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

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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.

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.

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Notes

  1. The code/data analysis for this paper was generated using SAS software, Version 9.3 of the SAS System for Windows. Copyright © 2014 SAS Institute Inc. SAS and all other SAS Institute Inc. product or service names are registered trademarks or trademarks of SAS Institute Inc., Cary, NC, USA.

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Acknowledgments

We gratefully acknowledge the Punto Seguro staff members: Nathalie Gras, Octavio Parra, Jehovani Tena. Biani Saavedra, Fernando Ruiz and Cecilia Hipólito provided research assistance; Dr. Carlos Conde’s INSP laboratory with María Olamendi and Santa García conducted the PCR diagnosis of chlamydia and gonococcus in urine samples. Dr. Florentino Badial-Hernández and Luis Juárez-Figueroa contributed to participants recruitment, care, and HIV testing. Questionnaires were programmed into A-CASI by CEO (Edgar Díaz). Project management and administration: CISIDAT (Research Consortium on HIV/AIDS and TB). We especially thank the participants for agreeing to become part of Punto Seguro. Supported by: US National Institutes of Health (R21HD065525; “Conditional economic incentives to reduce HIV risk: A pilot in Mexico”; PI: Galárraga); and the Mexican National Center for HIV/AIDS Control and Prevention (CENSIDA). Dr. Filipe Monteiro is supported by a postdoctoral fellowship, T32 Training Program in HIV and other Consequences of Substance Abuse (Grant Number T32-DA013911). Dr. Brandon Marshall is supported by a Richard B. Salomon Faculty Research Award from Brown University. This publication was made possible with help from the Lifespan/Tufts/Brown Center for AIDS Research. The described project was supported by Grant Number P30AI042853 from the National Institute of Allergy and Infectious Diseases. The content is solely of responsibility of the authors and does not necessarily represent the official views of the any of the National Institutes of Health.

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Authors and Affiliations

  1. School of Public Health, Brown University, 121 South Main Street, Box G-121S-7, Providence, RI, 02912, USA

    João Filipe G. Monteiro, Brandon D. L. Marshall, Daniel Escudero, Don Operario, Mark N. Lurie & Omar Galárraga

  2. Division of Infectious Diseases, The Miriam Hospital, Providence, RI, USA

    João Filipe G. Monteiro & Timothy Flanigan

  3. National Institute of Public Health (INSP), Cuernavaca, Morelos, Mexico

    Sandra G. Sosa-Rubí

  4. Clínica Especializada Condesa, Mexico City, Mexico

    Andrea González

  5. The Fenway Institute; Beth Israel Deaconess Medical Center; and Harvard Medical School, Boston, MA, USA

    Kenneth H. Mayer

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  1. João Filipe G. Monteiro
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Correspondence to Omar Galárraga.

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Monteiro, J.F.G., Marshall, B.D.L., Escudero, D. et al. Preventing HIV Transmission Among Partners of HIV-Positive Male Sex Workers in Mexico City: A Modeling Study. AIDS Behav 19, 1579–1588 (2015). https://doi.org/10.1007/s10461-014-0915-8

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