Prevalence and Risk Factors for HIV Infection in a Population of Homosexual, Bisexual, and Other Men Who Have Sex with Men in the Metropolitan Region of Chile: A Re-emerging Health Problem

Abstract

According to the most recent UNAIDS report, the number of new HIV infections has increased by 34% since 2010 in Chile, representing the largest increase in the Americas. The objective of this study was to identify factors associated with HIV prevalence among men who have sex with men (MSM) in the metropolitan region (MR) of Santiago, Chile. Cross-sectional study of MSM living in the MR, recruited using respondent-driven sampling (RDS). Participants were tested using Human Immunodeficiency virus rapid test, and reactive cases were confirmed withELISA. Participants were interviewed using a questionnaire adapted for the Chilean population. Descriptive and logistic regression analyses were then performed. All applicable ethical norms were followed in the execution of this study. The total sample consisted of 375 individuals. HIV prevalence among MSM was 17.6% overall. Among the HIV-negative men, most (71.5%) had not been tested for sexually-transmitted diseases (STIs) other than HIV in the past 12 months, and 24.1% had never been tested for HIV. Participants who had been tested for an STI other than HIV in the past 12 months had a 3.56-fold greater OR for HIV-positive status than those who had not. Conversely, having had an HIV test in the past 12 months was a protective factor against positive HIV status (OR = 0.09). The high prevalence of HIV among MSM suggests a re-emergence of the disease in Chile, and cases are specifically concentrated among young MSM. Access to sexual health care and STI testing in Chile is insufficient. Targeted prevention efforts are urgently needed as part of the Chilean national strategy to combat the spread of HIV, including community-based testing programs.

This is a preview of subscription content, log in to check access.

Fig. 1
Fig. 2
Fig. 3

References

  1. 1.

    UNAIDS. Ending AIDS: progress towards the 90–90–90 targets. 2017. http://www.unaids.org/en/resources/documents/2017/20170720_Global_AIDS_update_2017. Accessed 20 June 2018.

  2. 2.

    Instituto de Salud Pública Chile. Resultados confirmación de infección por VIH en Chile, 2010–2015. Bol ISP. 2016;6(11):1–13. http://www.ispch.cl/sites/default/files/BoletinVIH-27022017B.pdf. Accessed 20 June 2018.

  3. 3.

    Departamento de Epidemiologia, Ministerio de Salud. Informe Nacional “ Evolución VIH SIDA, Chile 1984–2015”. 2017;1–20.

  4. 4.

    Departamento de Epidemiología, Ministerio de Salud. Situación epidemiológica de las infecciones de transmisión sexual en Chile. 2016.

  5. 5.

    Guias sobre la Vigilancia del VIH de Segunda Generación. Grupo de trabajo ONUSIDA/OMS para la vigilancia mundial del VIH/sida e ITS. 2005.

  6. 6.

    Guía sobre indicadores para la vigilancia y notificación de la respuesta del sector salud al VIH/SIDA. ONUSIDA. 2012.

  7. 7.

    Recomendaciones para mejorar y fortalecer los sistemas de vigilancia del VIH, OPS. 2012.

  8. 8.

    Ministerio de Salud de Chile. ESTRATEGIA NACIONAL DE SALUD Para el cumplimiento de los Objetivos Sanitarios de la Década 2011–2020. 2011. pp. 1–426.

  9. 9.

    Wenjert C, Heckathorn DD. Respondent-driven sampling: operational procedures, evolution of estimators, and topics for future research. In Williams M and Vogt WP, editors. The SAGE handbook of innovation in social research methods; 2011. p. 473.

  10. 10.

    WHO. Introduction to HIV/AIDS and sexually transmitted infection surveillance: module 4: introduction to respondent-driven sampling. 2013; 34:193.

  11. 11.

    Salganik MJ, Heckathorn DD. Sampling and estimation in hidden populations using respondent-driven sampling. Soc Methodol. 2004;34:193.

    Article  Google Scholar 

  12. 12.

    Gios L, Mirandola M, Toskin I, Marcus U, Dudareva-Vizule S, Sherriff N, et al. Bio-behavioural HIV and STI surveillance among men who have sex with men in Europe: the Sialon II protocols. BMC Public Health. 2016. 16(1):212. http://www.ncbi.nlm.nih.gov/pubmed/26935752. Accessed 25 Apr 2017.

  13. 13.

    Family Health International (FHI), Implementing AIDS Preventing and Care Project (Impact). Behavioral Surveillance Surveys. Virginia; 2000. www.fhi.org.

  14. 14.

    Malekinejad M, Johnston LG, Kendall C, Kerr LRFS, Rifkin MR, Rutherford GW. Using respondent-driven sampling methodology for HIV biological and behavioral surveillance in international settings: a systematic review. AIDS Behav. 2008;12(SUPPL. 1):105–30.

    Article  Google Scholar 

  15. 15.

