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HIV community prevalence and testing practices in León, Nicaragua
(Obstetrics and Gynecology, UNAN León)
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health. (Internationell kvinno- & mödrahälsovård och migration/Essén)
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH). (International Maternal and Reproductive Health and Migration)
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health. (Obstetrisk forskning/Högberg)
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(English)Manuscript (preprint) (Other academic)
Abstract [en]

Our objective was to determine the HIV prevalence, testing practices, and HIV-related behaviors in a general population sample in the municipality of Leon, Nicaragua. We performed a cross-sectional community-based study of 2,204 males and females ages 18 to 69, from a health and demographic surveillance system. A behavior survey and blood sampling for HIV were also carried out. Seven of 1,960 individuals who provided biological samples (0.35%; CI 0.18–0.67) were HIV positive. The predicted prevalence of HIV among non-participants was about 11% higher than the observed prevalence but it was not significantly different. The major obstacle to HIV testing seemed to be the fear of being diagnosed HIV positive. This is the first study to determine HIV prevalence among the general population in Nicaragua. Our findings confirmed that this population has a low prevalence but high risk for HIV infection. Prevention strategies are essential to maintain this figure.

Keyword [en]
HIV, prevalence, testing, health demographic surveillance system, Nicaragua
National Category
Medical and Health Sciences
Research subject
Caring Sciences in Medical Sciences
Identifiers
URN: urn:nbn:se:uu:diva-185571OAI: oai:DiVA.org:uu-185571DiVA: diva2:572798
Available from: 2012-11-28 Created: 2012-11-26 Last updated: 2013-04-02
In thesis
1. Averting HIV and AIDS epidemic in Nicaragua: Studies of prevalence, knowledge, attitudes, and behavior
Open this publication in new window or tab >>Averting HIV and AIDS epidemic in Nicaragua: Studies of prevalence, knowledge, attitudes, and behavior
2012 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The overall aim of this thesis was to obtain an understanding of the dynamics of the HIV epidemic by estimating prevalence and exploring the relationship between HIV-related knowledge, attitudes, behavior, and HIV status in Nicaragua. Structured questionnaires were administered to adults from a health and demographic surveillance system in León, Nicaragua (Papers I–III). In-depth interviews and a survey were conducted among men who have sex with men (MSM, Paper IV). Blood sampling for HIV was carried out among 2,204 men and women (Paper I). Bivariate and multivariate analyses, including adjusted prevalence ratio (Papers I, II, IV), factor analysis, Cronbach’s alpha, and hierarchical regression analysis (Paper III) were performed. Thematic analysis was used with qualitative data (Paper IV).

The prevalence of HIV in the general population was 0.35% (95% CI, 0.17–0.73). Those who have taken a HIV test were more likely to be females, younger, living in an urban setting, have a higher level of education, be married or cohabiting, and have no religious affiliation. HIV-related knowledge was lower among members of the general population than among MSM. Unprotected sex was reported more times with regular partners than with casual partners. Findings suggested that consistency of condom use and emotional attachment (steady relations) were inversely related. Stigma and discrimination were reported high in the general population; they appeared to be negatively associated with HIV-related knowledge, self-perception of HIV risk, HIV testing, and willingness to disclose HIV status in the event of being HIV-positive. Findings demonstrated an increasing tolerance towards same-sex attractions. MSM have a better understanding of HIV transmission than men and women of the general population. Although seven out of ten MSM and six out of ten women were concerned about becoming infected with HIV, inconsistent condom use was common.

This study confirmed that Nicaragua has a low prevalence but high risk for HIV infection and transmission. Results underscore that social, behavioral, and cultural factors contribute to retard progress in achieving the Millennium Development Goals on reducing gender inequality and combating HIV/AIDS. Addressing these challenges depends not only on successful behavior change interventions, but requires a culturally gender-appropriate strategy.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2012. 67 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 847
Keyword
HIV-related knowledge, vulnerability, risk behaviors, stigma, discrimination, men who have sex with men, gender, sexuality, Nicaragua
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Medical Science; Social Medicine
Identifiers
urn:nbn:se:uu:diva-186673 (URN)978-91-554-8553-5 (ISBN)
Public defence
2013-01-16, Room IX, plan 2, Uppsala University Main Building, Biskopsgatan 3, Uppsala, 09:15 (English)
Opponent
Supervisors
Available from: 2012-12-21 Created: 2012-11-29 Last updated: 2013-04-02Bibliographically approved

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Ugarte, William JEssén, BirgittaHögberg, Ulf

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