BackgroundDespite 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.MethodsPASMO 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.ResultsExposure 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).ConclusionsPASMO’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.

This first region-wide study (N = 2,818) aims to estimate prevalence of HIV-related risks (sexual behavior, HIV disclosure, number of sex partners, violence) and factors associated with these risks as well as evaluate a behavior change communications program targeted to PLHIV in 6 countries in Central America. After 2 years, the program achieved moderate coverage, with 21 % of the sample reporting exposure to interpersonal communications (IPC) and 52 % to mass media program components. The odds of condom use, HIV disclosure, and participation in a self-help group increased by 1.4–1.8 times with exposure to mass media. Exposure to IPC increased odds of condom use by 2.7 and participation in self-help groups by 4.4 times. In addition, being in HIV care or taking ART was associated with condom use and HIV-status disclosure. About 30 % experienced physical or sexual violence, and those who did were 4 times less likely to use condoms. Findings suggest that behavioral interventions for PLHIV can reduce HIV-transmission risks and increase access to care.Electronic supplementary materialThe online version of this article (doi:10.1007/s10461-014-0910-0) contains supplementary material, which is available to authorized users.

Objetivo: presentar una revisión de la epidemiología, manifestaciones clínicas, diagnóstico, estrategias de tratamiento, seguimiento y prevención de la sífilis gestacional.Materiales y métodos: con las palabras clave sífilis, sífilis en el embarazo, sífilis gestacional y embarazo, se llevó a cabo la revisión bibliográfica en las bases de datos de Cochrane, PubMed/Medline, Scielo, Ovid, LILACS, así como en revistas médicas, textos y en la Secretaría Departamental de Salud del Cauca, con énfasis en la información disponible de los últimos cinco años. El resultado de esta búsqueda arrojó 72 referencias, de las cuales se seleccionaron 37 que permitían delinear mejor el panorama del diagnóstico y manejo de esta patología, teniendo en cuenta principalmente metanálisis, estudios aleatorizados, artículos de revisión, boletines, textos, protocolos y guías clínicas.Resultados: en el año 2003 se notificaron 110.000 recién nacidos con sífilis congénita en América Latina y el Caribe, hijos de 330.000 mujeres que no recibieron tratamiento durante el control prenatal. La detección de casos de sífilis gestacional y congénita se fundamenta en la búsqueda sistemática en todas las gestantes durante el control prenatal.El tratamiento de elección durante el embarazo es la penicilina. La identificación temprana y el tratamiento oportuno de la sífilis gestacional previenen complicaciones como muerte fetal o perinatal, bajo peso al nacer, enfermedad neonatal o infección latente, las cuales pueden producir secuelas tardías.Conclusión: existe dificultad para identificar precozmente a las mujeres infectadas y ofrecerles un tratamiento oportuno, lo cual ha aumentado la incidencia de la enfermedad, sin lograr erradicar la sífilis congénita, a pesar de que la penicilina sigue siendo el medicamento de elección. Deben fortalecerse las estrategias de un adecuado control prenatal que permitan alcanzar este objetivo.

No abstract

Belize has the highest rates of HIV infection in Central America and is experiencing a generalized epidemic. The Garífuna, a minority ethnic population, is at risk for HIV. This study uses survey data from Garífuna men and women to examine the frequency of multiple partnerships as well as sociodemographic characteristics and behavioral constructs correlated with having multiple partners. A high proportion of respondents reported having multiple partners, but rates were significantly higher for men, and men had a higher mean number of partners than women. A high proportion of respondents reported having a sexually transmitted infection (STI) in the last year, with more men reporting a history of STIs than women. Regression results show the importance of improving men and women's perceived susceptibility for HIV and encouraging them to know their HIV status. Reinforcing a social norm for partner reduction would also benefit men. Study findings support the need for HIV counseling and testing in Garí-funa communities as well as STI prevention, diagnosis and treatment. This study demonstrates that reducing multiple partnerships among Garífuna men and women is critical for reducing the spread of HIV in Belize.