HIV Diagnosis, Linkage to Care, and Retention among Men Who Have Sex with Men and Transgender Women in Guatemala City

Men who have sex with men (MSM) and transgender women are disproportionately affected by HIV in Guatemala, yet little is known about their experiences with diagnosis, linkage to care, and retention. We conducted qualitative interviews with 26 MSM and transgender women living with HIV in Guatemala City. HIV diagnosis experiences changed over time with increasing asymptomatic testing at non-governmental organizations. Fear of the physical and social impacts of HIV delayed testing, acceptance of diagnosis, and linkage to HIV care. These fears were driven by layered stigma and discrimination due to non-normative gender expressions and/or sexual orientation. Retention-specific determinants included HIV clinic dynamics and limited employment opportunities. There is an urgent need to improve support systems for early testing and linkage to care and to expand employment opportunities. Stigma and discrimination must be addressed at the family, clinic and contextual levels to reduce fear of diagnosis and improve access to care

HIV Infection and Risk Heightened Among Female Sex Workers Who Entered the Sex Trade as Adolescents in Guatemala

A dearth of empirical research exists on female sex workers in Central America who begin selling sex under age 18. Data were collected from adult female sex workers (N = 1216) sampled using census and modified time-location sampling in three urban centers of Guatemala. In adjusted analyses, female sex workers who entered the sex trade under age 16 years were more likely to be HIV positive (AOR = 4.6, 95% CI 1.6, 13.2), have not received HIV education in their first year of sex trade (AOR = 2.8, 95% CI 1.5, 5.5), have experienced violence to force commercial sex (AOR = 4.6, 95% CI 2.2, 9.8) and have not used condoms in their first month (AOR = 2.8, 95% CI 1.3, 6.1) , relative to those who entered as adults. An interaction between age at entry and foreign migration at entry was found for HIV risk. Efforts to prevent adolescent sex trade entry are needed and may also help to reduce HIV rates in Guatemala

Scale-up, retention and HIV/STI prevalence trends among female sex workers attending VICITS clinics in Guatemala.

Since 2007, Guatemala integrated STI clinical service with an HIV prevention model into four existing public health clinics to prevent HIV infection, known as the VICITS strategy. We present the first assessment of VICITS scale-up, retention, HIV and STI prevalence trends, and risk factors associated with HIV infection among Female Sex Workers (FSW) attending VICITS clinics in Guatemala.Demographic, behavioral and clinical data were collected using a standardized form. Data was analyzed by year and health center. HIV and STI prevalence were estimated from routine visits. Retention was estimated as the percent of new users attending VICITS clinics who returned for at least one follow-up visit to any VICITS clinic within 12 months. Separate multivariate logistic regression models were conducted to investigate factors associated with HIV infection and program retention.During 2007-2011 5,682 FSW visited a VICITS clinic for the first-time. HIV prevalence varied from 0.4% to 5.8%, and chlamydia prevalence from 0% to 14.3%, across sites. Attending the Puerto Barrios clinic, having a current syphilis infection, working primarily on the street, and using the telephone or internet to contact clients were associated with HIV infection. The number of FSW accessing VICITS annually increased from 556 to 2,557 (361%) during the period. In 2011 retention varied across locations from 7.7% to 42.7%. Factors negatively impacting retention included current HIV diagnosis, having practiced sex work in another country, being born in Honduras, and attending Marco Antonio Foundation or Quetzaltenango clinic sites. Systematic time trends did not emerge, however 2008 and 2010 were characterized by reduced retention.Our data show local differences in HIV prevalence and clinic attendance that can be used to prioritize prevention activities targeting FSW in Guatemala. VICITS achieved rapid scale-up; however, a better understanding of the causes of low return rates is urgently needed

Factors associated with retention among FSW attending VICITS clinics for the first-time, Guatemala, 2007–2011 (N = 4,449).

<p>*Telephone or internet contacts.</p><p>Factors associated with retention among FSW attending VICITS clinics for the first-time, Guatemala, 2007–2011 (N = 4,449).</p

Prevalence of HIV and other STI among FSW attending VICITS clinics for the first-time by clinic, Guatemala, 2007–2011.

<p>Notes: HIV measure takes into account tests prior to and including the respective year; other STI measures include results during the year. Results not shown for n<25. Chlamydia and gonorrhea results not available at Quetzaltenango and FMA clinics. Syphilis results not available at the Quetzaltenango clinic.</p><p>Prevalence of HIV and other STI among FSW attending VICITS clinics for the first-time by clinic, Guatemala, 2007–2011.</p

Sociodemographic and behavioral characteristics of FSW attending VICITS clinics for the first time by clinic, Guatemala, 2007–2011 (N = 5,682).

<p><b>*</b>Totals do not add up due to missing observations.</p><p>**Chi-square test for categorical variables and Mann-Whitney-Wilcoxon test for continuous variables.</p><p>Sociodemographic and behavioral characteristics of FSW attending VICITS clinics for the first time by clinic, Guatemala, 2007–2011 (N = 5,682).</p

Distribution of FSW who returned for a follow-up visit within 1 year of initial visit by clinic, Guatemala, 2007–2011.

<p>Note: Data include patients with initial visits up to August 20, 2011.</p><p>Distribution of FSW who returned for a follow-up visit within 1 year of initial visit by clinic, Guatemala, 2007–2011.</p

Number of active FSW attending VICITS clinics over time by clinic, Guatemala, 2007–2011.

<p>Number of active FSW attending VICITS clinics over time by clinic, Guatemala, 2007–2011.</p