Factors associated with HIV infection among a respondent-driven sample of men who have sex with men in Salvador, Brazil

Brignol, Sandra; Kerr, Ligia; Amorim, Leila Denise; Dourado, Inês

doi:10.1590/1980-5497201600020004

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ORIGINAL ARTICLE • Rev. bras. epidemiol. 19 (02) • Apr-Jun 2016 • https://doi.org/10.1590/1980-5497201600020004 copy

Factors associated with HIV infection among a respondent-driven sample of men who have sex with men in Salvador, Brazil

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT:

Human immunodeficiency virus (HIV) continues to disproportionately affect men who have sex with men (MSM); therefore, we investigated the sociodemographic, biological, and sexual behavioral risk factors associated with HIV infection in the city of Salvador, Bahia. This study is part of the national survey Behavior, Attitudes, Practices and Prevalence of HIV and Syphilis among men who have sex with men in 10 Brazilian Cities, which is a cross-sectional survey whose participants were selected by means of the respondent-driven sampling. Exact logistic regression analysis was used to measure the association of potential risk factors with HIV infection due to an HIV prevalence lower than 10% and a small sample size (383). The prevalence of HIV was 6.3% (95%CI 3.9-8.8) and the risk factors associated with HIV infection in our adjusted final model included having never been tested for syphilis (OR = 3.1; 95%CI 1.3 - 7.3) and having more than eight sexual partners (OR = 3.3; 95%CI 1.4 - 8.1). This study highlights the high prevalence of HIV among MSM in the sample compared with the general population and confirms the importance of testing for syphilis in the context of the HIV epidemic as early detection may provide opportunities to prevent sexually transmitted diseases.

Keywords:
HIV; Syphilis; Vulnerable populations; Male homosexuality; Risk factors; Logistic models

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E-mail: revbrepi@usp.br

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[1] Corresponding author: Sandra Mara Silva Brignol. Rua Marquês do Paraná, 303, 3º andar, prédio anexo ao HUAP, Centro, CEP: 24033-900, Niterói, RJ, Brasil. E-mail: sandrabrignol@gmail.com

Factors	n	Mean	Median	Min.	Max.
Family income	271	1,733.30	1.000	0	60,000^a
Number of people living in your household	381	3.1	3	0	54^b
Education (in years of schooling)	382	11.4	11	1	22^c
Current age	382	25.3	24	18	53
With how many partners have you had sexual intercourse (in the last 6 months)?	362	8.2	3	1	451
Age at first intercourse	383	14.5	15	6	28
Variables	n	%
Result of the rapid screening test for HIV
Negative	359	93.7
Positive	24	6.3
Result of the rapid screening test for syphilis
Negative	335	90.3
Positive	36	9.7
Syphilis testing at least once in life
No	100	27.7
Yes	274	73.3
HIV testing at least once in life
No	214	55.9
Yes	169	44.1
STD symptomsd
No	289	75.6
Yes	94	24.4
Race/color
White/others	34	8.9
Black	349	91.1
Economic class (Brazilian Economic Classification Criteria)
Upper class/upper middle class	60	15.7
Lower middle class/ working class/lower class	323	84.3
Sex category
MSM	184	48.2
Homosexual/gay	198	51.6
Told someonee you are sexually attracted to men
Yes	161	48.8
No	169	51.2
Variáveis	n	%
Experienced some kind of discrimination regarding race/color, social status, age, sexual orientation, or name-calling (ever or in the last year)
No	164	42.7
Yes	219	57.3
URAI with male casual partner in the last 6 months
Did not have anal intercourse or always used a condom during anal intercourse	148	68.0
Did not use a condom during anal intercourse at least once	70	32.0
URAI with a male steady partner in the last six months
Did not have anal intercourse or always used a condom during anal intercourse	93	54.9
Did not use a condom during anal intercourse at least once	176	45.1

