Vulnerability in the context of HIV and syphilis infection in a
					population of men who have sex with men (MSM) in Salvador, Bahia State,
					Brazil

Brignol, Sandra; Dourado, Inês; Amorim, Leila D.; Kerr, Lígia Regina Franco Sansigolo

doi:10.1590/0102-311X00178313

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ARTICLE • Cad. Saúde Pública 31 (5) • May 2015 • https://doi.org/10.1590/0102-311X00178313 copy

Vulnerability in the context of HIV and syphilis infection in a population of men who have sex with men (MSM) in Salvador, Bahia State, Brazil

La vulnerabilidad en el contexto de VIH y sífilis en una población de hombres que mantienen sexo con hombres (MSM) en Salvador, Bahía, Brasil

Authorship SCIMAGO INSTITUTIONS RANKINGS

Social, individual, and programmatic vulnerability of men who have sex with men (MSM) in the context of the HIV epidemic and other sexually transmitted infections (STI) is a reality in many countries. The survey Behavior, Attitudes, Practices, and Prevalence of HIV and Syphilis in Men Who Have Sex with Men in 10 Brazilian Cities selected 383 MSM in the city of Salvador, Bahia State, Brazil, using the respondent driven sampling (RDS) technique. Individual vulnerability: early sexual initiation (51%), average of eight sex partners, and unprotected receptive anal sex with casual (32%) and steady partners (45%) and positive rapid tests HIV (6.5%) and syphilis (9%). Social vulnerability: young adults (80%), black race/skin color (91%), mean monthly family income of BRL 1,000.00, and personal history of discrimination (57%). Programmatic factors: no previous HIV test (63%) and no access to lubricant gel (88%). The study showed a profile of vulnerability and the urgent need for interventions and STI prevention in the MSM population in Salvador, in addition to high prevalence rates for HIV and syphilis.

Male Homosexuality; HIV; Syphilis; Health Vulnerability

Individual vulnerability factors	RDS-weighted			RDS-non-weighted
Individual vulnerability factors	n	%	95%CI	%	95%CI
Result of HIV test in the study
Negative	340	93.5		92.6
Positive	23	6.5	3.9; 9.0	7.4	4.9; 10.6
Result of rapid test for syphilis in the study
Negative	331	91.2		87.9
Positive	32	8.8	5.7; 11.7	12.1	8.9; 15.9
Reported STI symptoms *
Yes	89	24.5		23.8
No	274	75.5	71.1; 80.0	76.2	71.7; 80.4
Age on date of interview (years)
30-53	71	19.7		24.1
18-29	291	80.3	76.2; 84.4	75.9	71.2; 80.1
How old were you the first time you had sex? (years)
≥ 15	179	49.2		52.5
< 15	184	50.8	45.6; 55.9	47.5	42.4; 52.7
During the six months prior to the interview
Total number of sex partners (men, women, and transvestites)
< 8	291	85.7		79.8
≥ 8	49	14.3	10.6; 18.1	20.2	16.2; 24.7
Unprotected receptive anal sex ** with last male casual partner
Did not have anal sex or always used a condom	139	68.3		72.3
Failed to use a condom at least once	65	31.7	25.8; 37.7	27.7	22.2; 33.6
Unprotected receptive anal sex ** with last male steady partner
Did not have anal sex or always used a condom	88	55.2		51.3
Failed to use a condom at least once	71	44.9	37.6; 52.1	48.7	41.6; 55.9

