Knowledge of HIV transmission and condom use among HIV-positive heterosexual men and women in Guatemala

Background: The prevalence of HIV/AIDS in Guatemala among the general population is 0.79%, and 94% of transmission is directly related to sexual contact. Studies have been conducted on high-prevalence HIV-positive populations (men who have sex with men, commercial sex workers and prisoners). Heterosexual transmission has gained importance in the epidemic in Central America. To our knowledge, no study addressing knowledge of mechanisms of HIV transmission and condom use has been done on HIV-positive heterosexual men and women. Methods: A closed-ended structured interview that addressed knowledge of mechanisms of HIV transmission and condom use was conducted on 283 heterosexual HIV-positive men (54.8%) and women (45.2%) outpatients who attend the Roosevelt Hospital's Clinic of Infectious Diseases in Guatemala City. Differences between selected characteristics were examined for significance using the Chi-square test. A multiple logistic regression was done to determine socio-demographic variables associated with inconsistent condom use. Results: Of the interviewed persons, 68.5% were either living with a partner or married, and 94.3% were currently using antiretroviral therapy. Most respondents knew the mechanisms of transmission of HIV. 81.7% and 87.3% reported always using a condom with their regular and casual sexual partner in the past year, respectively. There was no statistically difference in condom use according to the patient's formal education, gender, type of partner (regular or casual) or number of sexual partners. According to the interviewees, 72% of sexual partners in the past year were either HIV negative or of an unknown serostatus. Potentially, these HIV-negative persons are at risk of contracting the virus. Among the main reasons given for not using a condom were: "my partner did not want to use a condom"; and "the condom irritates or makes my partner uncomfortable". Conclusions: Since no socio-demographic or sexual behavior variable was associated with inconsistent condom use, we recommend intensive and regular condom counselling for every heterosexual HIV-positive outpatient who attends the clinic. Further studies should be done to determine condom use negotiation between partners; and to determine social, interpersonal and psychological factors that might affect the decision to use a condom or not.