High HIV Burden in Men Who Have Sex with Men across Colombia’s Largest Cities: Findings from an Integrated Biological and Behavioral Surveillance Study

BACKGROUND: Among Latin Americas concentrated HIV epidemics little is known about men who have sex with men (MSM) in Colombia the regions third largest country. To date surveillance studies have been limited to Bogota while 80% of HIV cases and deaths originate from Colombias other cities and departments. The extent to which interventions should prioritize MSM outside of Bogota is unknown. METHODS: We recruited 2603 MSM using respondent-driven sampling from seven of Colombias largest cities. HIV prevalence was estimated by site from dried blood spot samples. Behavioral data were collected through face-to-face interviews and risk factors for HIV infection analyzed using weighted multi-level logistical regression models accounting for recruitment patterns. RESULTS: Across cities HIV prevalence averaged 15% varied from 6% to 24% and was highest in Cali Bogota and Barranquilla. In the past 12 months 65% of MSM had >/= 5 casual male partners and 23% had a female partner. Across partnerships (i.e. casual stable and commercial) the proportion of MSM engaging in unprotected sex was >/= 52% with male partners and >/= 66% with female partners. Self-reported history of STI (24%) and past-year illicit drug use (38%) were also common. In multivariate analysis age >/= 35 (adjusted odds ratio [AOR] 19.2) and 25-39 (AOR 5.6) relative to casual partners on the Internet (adjusted odds ratio [AOR] 3.1) and age of sexual debut of