A cross sectional survey was administered to 670 men who have sex with men (MSM) and transgender women (TW) in San Salvador through respondent driven sampling to identify determinants of ever testing for HIV using a minority stress framework. A positive association was found between ever testing and older age [adjusted odds ratio (aOR) 2.10], past experience of sexual assault (aOR 2.92), perceiving that most social acquaintances had tested (aOR 1.81), and knowing a PLHIV (aOR 1.94). A negative association was found between homelessness and ever testing (aOR 0.43). Among the MSM sub-sample (n = 506), similar results were found for older age (aOR 2.63), and past experience of sexual assault (aOR 2.56). Internalized homonegativity was negatively associated with ever testing for HIV among MSM (aOR 0.46), and HIV testing stigma and experienced provider discrimination further strengthened this relationship. It is important to mitigate sexual minority stigma in order to increase HIV testing among MSM. Future research should explore this construct among TW.

Epidemiological studies on benign lesions related to human papillomavirus (HPV) infection are scarce in Latin America. We enrolled 342 consecutive patients with lesions suspected of being genital warts (GW). All patients underwent confirmatory biopsy and GP5+/GP6+/- Reverse Line Blot HPV testing on frozen tissue. In 261 (81%) cases, the diagnosis was confirmed by histopathology and HPV was detected in 90.6% of men and 87.7% of women. HPV 6 was by far the most common type in both women (62%) and men (56%), followed by HPV 11 (∼20%). Co-infection with these two types occurred in 7% and 12% of women and men, respectively. HPV16 ranked third in prevalence, with 16% of patients testing positive. Twenty-five percent of cases tested positive for multiple HPV genotypes. Although HPV 6 and HPV 11 were the main types detected and no differences between men and women were observed, we found HPV 11 contributed more to GW aetiology compared with previous reports, showing a variability of HPV type distribution in GW across populations. This information is valuable baseline data in Latin America for future estimations of the burden of GW in men and women and shows the potential benefit obtainable by prophylactic vaccination against HPV types 6 and 11.

Objective HIV in Central America is concentrated among certain groups such as men who have sex with men (MSM) and female sex workers (FSW). We compared social recruitment chains and HIV transmission clusters from 699 MSM and 757 FSW to better understand factors contributing to ongoing HIV transmission in El Salvador. Methods Phylogenies were reconstructed using pol sequences from 119 HIV-positive individuals recruited by respondent driven sampling (RDS) and compared to RDS chains in three cities in El Salvador. Transmission clusters with a mean pairwise genetic distance ≤0.015 and Bayesian posterior probabilities=1 were identified. Factors associated with cluster membership were evaluated among MSM. Results Sequences from 34 (43%) MSM and 4 (10%) FSW grouped in 14 transmission clusters. Clusters were defined by risk group (12 MSM clusters) and geographic residence (only one spanned separate cities). In 4 MSM clusters (all n=2), individuals were also members of the same RDS chain but only 2 had members directly linked through recruitment. All large clusters (n≥3) spanned more than one RDS chain. Among MSM, factors independently associated with cluster membership included recent infection by BED assay (P=0.02), sex with stable male partners (P=0.02), and sex with ≥3 male partners in past year (P=0.04). Conclusions We found few HIV transmissions corresponding directly with the social recruitment. However, we identified clustering in nearly one half of MSM suggesting RDS recruitment was indirectly but successfully uncovering transmission networks, particularly among recent infections. Interrogating RDS chains with phylogenetic analyses may help refine methods for identifying transmission clusters.

Background High rates of HIV and sexually transmitted infections (STI) are found in men who have sex with men (MSM) in Nicaragua. This study investigated HIV, STI, and risk behaviours in MSM. Methods From 9/2009 to 2/2010, MSM 18 years or older who gave written informed consent and reported having anal sex with a man in the last year were recruited using respondent-driven sampling in Managua. The survey process included audio computer assisted survey instruments (ACASI) and face-to-face interviews followed by STI counselling and specimen collection for HIV (Uni-Gold RecombigenÒ, DetermineÒ, HIV Elisa and Western Blot), HSV-2 (Elisa IgG FocusÒ Technology, Inc), and syphilis testing (RPR/ TPPA). Gonorrhoea, Chlamydia, Mycoplasma genitalium and Trichomonas were tested by PCR. The BED IgG capture enzyme immunoassay was applied to HIV positive specimens to detect recently-acquired HIV infections, used to estimate HIV incidence. Population proportions and 95% CIs were calculated and adjusted for RDS-sampling weights. Incidence estimates were adjusted using a locally-established false-recent rate for the assay. Data analyses were conducted in STATA 9.0 and RDSAT 6.1. Results Respondents self-identified as bisexual (50%), gay (41%), heterosexual (1%) or transgender (8%). In the last year, 34.5% had one or more stable partner and 66% had occasional partners. Sex with women during lifetime was reported by 66% and 40% in the last year. Consistent condom use (last 30 days) was reported at 31% with stable male partner, 12%, with stable female partner, 38% with occasional partner, and 38% with clients. Condom use in last sex was 62%. Overall, 36% had received peer-driven outreach for HIV prevention and 64% had been tested for HIV in the last year. HIV prevalence in Managua was determined to be 7.5% (CI 4.5% to 11%), incidence 2.9% (CI 0.2% to 5.6%). Herpes simplex 2 was the most prevalent STI at 39.9% (CI 34.4% to 46%) see Abstract P1-S2.55 Table 1. Conclusions The 2003 Multicentric Study found a similar prevalence in Managua among MSM at 9.4% (CI 5.3% to 14.8%). Condom use is low with all types of partners, but lowest with female partners. The population's high HIV incidence, coupled with low access to education, underlines the urgency of enhancing prevention activities among this population. Stronger strategies are needed to ensure that prevention, care, and treatment interventions reach this population. Methods In a retrospective study we analysed the laboratory data of 16 HCV positive/HIV positive MSM (cases), HCV diagnosis in 2010, and 32 HCV negative/HIV positive MSM (controls), followed at the HIV/ STI clinic in Antwerp, Belgium. All laboratory confirmed STI episodes (syphilis, gonorrhoea, lymphogranuloma venereum, and rectal and urethral non-LGV chlamydial infections) were recorded since the date of presentation at our clinic, until the date of HCV diagnosis of the cases. Controls were selected from consecutive patients that consulted on the same day. Both cases and controls were regularly followed up at the clinic in...

programs to successfully prevent and control STDs may be complicated by recruitment of new sex partners at such events. Innovative collaborative prevention interventions at sex events and for residents returning from such events should be explored.