Vulnerability factors	RDS-weighted			RDS-non-weighted
Vulnerability factors	n	%	95%CI	%	95%CI
Social vulnerability
Schooling (years)
> 8	258	67.4		82.2
≤ 8	125	32.5	27.7; 37.4	17.8	14.1; 22.0
Race/Color
White/Other	31	8.6		11.7
African-descendant (brown and black)	332	91.4	88.5; 94.3	88.3	84.6; 91.3
Monthly family income (BRL)
≤ 600.00	84	32.8		26.6
> 600.00	173	67.2	61.4; 73.0	73.4	67.8; 78.6
Current work status
Employed	226	62.3		67.5
Unemployed	136	37.7	32.7; 42.7	32.5	27.9; 37.5
Sexual category
Homosexual/Gay	183	50.6		63.0
MSM	179	49.4	44.3; 54.6	37.0	32.1; 42.1
Suffered some type of discrimination (race/color, social status, age, sexual orientation, or cursing) in life and in the last year
No	157	43.2		34.2
Yes	206	56.7	51.6; 61.8	65.8	60.8; 70.5
Have you told your parents that you feel sexually attracted to men?
Yes	183	56.5		43.7
No	140	43.5	38.2; 48.8	56.3	51.0; 61.5
Programmatic vulnerability
Previous HIV test?
Yes	135	37.2		44.1
No	228	62.8	57.8; 67.9	55.9	50.7; 60.9
Do you know of some health service that provides free HIV testing?
Yes	121	33.4		43.9
No	242	66.6	61.7; 71.4	56.1	51.0; 61.2
Previous test for syphilis?
Yes	282	79.9		73.3
No	71	20.1	16.0; 24.3	26.7	22.2; 31.2
Have you used or do you usually use public healthcare services (SUS)?
Yes	189	55.1		59.0
No	155	44.9	39.7; 50.2	41.0	36.0; 46.2
Have you accessed some information or input for STI prevention? *
Yes	286	78.8		82.2
No	77	21.2	17.0; 25.4	17.8	14.1; 22.0
Have you received lubricant gel? *
Yes	44	12.1		13.1
No	319	87.9	84.5; 91.3	86.9	83.2; 90.2
Have you participated in (or do you know of) some activity organized by a church, religious group, or HIV-AIDS/human rights NGO?
Yes	149	41.1		38.9
No	214	58.9	53.8; 64.0	61.1	56.0; 66.0

Vulnerability factors	HIV+			Syphilis+
Vulnerability factors	n = 27	%	p-value	n = 44	%	p-value
Individual vulnerability
Result of HIV test in the study
Negative	-	-		34	10.1	0.000
Positive	-	-		10	37.0
Result of rapid test for syphilis in the study
Negative	17	5.3	0.000	-	-
Positive	10	22.7		-	-
Reported STI symptoms *
No	17	6.2	0.158	31	11.2	0.355
Yes	10	11.4		13	14.8
Age on date of interview (years)
18-29	16	5.8	0.033	24	8.6	0.002
30-53	11	13.1		19	22.6
How old were you the first time you had sex? (years)
≥ 15	8	4.3	0.026	12	6.4	0.001
< 15	19	10.9		32	18.2
Total number of sex partners (men, women, and transvestites)
< 8	14	5.1	0.008	30	10.9	0.219
≥ 8	11	15.5		12	16.9
Unprotected receptive anal sex with last male casual partner
Did not have anal sex or always used a condom	14	8.1	1.000	25	14.4	0.687
Failed to use a condom at least once	5	7.6		11	16.7
Unprotected receptive anal sex with last male steady partner
Did not have anal sex or always used a condom	8	8.3	0.571	13	13.5	0.242
Failed to use a condom at least once	5	5.6		7	7.8
Social vulnerability
Schooling (years)
> 8	24	8.1	0.440	31	10.5	0.096
≤ 8	3	4.5		12	17.9
Monthly family income (BRL)
≤ 600.00	4	5.7	0.604	5	7.1	0.631
> 600.00	15	8.1		19	10.2
Sexual category
MSM	6	4.4	0.101	10	7.4	0.032
Homosexual/Gay	21	9.3		34	15.0
Have you told your parents that you feel sexually attracted to men?
Yes	7	4.6	0.045	12	8.0	0.015
No	20	10.7		32	17.0
Programmatic vulnerability
Previous HIV test
Yes	15	9.5	0.227	28	17.7	0.005
No	12	5.9		16	7.8
Do you know of some health service that provides free HIV testing?
Yes	15	9.6	0.226	29	18.5	0.002
No	12	5.8		15	7.3
Previous test for syphilis
Yes	14	5.4	0.012	24	9.2	0.009
No	13	13.8		19	20.2
Programmatic vulnerability
Received lubricant gel in the last 12 months?
Yes	8	16.0	0.021	10	20.0	0.098
No	19	6.1		34	10.8
Have you participated in (or do you know of) some activity organized by a church, religious group, or HIV-AIDS/human rights NGO?
Yes	9	6.3	0.545	12	8.3	0.073
No	18	8.2		32	14.6

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[1] Correspondence: S. Brignol. Rua Treze, lote 22, quadra 99, Niterói, RJ 24340-235, Brasil. sandrabrignol@gmail.com