Effectiveness of a combination prevention strategy for HIV risk reduction with men who have sex with men in Central America: a mid-term evaluation

BMC Public Health

Lung Vu¹  Jennifer Wheeler²  Susan Ruether²  Alejandra Cabrera³  Susana Lungo³  Jorge Rivas³  Rebecca Firestone² 

[1] Population Council, 4301 Connecticut Ave NW, Suite 280, Washington, DC 20008, USA;Population Services International, 1120 19th Street, NW, Suite 600, Washington, DC 20036, USA;Pan-American Social Marketing Organization (PASMO), 13 Calle 3-40, Zona 10, Edificio Atlantis, Nivel 13, Oficina 1305, Guatemala City, Guatemala

关键词: Social marketing;    HIV prevention interventions;    HIV testing and counseling;    Condom use;    Central America;    Combination prevention;    Men who have sex with men;   

Others  :  1122863
DOI  :  10.1186/1471-2458-14-1244

 received in 2014-08-21, accepted in 2014-11-18,  发布年份 2014

【 摘 要 】

Background

Despite over a decade of research and programming, little evidence is available on effective strategies to reduce HIV risks among Central American men who have sex with men (MSM). The Pan-American Social Marketing Organization (PASMO) and partners are implementing a HIV Combination Prevention Program to provide key populations with an essential package of prevention interventions and services: 1) behavioral, including interpersonal communications, and online outreach; 2) biomedical services including HIV testing and counseling and screening for STIs; and 3) complementary support, including legal support and treatment for substance abuse. Two years into implementation, we evaluated this program’s effectiveness for MSM by testing whether exposure to any or a combination of program components could reduce HIV risks.

Methods

PASMO surveyed MSM in 10 cities across Guatemala, El Salvador, Nicaragua, Costa Rica, and Panama in 2012 using respondent-driven sampling. We used coarsened exact matching to create statistically equivalent groups of men exposed and non-exposed to the program, matching on education, measures of social interaction, and exposure to other HIV prevention programs. We estimated average treatment effects of each component and all combined to assess HIV testing and condom use outcomes, using multivariable logistic regression. We also linked survey data to routine service data to assess program coverage.

Results

Exposure to any program component was 32% in the study area (n = 3531). Only 2.8% of men received all components. Men exposed to both behavioral and biomedical components were more likely to use condoms and lubricant at last sex (AOR 3.05, 95% CI 1.08, 8.64), and those exposed to behavioral interventions were more likely to have tested for HIV in the past year (AOR 1.76, 95% CI 1.01, 3.10).

Conclusions

PASMO’s strategies to reach MSM with HIV prevention programming are still achieving low levels of population coverage, and few men are receiving the complete essential package. However, those reached are able to practice HIV prevention. Combination prevention is a promising approach in Central America, requiring expansion in coverage and intensity.

【 授权许可】

   
2014 Firestone et al.; licensee BioMed Central Ltd.

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