P1-S5.11 High prevalence of STIs and risk behaviours among persons living with HIV in Nicaragua: missed opportunities for prevention
Authors: Goins J , Romero L M , de María Hernandez F , Delgado S , Alvarez B , Beteta E , Paz-Bailey G , Morales S 
Published: July 2011

Background

The UNAIDS Report on the Global AIDS Epidemic estimated that in 2009 Nicaragua had 6900 cases of HIV, almost double the 2001 estimate. Among people living with HIV in Nicaragua, it remains important to monitor sexually transmitted infections (STIs) and behavioural risk factors in order to inform STI prevention programs about the health needs of this population.

Methods

In this cross sectional study, 200 people living with HIV were recruited consecutively from patients attending the Roberto Calderon Hospital in Managua, Nicaragua. Data was collected using computer-assisted self-interviews. Both men and women were tested for active syphilis (RPR titer≥1:8) and herpes simplex virus type 2 (HSV-2) by serology, and forChlamydia trachomatis,Neisseria gonorrhoeae,Trichomonas vaginalis, andMycoplasma genitalium, by PCR. Acute STI was defined as infection with active syphilis or any of the PCR diagnosed STIs. We examined associations between acute STI infection and reported condom use as well as between STI infection and gender using simple logistic regression.

Results

The most prevalent STI among study participants was HSV-2 (81.5%). Active syphilis was diagnosed in 6.0% of the population. Men were less likely to be infected with an acute STI than women (OR=0.24; 95% CI 0.10 to 0.57, Abstract P1-S5.11 table 1). A high percentage of participants reported having an HIV positive stable partner at the time of the interview (85.1%). Consistent condom use in the last year was reported to be 59.9% with stable partners, 66.7% with commercial sex partners and 74.6% with occasional partners. Condom use at last sex was found to be protective for infection with acute STI (OR=0.38; 95% CI 0.17 to 0.85).

Abstract P1-S5.11 Table 1

Prevalence of STIs among persons living with HIV and OR by gender

TotalMenWomenNn% (95% CI)Nn% (95% CI)Nn% (95% CI)OR* (95% CI)HSV-220016381.5 (75.4 to 86.6)1078478.5 (69.5 to 85.9)937985.0 (76.0 to 91.5)0.65 (0.31 to 1.35)Syphilis1992311.6 (7.5 to 16.8)1061312.3 (6.7 to 20.1)931010.8 (5.3 to 18.9)1.16 (0.48 to 2.79)Active syphilis199126.0 (3.2 to 10.3)10665.7 (2.1 to 11.9)9366.5 (2.4 to 13.5)0.87 (0.27 to 2.80)Bacterial vaginosis812328.4 (18.9 to 39.5)–––812328.4 (18.9 to 39.5)–Chlamydia trachomatis19842.0 (0.6 to 5.1)10710.9 (0.0 to 5.1)9133.3 (0.7 to 9.3)0.28 (0.03 to 2.71)Neisseria gonorrhoeae19800 (0.0 to 1.8)†10700 (0.0 to 3.4)†9100 (0.0 to 4.0)†–Mycoplasma gentitalium19894.6 (2.1 to 8.5)10710.9 (0.0 to 5.1)9188.8 (3.9 to 16.6)0.10‡ (0.01 to 0.80)Trichomonas vaginalis198126.1 (3.2 to 10.6)10700 (0.0 to 3.4)†911213.19 (7.0 to 21.9)–Any acute STI¶1973115.7 (10.9 to 21.6)10687.5 (3.3 to 14.3)912325.3 (16.7 to 35.5)0.24§ (0.10 to 0.57)*

Referent gender category: Women.

†

One-sided, 97.5% CI.

‡

p value <0.05.

§

p value=0.001.

¶

Active syphilis,Chlamydia trachomatis,Neisseria gonorrhoeae,Mycoplasma gentitaliumorTrichomonas vaginalis.

Conclusion

Despite personal experience with HIV, risky sexual behaviours and STI prevalence remain a problem in persons living with HIV in the capital city of Nicaragua. In order to prevent reinfection between serodiscordant partners as well as continued STI transmission, it is important for STI prevention programs to continue to develop their sexual health services, focusing on improved condom access and promotion.