Horizons Projects | Assessment of the Risk Factors for HIV Infection in Sex Workers and Men Who Have Sex with Men (MSM) Populations at the Triple-Border Area in Ciudad del Este, Paraguay

HORIZONS PROJECT
Assessment of the Risk Factors for HIV Infection in Vulnerable Populations in Ciudad del Este, Paraguay

Focused prevention activities with highly vulnerable populations could be a cost-effective means of containing and reversing the HIV and AIDS epidemic in Paraguay. Horizons/Population Council and US Agency for International Development (USAID) conducted formative research with vulnerable populations, including truckers, sex workers, drug users, and health care providers in Ciudad del Este, a town in Paraguay bordering Argentina and Brazil. This formative research pointed to the need to implement interventions to promote STI, HIV, and AIDS prevention specifically targeted to male and female sex workers and men who have sex with men (MSM).

To this end, a cross-sectional study (formally titled "Assessment of the Risk Factors for HIV Infection in Sex Worker and Men Who Have Sex with Men [MSM] Populations at the Triple-border Area in Ciudad del Este, Paraguay") was conducted to estimate HIV and syphilis seroprevalence and to determine contextual and behavioral factors that increase syphilis and HIV vulnerability among male and female sex workers (FSWs) and MSM in Ciudad del Este. Data collection efforts were completed using a respondent-driven sampling (RDS) strategy and included interviewer-administered interviews and biological specimen collection to determine sociocultural, demographic, behavioral, and environmental factors associated with syphilis and HIV infections.

Key findings include:

Consistent condom use is very low among FSWs, with condom use being significantly lower with regular partners and non-paying partners.
The MSM population also had very low rates of condom use; MSM who have sex exclusively with men and have a high frequency of receptive anal sex are the most vulnerable subgroups, as reflected in the higher lifetime risk of syphilis.
In both FSW and MSM populations, there was a relatively low HIV prevalence, although it was higher than the prevalence in the general population. However, syphilis prevalence was very high. This finding, combined with low levels of condom use, the high level of bisexual behavior, and the low coverage of HIV/STI prevention and care services, creates a ripe environment for a rapid expansion of the HIV epidemic within and beyond these groups (through bridging behaviors) if aggressive educational prevention campaigns are not implemented and access to services is not significantly improved.
Because the RDS recruitment method relies on participants recruiting their peers, the sample may be biased by the recruitment patterns of the participants. Therefore, inferences to the larger population of FSWs and MSM should be made with caution. Among the MSM sample, male sex workers may have been oversampled owing to their larger network sizes and greater tendency to recruit other male sex workers. Among FSWs, the sample was not large enough to overcome the bias that FSWs had a high tendency to recruit other FSWs from the same place of work (i.e., brothel-based vs. non-brothel-based). Therefore, the sample attained may not be representative of the larger population of FSWs and MSM. The data will be used to design an operations research strategy to test interventions aimed at reducing the spread of the HIV and AIDS epidemic.

Location

Ciudad del Este, Paraguay

Duration

July 2005–June 2007

Horizons and Population Council researchers

Waimar Tun, Juan Díaz, Magda Chinaglia, Tamil Kendall, Maeve Mello

Non-Council collaborators

Karrina Helena Bianchi Fanego, Magdalena Martinez, Carmelo David Mranda Dure, Laura Murray (consultants)

Center for Attention, Prevention, and Surveillance of Boys, Girls, and Adolescents (CEAPRA)

National STI/HIV/AIDS Program (PRONASIDA), Paraguay Ministry of Public Health and Welfare

Prevención del Alto Paraná (PREALPA)

Program to Combat AIDS, Ciudad del Este

USAID Mission, Paraguay

Donor

US Agency for International Development

Publications/Resources
Horizons and Population Council researchers' names appear in boldface type.

2008
Chinaglia, Magda, Waimar Tun, Maeve Mello, Magdalena Insfran, and Juan Díaz. 2008. “Assessment of risk factors for HIV infection in female sex workers and men who have sex with men in Ciudad del Este, Paraguay,” Horizons Final Report. Washington, DC: Population Council. (PDF)