AIDS and Behavior

, Volume 19, Issue 9, pp 1579–1588 | Cite as

Preventing HIV Transmission Among Partners of HIV-Positive Male Sex Workers in Mexico City: A Modeling Study

  • João Filipe G. Monteiro
  • Brandon D. L. Marshall
  • Daniel Escudero
  • Sandra G. Sosa-Rubí
  • Andrea González
  • Timothy Flanigan
  • Don Operario
  • Kenneth H. Mayer
  • Mark N. Lurie
  • Omar Galárraga
Original Paper

Abstract

Mexico has a concentrated HIV epidemic, with male sex workers constituting a key affected population. We estimated annual HIV cumulative incidence among male sex workers’ partners, and then compared incidence under three hypothetical intervention scenarios: improving condom use; and scaling up HIV treatment as prevention, considering current viral suppression rates (CVS, 60.7 %) or full viral suppression among those treated (FVS, 100 %). Clinical and behavioral data to inform model parameterization were derived from a sample (n = 79) of male sex workers recruited from street locations and Clínica Condesa, an HIV clinic in Mexico City. We estimated annual HIV incidence among male sex workers’ partners to be 8.0 % (95 % CI: 7.3–8.7). Simulation models demonstrated that increasing condom use by 10 %, and scaling up HIV treatment initiation by 50 % (from baseline values) would decrease the male sex workers-attributable annual incidence to 5.2, 4.4 % (CVS) and 3.2 % (FVS), respectively. Scaling up the number of male sex workers on ART and implementing interventions to ensure adherence is urgently required to decrease HIV incidence among male sex workers’ partners in Mexico City.

Keywords

Epidemiology Men who have sex with men Monte Carlo simulation methods Data imputation HIV prevention 

Resumen

México enfrenta una epidemia concentrada del VIH, con hombres trabajadores sexuales que constituyen una población afectada clave. Se estimó la incidencia acumulada anual del VIH entre las parejas de hombres trabajadores sexuales. Se modeló esa incidencia bajo tres escenarios de intervención hipotéticos: mejorar el uso del condón; la ampliación del tratamiento del VIH como prevención, teniendo en cuenta las tasas de supresión viral actual (SVA, 60,7 %), o la supresión viral completa entre los tratados (SVC, 100 %). Los datos clínicos y de comportamiento para informar los parámetros del modelo se obtuvieron de una muestra (n = 79) de hombres trabajadores sexuales reclutados de lugares de la calle y la Clínica Especializada Condesa, en la Ciudad de México. Se estimó la incidencia anual del VIH entre las parejas de hombres trabajadores sexuales en 8,0 % (IC 95 %: 7,3–8,7). La simulación demostró que el aumento del uso del preservativo en un 10 %, y la ampliación de la iniciación del tratamiento del VIH en un 50 % (a partir de los valores basales) disminuiría la incidencia anual de la transmisión atribuible a hombres trabajadores sexuales al 5,2 %, al 4,4 % (SVA) y al 3,2 % (SVC), respectivamente. Se requiere urgentemente el aumento del número de hombres trabajadores sexuales en tratamiento antirretroviral e intervenciones para garantizar el apego al tratamiento para reducir la incidencia del VIH entre las parejas de hombres trabajadores sexuales en la Ciudad de México.

Palabras clave

epidemiología hombres que tienen sexo con hombres métodos de simulación Monte Carlo imputación de datos prevención del VIH 

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Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • João Filipe G. Monteiro
    • 1
    • 2
  • Brandon D. L. Marshall
    • 1
  • Daniel Escudero
    • 1
  • Sandra G. Sosa-Rubí
    • 3
  • Andrea González
    • 4
  • Timothy Flanigan
    • 2
  • Don Operario
    • 1
  • Kenneth H. Mayer
    • 5
  • Mark N. Lurie
    • 1
  • Omar Galárraga
    • 1
  1. 1.School of Public HealthBrown UniversityProvidenceUSA
  2. 2.Division of Infectious DiseasesThe Miriam HospitalProvidenceUSA
  3. 3.National Institute of Public Health (INSP)CuernavacaMexico
  4. 4.Clínica Especializada CondesaMexico CityMexico
  5. 5.The Fenway Institute; Beth Israel Deaconess Medical Center; and Harvard Medical SchoolBostonUSA

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