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Correlates of Bisexual Behaviors Among Men who have Sex with Men in El Salvador

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Abstract

Bisexual behaviors may increase transmission pathways of HIV and sexually transmitted infections (STIs) from a higher prevalence group to lower prevalence groups in El Salvador. In 2008, men who have sex with men (MSM) were recruited in San Salvador and San Miguel using respondent driven sampling. Participants were interviewed and tested for HIV and STIs. Sixteen seeds and 797 MSM participated; 34.9% in San Salvador and 58.8% in San Miguel reported bisexual behavior. Bisexual behavior was associated with drug use (adjusted odds ratio (AOR) = 2.57, 95% CI: 1.30–5.06) and insertive anal sex (AOR = 5.45, 95% CI: 3.01–9.87), and inversely associated with having a stable male partner (AOR = 0.47, 95% CI: 0.26–0.84) and disclosing MSM behavior to family (AOR = 0.41, 95% CI: 0.22–0.75). Bisexual behavior was associated with risk behaviors with male and female partners that may be associated with HIV and STI transmission. Bisexual men displayed a distinct identity calling for tailored interventions.

Resumen

En El Salvador las prácticas bisexuales pueden aumentar las vías de transmisión del VIH e infecciones de transmisión sexual (ITS) desde un grupo de mayor prevalencia a grupos de menor prevalencia. En el 2008, se usó el muestreo dirigido por participantes para reclutar a hombres que tienen sexo con hombres (HSH) en San Salvador y San Miguel. Los participantes fueron entrevistados y se les realizaron pruebas de laboratorio para VIH e ITS. Dieciséis semillas y 797 HSH participaron; 34.9% en San Salvador y 58.8% en San Miguel reportaron comportamiento bisexual. El comportamiento bisexual fue asociado con uso de drogas (razón de probabilidades ajustadas (ORA) = 2.57, 95% IC: 1.30–5.06) y sexo anal insertivo (ORA = 5.45, 95% IC: 3.01–9.87), e inversamente asociado con tener una pareja estable masculina (ORA = 0.47, 95% IC: 0.26–0.84), y haber informado a su familia de su preferencia sexual (ORA = 0.41, 95% IC: 0.22–0.75). El comportamiento bisexual fue asociado con comportamientos de riesgo con parejas masculinas y femeninas, lo que puede estar asociado con la transmisión del VIH e ITS. Los hombres bisexuales mostraron una identidad distinta y necesitan intervenciones especificas.

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Acknowledgments

We would like to express our gratitude to the Ministry of Health of El Salvador for leading this study and providing permission to use government health facilities. We would especially like to thank the study staff and the study participants who made this survey possible. We thank Ron Ballard and Lisa Steele for providing quality control for laboratory testing at the Centers for Disease Control and Prevention STD Laboratory and to Nelly Arguera from the National Laboratory of the Ministry of Health in El Salvador for processing all serological testing. Many thanks to Maricarmen Estrada from the United States Agency for International Development for her support and guidance during the study design and data collection. Thanks to the Pan-American Social Marketing Organization (PASMO) for their collaboration in managing the study. A special thanks to William Hernandez from Entreamigos and Monica Hernandez from Arco Iris for facilitating data collection and results dissemination. Funding for this study was provided by the United States Centers for Disease Control and Prevention, United States Agency for International Development, the Ministry of Health of El Salvador, and the World Bank.

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Authors and Affiliations

  1. Division of Global HIV/AIDS, Centers for Disease Control and Prevention, 1600 Clifton Road NE, MS E-30, Atlanta, GA, 30333, USA

    Evelyn J. Kim, Neha Shah, Andrea A. Kim & Edgar Monterroso

  2. Centro de Estudios en Salud, Universidad del Valle de Guatemala, Guatemala City, Guatemala

    Jacob Creswell & Gabriela Paz-Bailey

  3. Training Programs in Epidemiology and Public Health Interventions Network, Atlanta, GA, USA

    Maria Elena Guardado, Flor de Maria Hernandez-Ayala & Gabriela Paz-Bailey

  4. National AIDS Program, Ministry of Health, San Salvador, El Salvador

    Ana Isabel Nieto

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  1. Evelyn J. Kim
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Correspondence to Evelyn J. Kim.

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Kim, E.J., Creswell, J., Guardado, M.E. et al. Correlates of Bisexual Behaviors Among Men who have Sex with Men in El Salvador. AIDS Behav 17, 1279–1287 (2013). https://doi.org/10.1007/s10461-012-0152-y

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