High rates of STD and sexual risk behaviors among Garífunas in Honduras.

BACKGROUND Honduras has the highest concentration of HIV and AIDS cases in Central America, with an estimated adult HIV prevalence of 1.5%. Prevalence is higher among certain ethnic groups such as the Garífuna with a reported HIV prevalence of 8%. METHODS A biological and behavioral survey was conducted on a stratified random sample of the Garífuna population in Honduras, using computer-assisted interviews. Blood was tested for HIV, herpes simplex type 2 (HSV-2), and syphilis; urine was tested for Chlamydia trachomatis, Neisseria gonorrhoea, Trichomonas vaginalis, and Mycoplasma genitalum. RESULTS We enrolled a total of 817 participants, 41% female and 51% male. Estimated prevalences and 95% confidence intervals (CI) were: HIV, 4.5% (95% CI: 3.0 to 6.6), HSV-2, 51.1% (95% CI: 46.7 to 55.6), and syphilis seropositivity, 2.4% (95% CI: 1.4 to 4.0). Sexually transmitted infections in urine were: chlamydia, 6.8% (95% CI: 4.7 to 9.7), gonorrhea, 1.1% (95% CI: 0.4 to 2.9), trichomoniasis, 10.5% (95% CI: 8.1 to 13.6), and Mycoplasma genitalium, 7.1% (95% CI: 5.1 to 9.9). Consistent condom use was low with stable (10.6%) and casual (41.4%) partners. In multivariate analysis, HIV was associated with rural residence. HSV-2 was associated with female sex, older age, and syphilis seropositivity. CONCLUSIONS We found a moderate prevalence of HIV and a high prevalence of HSV-2 among the Garífunas. HSV-2 may increase the vulnerability of these populations to HIV in the future. Intervention strategies should emphasize sexually transmitted infection control and condom promotion, specifically targeting the Garífuna population.