    Beyrer C, Baral S, Griensven F van. Global epidemiology of HIV infection in men who have sex with men. Lancet. 2012;380(9839):367–77. http://www.sciencedirect.com/science/article/pii/S0140673612608216. Accessed 20 June 2018.

    Article  Google Scholar 

  16. 16.

    Miller WM, Buckingham L, Sánchez-Domínguez MS, Morales-Miranda S, Paz-Bailey G. Systematic review of HIV prevalence studies among key populations in Latin America and the Caribbean. Salud Publica Mex. 2013;55(SUPPL.1):65–78.

    Article  Google Scholar 

  17. 17.

    Gómez F, Barrientos J, Cárdenas M. Relation between HIV status, risky sexual behavior, and mental health in an MSM sample from three Chilean cities. Rev Panam Salud Publ. 2017;41:e4.

    Google Scholar 

  18. 18.

    Coates TJ, Richter L, Caceres C. Behavioural strategies to reduce HIV transmission: how to make them work better. Lancet. 2008. 372(9639):669–684. http://www.ncbi.nlm.nih.gov/pubmed/18687459. Accessed 2 Mar 2018.

    Article  Google Scholar 

  19. 19.

    Càseres C. Intervenciones para la prevención del VIH e ITS en América Latina y Caribe: una revisión de la experiencia regional. Cad Saude Publ. 2004;20(6):6–10.

    Google Scholar 

  20. 20.

    ECDC. HIV and STI prevention among men who have sex with men. 2015. p. 34. http://ecdc.europa.eu/en/publications/Publications/hiv-sti-prevention-among-men-who-have-sex-with-men-guidance.pdf.

  21. 21.

    Kennedy CE, Fonner VA, O’Reilly KR, Sweat MD. A systematic review of income generation interventions, including microfinance and vocational skills training, for HIV prevention. AIDS Care. 2014;26(6):659–73.

    Article  Google Scholar 

  22. 22.

    Organización Panamericana de Salud A, Programa Conjunto de las Naciones Unidas sobre el VIH/Sida para América Latina y el Caribe B. Prevención de la infección por el VIH bajo la lupa. Un análisis desde la perspectiva del sector de la salud en América Latina y el Caribe. 2017. https://www.paho.org/prevencion-vih-la-lupa-2017/.

  23. 23.

    Folch C, Casabona J, Muñoz R, González V, Zaragoza K. Incremento en la prevalencia del VIH y en las conductas de riesgo asociadas en hombres que tienen sexo con hombres: 12 años de encuestas de vigilancia conductual en Cataluña. Gac Sanit. 2010;24(1):40–6.

    Article  Google Scholar 

  24. 24.

    Stromdahl S, Hickson F, Pharris A, Sabido M, Baral S, Thorson A. A systematic review of evidence to inform HIV prevention interventions among men who have sex with men in Europe. Eur Commun Dis Bull. 2015;20:21096.

    Google Scholar 

  25. 25.

    Montealegre JR, Johnston LG, Murrill C, Monterroso E. Respondent driven sampling for HIV biological and behavioral surveillance in Latin America and the Caribbean. AIDS Behav. 2013;17(7):2313–40.

    Article  Google Scholar 

  26. 26.

    García de Olalla P, Reyes JM, Caylà JA. Delay in diagnosis of HIV infection. Rev Esp Sanid Penit. 2012. 14(1):28–35. http://www.ncbi.nlm.nih.gov/pubmed/22437906. Accessed 16 Apr 2018.

  27. 27.

    Geibel S, Tun W, Tapsoba P, Kellerman S. HIV vulnerability of men who have sex with men in developing countries: horizons studies, 2001–2008. Public Health Rep. 2010;125:316.

    Article  Google Scholar 

  28. 28.

    Pachankis JE, Hatzenbuehler ML, Hickson F, Weatherburn P, Berg RC, Marcus U, et al. Hidden from health: structural stigma, sexual orientation concealment, and HIV across 38 countries in the European MSM Internet Survey. AIDS. 2015;29:1239.

    Article  Google Scholar 

  29. 29.

    Boivin RR. Se podrían evitar muchas muertas: discriminación, estigma y violencia contra minorias sexuales en México. Sex Salud y Soc (Rio Janeiro). 2014.

  30. 30.

    Gudelunas D. There’s an app for that: the uses and gratifications of online social networks for gay men. Sex Cult. 2012;16:347.

    Article  Google Scholar 

  31. 31.

    Lehmiller JJ, Ioerger M. Social networking smartphone applications and sexual health outcomes among men who have sex with men. PLoS ONE. 2014;9:e86603.

    Article  CAS  Google Scholar 

  32. 32.

    Zou H, Fan S. Characteristics of men who have sex with men who use smartphone geosocial networking applications and implications for HIV interventions: a systematic review and meta-analysis. Arch Sex Behav. 2016;46:885.

    Article  Google Scholar 

  33. 33.

