients compared to national estimates, and a substantial proportion of them act as a bridge for HIV/STI transmission between FSWs and the general population in Escuintla. Given that this is fuelling the current HIV epidemic, preventive interventions addressing this hard-to-reach group are urgently required.

The UALE Project: decline in the incidence of HIV and sexually transmitted infections and increase in the use of condoms among sex workers in Guatemala.

OBJECTIVES: To assess the impact of a multilevel sexually transmitted infections (STI)/HIV prevention and treatment intervention on the incidence of STIs and HIV, the use of condoms, and HIV knowledge among sex workers (SWs). METHODS: An open-enrolment cohort of 1554 SWs attending STI clinics integrated within the primary health care system of Escuintla, Guatemala. They were offered 6 monthly STI/HIV screening, condom promotion, education, and community-based interventions. We evaluated trends in condom use, HIV-related knowledge, and STI/HIV incidence using generalized estimating equations. RESULTS: For over three and a half years, there was a significant increase in the proportion of consistent condom use from the baseline visit through the third follow-up visit (94.29%-99.11% with new clients and 90.36%-97.22% with regular clients) and in HIV-related knowledge (95.99%-97.22%). Except for syphilis, we observed a significant decline in gonorrhoea, chlamydia, trichomoniasis, and candidiasis in each follow-up visit, from 11.30 per 100 person-years, 10.71 per 100 person-years, 6.88 per 100 person-years, and 8.23 per 100 person-years in the first follow-up visit to 6.44 per 100 person-years, 6.21 per 100 person-years, 4.81 per 100 person-years, and 6.17 per 100 person-years in the third follow-up visit, for each STI, respectively. HIV global incidence was 0.41 per 100 person-years, and it significantly declined from 1.85 per 100 person-years (2005) to 0.42 per 100 person-years (2008). CONCLUSIONS: Although a longer follow-up would be needed, the results suggest that the intervention was feasible and has been shown to be effective in reducing STI and HIV incidence and in increasing condom use with clients and HIV-related knowledge.