Incidence and time-varying predictors of HIV and sexually transmitted infections among male sex workers in Mexico City

Karla Y Ganley,Andrew R Zullo,Don Operario,Mark N Lurie,Brandon D L Marshall,Marta Wilson-Barthes,Carlos J Conde-Glez,Omar Galárraga,Santa García-Cisneros,Kenneth H Mayer,Sandra G Sosa-Rubí

doi:10.1186/s40249-020-00792-2

Abstract

BackgroundMale sex workers are at high-risk for acquisition of sexually transmitted infections (STIs), including human immunodeficiency virus (HIV). We quantified incidence rates of STIs and identified their time-varying predictors among male sex workers in Mexico City.MethodsFrom January 2012 to May 2014, male sex workers recruited from the largest HIV clinic and community sites in Mexico City were tested for chlamydia, gonorrhea, syphilis, hepatitis, and HIV at baseline, 6-months, and 12-months. Incidence rates with 95% bootstrapped confidence limits were calculated. We examined potential time-varying predictors using generalized estimating equations for a population averaged model.ResultsAmong 227 male sex workers, median age was 24 and baseline HIV prevalence was 32%. Incidence rates (per 100 person-years) were as follows: HIV [5.23; 95% confidence interval (CI): 2.15–10.31], chlamydia (5.15; 95% CI: 2.58–9.34), gonorrhea (3.93; 95% CI: 1.88–7.83), syphilis (13.04; 95% CI: 8.24–19.94), hepatitis B (2.11; 95% CI: 0.53–4.89), hepatitis C (0.95; 95% CI: 0.00–3.16), any STI except HIV (30.99; 95% CI: 21.73–40.26), and any STI including HIV (50.08; 95% CI: 37.60–62.55). In the multivariable-adjusted model, incident STI (excluding HIV) were lower among those who reported consistently using condoms during anal and vaginal intercourse (odds ratio = 0.03, 95% CI: 0.00–0.68) compared to those who reported inconsistently using condoms during anal and vaginal intercourse.ConclusionsIncidence of STIs is high among male sex workers in Mexico City. Consistent condom use is an important protective factor for STIs, and should be an important component of interventions to prevent incident infections.

Highlights

Male sex workers are at high-risk for acquisition of sexually transmitted infections (STIs), including human immunodeficiency virus (HIV)
We chose to include the variable on number of non-paying sexual partners because it is an important covariate in the literature; as such, we were balancing formal goodness-of-fit measures with epidemiological theory. In this secondary analysis of a randomized controlled trial of male sex workers (MSWs) in Mexico City, we found that incidence rates of HIV/STI were high: incidence of HIV was 5.23 cases/100 PY and incidence of syphilis was 13.04 cases/100 PY
This study found that MSWs in Mexico City have a high incidence of STIs, HIV and active syphilis

Summary

Introduction

Male sex workers are at high-risk for acquisition of sexually transmitted infections (STIs), including human immunodeficiency virus (HIV). We quantified incidence rates of STIs and identified their time-varying predic‐ tors among male sex workers in Mexico City. Scant information is available about the incidence of STIs among MSWs in Mexico City. This is partly due to underreporting of STIs in Latin American countries, including Mexico, because national STI programs lack consistency about which STIs are reportable by law, and definitions of these STIs— clinical versus syndromic versus laboratory based [8].

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Conclusion