    Landovitz RJ, Tseng CH, Weissman M, Haymer M, Mendenhall B, Rogers K, et al. Epidemiology, sexual risk behavior, and HIV prevention practices of men who have sex with men using GRINDR in Los Angeles. J Urban Heal: California; 2013.

    Google Scholar 

  34. 34.

    Tang W, Best J, Zhang Y, Liu FY, Tso LS, Huang S, et al. Gay mobile apps and the evolving virtual risk environment: a cross-sectional online survey among men who have sex with men in China. Sex Transm Infect. 2016;92:508.

    Article  Google Scholar 

  35. 35.

    Ramallo J, Kidder T, Albritton T, Blick G, Pachankis J, Grandeleski V, et al. Exploring social networking technologies as tools for HIV prevention for men who have sex with men. AIDS Educ Prev. 2015;27:298.

    Article  Google Scholar 

  36. 36.

    Ministerio de Salud de Chile. Encuesta Nacional de Salud 2016–2017 Primeros resultados. 2017. http://web.minsal.cl/wp-content/uploads/2017/11/ENS-2016-17_PRIMEROS-RESULTADOS.pdf.

  37. 37.

    Folch C, Munoz R, Zaragoza K, Casabona J. Sexual risk behaviour and its determinants among men who have sex with men in Catalonia, Spain. Eur Commun Dis Bull. 2009;14(47):1–7.

    Google Scholar 

  38. 38.

    Agustí C, Fernández L, Mascort J, Carrillo R, Casabona J. Barreras para el diagnóstico de las infecciones de transmisión sexual y virus de la inmunodeficiencia humana en Atención Primaria en España. Enferm Infecc Microbiol Clin. 2013;31:451.

    Article  Google Scholar 

  39. 39.

    Baltrons JR, Fernàndez-López L, Casabona I Barbarà J, Grupo red COBATEST España. Cobatest network: users’ characteristics of community-based voluntary,counselling and testing centres in Spain. Rev Esp Salud Publica. 2017. 91. http://www.ncbi.nlm.nih.gov/pubmed/29251281. Accessed 7 Apr 2018.

  40. 40.

    Perelman J, Rosado R, Amri O, Morel S, Rojas Castro D, Chanos S, et al. Economic evaluation of HIV testing for men who have sex with men in community-based organizations—results from six European cities. AIDS Care. 2016;29:985.

    Article  Google Scholar 

  41. 41.

    Reyes-Urueña J, Breveglieri M, Furegato M, Fernàndez-López L, Agusti C, Casabona J. Heterogeneity of community-based voluntary, counselling and testing services for HIV in Europe: the HIV-COBATEST survey. Int J STD AIDS. 2015;28:28.

    Article  Google Scholar 

  42. 42.

    WHO. Service delivery approaches to HIV testing and counselling (HTC); a strategic HTC programme framework. Geneva: WHO; 2012.

  43. 43.

    Johnston LG, Hakim AJ, Dittrich S, Burnett J, Kim E, White RG. A systematic review of published respondent-driven sampling surveys collecting behavioral and biologic data. AIDS Behav. 2016;20:1754.

    Article  Google Scholar 

Download references

Acknowledgements

We would like to thank the Fondo Nacional de Desarrollo Científico y Tecnológico FONDECYT, project VIBIMOS No. 11140021: Bio-behavioral surveillance for HIV/AIDS in hard-to-reach populations in the Metropolitan Region of Santiago, Chile, for funding this research; Luis, Diego, Ricardo, Guillermo, and all of the volunteers at the NGO Red OSS for their invaluable efforts to fight HIV in this country; Astrid, Victor, and Diagnóstiko for their enthusiastic and rigorous collaboration; the Fundación SAVIA for their constant support; the entire team of investigators who participated in this project; and each of the participants for their time and generosity.

Funding

This study was funded by the National Fund for Scientific and Technological Development (FONDECYT—Grant Number 11140021)—VIBIMOS project/Bio-behavioral surveillance for HIV/AIDS in hard-to-reach populations in the Metropolitan Region of Santiago, Chile.

Author information

Affiliations

Authors

Corresponding author

Correspondence to Valeria Stuardo Ávila.

Ethics declarations

Conflict of interest

Authors declare that they have no conflicts of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The project was approved by the Ethics Committee of the Faculty of Medicine of the University of Chile, approval No. 175-2014.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Stuardo Ávila, V., Fuentes Alburquenque, M., Muñoz, R. et al. Prevalence and Risk Factors for HIV Infection in a Population of Homosexual, Bisexual, and Other Men Who Have Sex with Men in the Metropolitan Region of Chile: A Re-emerging Health Problem. AIDS Behav 24, 827–838 (2020). https://doi.org/10.1007/s10461-019-02486-9

Download citation

Keywords

  • HIV
  • HIV prevalence
  • Homosexual
  • Bisexual
  • MSM