Fatores	n	HIV + (n = 27)			OR^a	95%CI	p-Value
Fatores	Total	n	(%)
Socioeconomic and demographic factors
Family income
Up to 1,000 BRL	143	8	5.6	1
More than 1,000 BRL	128	11	8.6	1.6	0.6 - 4.7	0.467
Education (in years of schooling)					0.6 - 4.7	0.467
More than 8 years	314	24	7.6	1
Up to 8 years	68	3	4.4	0.6	0.1 - 1.9	0.513
Current age (in years)					0.1 - 1.9	0.513
Between 18 and 29	290	16	5.5	1
Between 30 and 53	92	11	12.0	2.3	0.9 - 5.6	0.071
Sexual behavioral factors
Compared to you, your last casual sex partner is
Less exposed to risks	87	4	4.6	1
Exposed to the same amount of risks	192	19	9.9	2.3	0.7 - 9.5	0.202
More exposed to risks	89	4	4.5	0.9	0.2 - 5.4	1.000
Told someoneb you are sexually attracted to men					0.2 - 5.4	1.000
Yes	161	5		1
No	169	22		2.5	0.9 - 8.7	0.088
URAI with male casual partner in the last 6 months					0.9 - 8.7	0.088
Did not have anal intercourse or always used a condom during anal intercourse	183	14	8.1	1
Never used a condom during anal intercourse	70	5	7.6	0.9	0.2 - 2.8	1.000
URAI with a male steady partner in the last 6 months					0.2 - 2.8	1.000
Did not have anal intercourse or always used a condom during anal intercourse	101	8	7.9	1
Never used a condom during anal intercourse	96	5	5.2	0.64	0.2 - 2.3	0.634
Total number of sexual partners (men, women, and transvestites) in the last 6 months					0.2 - 2.3	0.634
Less than three partners	184	11		1
Between three and eight partners	105	3		0.46	0.8 - 1.8	0.369
More than eight partners	73	11		2.8	1.03 - 7.5	0.042
Age at first intercourse (years)					1.03 - 7.5	0.042
15 or over	200	8	4.0	1
Under 15	182	19	10.4	2.798	1.14 - 7.61	0.023
Biological factors
Ever had syphilis?
No	326	20	6.1	1
Yes	21	7	33.3	7.6	2.3 - 22.9	0.000
Had a rapid screening test for syphilis during the study					2.3 - 22.9	0.000
Negative	320	17	5.3	1
Positive	44	10	22.7	5.2	2.0 - 13.2	0.000
STD symptomsc					2.0 - 13.2	0.000
No	292	17	5.8	1
Yes	91	10	11.0	2.0	0.8 - 4.8	0.156
Ever been tested for HIV?					0.8 - 4.8	0.156
Yes	169	15	8.9	1
No	214	12	5.6	0.6	0.3 - 1.4	0.299
Ever been tested for syphilis?					0.3 - 1.4	0.299
Yes	274	14	5.1	1
No	100	13	13.0	2.8	1.1 - 6.6	0.021
Had access to information or STD prevention materials in the last 12 months?					1.1 - 6.6	0.021
Yes	315	22	7.0	1
No	68	5	7.4	1.1	0.3 - 3.0	1.000
Received lubricant gel in the last 12 months					0.3 - 3.0	1.000
Yes	50	8	16.0	1
No	333	19	5.7	0.3	0.1 - 0.9	0.030
Engaged in or know of any organized activityd					0.1 - 0.9	0.030
Yes	149	9	6.0	1
No	234	18	7.7	1.3	0.5 - 3.4	0.690
Used or frequently use any SUS health-care service?					0.5 - 3.4	0.690
Yes	217	16	7.4	1
No	151	11	7.3	0.9	0.4 - 2.4	1.000
Have health insurance?					0.4 - 2.4	1.000
Yes	96	10	10.4	1
No	283	17	6.0	0.5	0.2 - 1.4	0.228