| Background. This cross-sectional study was carried out in Central American female sex workers (FSW) and men who have sex with men (MSM). In FSW, we assessed the relationship between prevalences of sexually transmitted infections (STI) including HIV and both individual-level socio-behavioral and commercial sex workplace-level characteristics.; Methods. In 2000-2001, 2,466 FSW and 1,418 MSM in El Salvador, Guatemala, Honduras, Nicaragua and Panama, underwent a standardized interview and screening and confirmatory tests for HIV, HSV-2 and syphilis seropositivity; PCR tests for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG); and Gram stain for bacterial vaginosis (BV) and culture for Trichomonas vaginales (TV) in women. Odds ratios (OR) or prevalence ratios (PR) of each STI reflect associations with individual- and workplace-level characteristics.; Results. Overall HIV seroprevalence in MSM was 11.7% and 3.6% in FSW. Overall HSV-2 seroprevalence in FSW was 85.3%. Condom use was negatively associated with HIV seropositivity [OR=0.05; 0.01, 0.4], CT [PR=0.6; 0.4, 0.9], TV [PR=0.5; 0.4, 0.8], BV [PR=0.6; 0.5, 0.9] or putative recent syphilis VDRL titre≥1:16 [OR=0.3; 0.1, 0.6]. Street- or park-based sex work was positively associated with HIV [OR 2.7; 1.4, 5.1], syphilis [OR=2.2; 1.4, 3.4], NG [OR=2.5; 1.5, 4.3], TV [PR=2.6; 1.7, 4.0] and BV [PR=1.2; 1.0, 1.4]. By multilevel modeling, better workplace access to condoms was negatively associated with HIV [OR=0.7; 0.4, 1.5], NG and TV [OR=0.4; 0.2, 0.7 and PR=0.5; 0.3, 0.8]. High FSW turnover was positively associated with HIV [OR=2.0; 1.0, 4.1] and NG infection [OR=1.8; 1.1, 3.1]. Poorer workplace security was positively associated with HIV [OR=2.3; 1.3, 4.1]. Workplaces with greater average payment by clients were characterized by lower prevalence of syphilis and TV [OR=0.7; 0.5, 1.0 and PR=0.8; 0.6, 1.0].; Conclusions. We found high HIV prevalence in MSM and a potential role of HSV-2 as a risk factor for HIV acquisition in FSW. Better condom access, lower FSW turnover, higher average payment and better security at the workplace-level all were associated with lower risk of HIV, syphilis, NG and/or TV. These associations were independent of a negative association between condom use and HIV, syphilis and TV by individual-level analyses. |
