Is the HIV epidemic stable among MSM in Mexico? HIV prevalence and risk behavior results from a nationally representative survey among men who have sex with men

Abstract

Background: Recent evidence points to the apparent increase of HIV prevalence among men who have sex with men (MSM) in different settings with concentrated epidemics, including the Latin American region. In 2011, Mexico implemented an ambitious HIV prevention program in all major cities, funded by the Global Fund to Fight Aids, Tuberculosis and Malaria. The program was intended to strengthen the prevention response for the most at risk populations: MSM and injecting drug users. This paper presents the HIV prevalence results of a nationally representative baseline survey in 24 Mexican cities throughout the 5 regions in the country and reports the socio-demographic and sexual risk behaviors that predict the probability of infection.

Methods: The survey was implemented in two phases. We first identified and characterized places where MSM gather in each city and then conducted in a second phase, a seroprevalence survey that included rapid HIV testing and a self-administered questionnaire. The prevalence of HIV was estimated by adjusting for positive predicted value. We applied a probit model to estimate the probability of having a positive result from the HIV test as a function of socio-demographic characteristics and self-reported sexual risk behaviors.

Results: We found an overall HIV prevalence among MSM gathering in meeting points of 16.9% [95% CI: 15.6-18.3], significantly higher than previously reported estimates. Our regression results suggest that the risk of infection increases with age, with the number of sexual partners, and among those who play a receptive sexual role, and the risk decreases with higher education.

Discussion: Our findings suggest a higher HIV prevalence among MSM than previously acknowledged and that a significant regional variability exist throughout the country. These two findings combined, signal an important dynamic in the epidemic that should be better understood and promptly addressed with strong prevention efforts targeted at key populations.

Figure 1. HIV prevalence by rapid testing among MSM in Mexico by region, 2011.

Region 1: MA of México City, MA Puebla-Tlaxcala, MA Toluca, MA Cuernavaca, MA Veracruz, MA Acapulco, MA Xalapa, MA Pachuca, MA Tehuantepec-Juchitán; Region 2: MA Guadalajara, MA León-Silao, MA Aguascalientes, Puerto Vallarta; Region 3: MA Tijuana, MA Juárez, Mexicalli, Hermosillo; Region 4: MA Monterrey, MA San Luis Potosí, MA Reynosa-Río Bravo, Matamoros; Region 5: MA Mérida, MA Cancún, Campeche. (MA = metropolitan area).