Knowledge of HIV transmission and condom use among HIV-positive heterosexual men and women in Guatemala

Journal of the International AIDS Society Knowledge of HIV transmission and condom use among HIV-positive heterosexual men and women in Guatemala Juan J Delgado Hurtado 0 2 Marcela Pineda 0 2 Iris Cazali 0 1 2 Carlos Meja 1 0 Universidad Francisco Marroquin, School of Medicine , Guatemala City , Guatemala 1 Infectious Diseases Unit, Roosevelt Hospital , Guatemala City , Guatemala 2 Universidad Francisco Marroquin, School of Medicine , Guatemala City , Guatemala Background: The prevalence of HIV/AIDS in Guatemala among the general population is 0.79%, and 94% of transmission is directly related to sexual contact. Studies have been conducted on high- prevalence HIV-positive populations (men who have sex with men, commercial sex workers and prisoners). Heterosexual transmission has gained importance in the epidemic in Central America. To our knowledge, no study addressing knowledge of mechanisms of HIV transmission and condom use has been done on HIV-positive heterosexual men and women. Methods: A closed-ended structured interview that addressed knowledge of mechanisms of HIV transmission and condom use was conducted on 283 heterosexual HIV-positive men (54.8%) and women (45.2%) outpatients who attend the Roosevelt Hospital's Clinic of Infectious Diseases in Guatemala City. Differences between selected characteristics were examined for significance using the Chi-square test. A multiple logistic regression was done to determine socio-demographic variables associated with inconsistent condom use. Results: Of the interviewed persons, 68.5% were either living with a partner or married, and 94.3% were currently using antiretroviral therapy. Most respondents knew the mechanisms of transmission of HIV. 81.7% and 87.3% reported always using a condom with their regular and casual sexual partner in the past year, respectively. There was no statistically difference in condom use according to the patient's formal education, gender, type of partner (regular or casual)or number of sexual partners. According to the interviewees, 72% of sexual partners in the past year were either HIV negative or of an unknown serostatus. Potentially, these HIV-negative persons are at risk of contracting the virus. Among the main reasons given for not using a condom were: my partner did not want to use a condom"; and the condom irritates or makes my partner uncomfortable. Conclusions: Since no socio-demographic or sexual behavior variable was associated with inconsistent condom use, we recommend intensive and regular condom counselling for every heterosexual HIV-positive outpatient who attends the clinic. Further studies should be done to determine condom use negotiation between partners; and to determine social, interpersonal and psychological factors that might affect the decision to use a condom or not. - Background Guatemala is the most populated country in Central America, with almost 14 million inhabitants [1], 3 million of whom live in Guatemala City, its capital [2]. It is estimated that 51% of the countrys population live in poverty [3]. Guatemalas population annual growth rate is 2.06% [1], which is higher than that of the rest of Latin America. According to the Human Development Index, it is categorized as a medium-developed country with a current ranking of 131 out of 187 [4]. The prevalence of HIV/AIDS among the general population is 0.79% [1]. It is estimated that 94% of transmission is directly related to sexual contact and that 5% of the new cases are transmitted vertically. The HIV-positive population lives predominantly in urban areas along commercially important roads and migration routes to the United States and Mexico. Most of the cases (80%) have occurred in persons in the range of 15 to 49 years of age. The prevalence of HIV among men who have sex with men (MSM) is 18.3%, among commercial sex workers 1.09% and among prison inmates 3.24% [1]. The number of HIV cases in women is increasing. According to information provided by the two HIV clinics located in Guatemala City (Luis Angel Garcia, San Juan de Dios Hospital and Infectious Diseases Clinic, Roosevelt Hospital), in 2004, 74% of new HIV cases were women without any risk factor other than having sexual relations with their regular partner [5]. This feminization of the epidemic is probably a result of having sex with infected men who, in their turn, have had extramarital sexual relations with HIV-positive people [5]. To provide effective measures that diminish HIV transmission, it is important to study the knowledge of mechanisms of HIV transmission, sexual behaviour and condom use among heterosexual HIV-positive patients. In some countries, this type of transmission has been increasingly examined. In Guatemala, there has been some research done on condom use and knowledge of HIV transmission in sex workers [6] and MSM [7]. According to a study done on MSM, 82.3% of respondents expressed consistently using a condom with their casual partner in the previous month, while 62.8% reported consistently using condoms with their regular partner in the previous month. In total, 80.1% of the sample had used a condom in their most recent sexual relation. This study also addressed knowledge of mechanisms of HIV transmission. Of the respondents, 21.9% thought mutual faithfulness was a method of preventing transmission of HIV [7]. A study done on female sex workers reported that 78.8% and 96.1% of the sample expressed using a condom consistently with their casual and regular sex clients, respectively, in the previous month [6]. A study that examined the impact HIV voluntary counselling and testing had on self-reported behavioural risk (in the previous three months) of people living with HIV (PLHIV) found that it resulted in a modification of risky behaviour. Initially, before being counselled and diagnosed with HIV; 12.19% (5) of the sample (41 persons) stated that they had never had unprotected sexual relations in the prior three months. On the follow up visit, three months after counselling and diagnosis, 73.17% reported never having unprotected sexual relations in the prior three months [8]. This difference was statistically significant. Heterosexual transmission has gained importance in the epidemic in Central America. In some countries, this type of transmission has been increasingly examined, but in Guatemala to our knowledge, few studies have been done on heterosexual people. Therefore, the objectives of this study were to describe the socio-demographic characteristics of the sample, to determine the knowledge of the mechanisms of HIV transmission, to determine condom use among heterosexual PLHIV, and to identify variables associated with inconsistent condom use. This can help generate more focused counselling for non-condom-adherent heterosexual PLHIV. Methods This cross-sectional descriptive study was conducted in 2010 at the Roosevelt Hospitals Clinic of Infectious Diseases, an outpatient clinic, in Guatemala City, under (...truncated)