SEXUAL BEHAVIORS AND RISK-FACTORS FOR HIV-INFECTION AMONG MEN WHO HAVE SEX WITH MEN IN THE DOMINICAN-REPUBLIC

Objective: To describe self-reported types of sexual identity of men w ho have sex with men (MSM) in the Dominican Republic, assess sociodemo graphics and behavioral characteristics, and measure the prevalence of HIV-1 and syphilis. Design: Cross-sectional study of MSM recruited fr om a variety of community settings. Methods: A total of 354 men agreed to participate after giving verbal informed consent. Information was obtained using a standardized questionnaire assessing demographics and AIDS-relevant information. Blood was obtained for HIV and syphilis te sting. Results: Five main sexual identity groups emerged: cross dresse rs, homosexuals, gigolos, bisexuals and heterosexuals. Receptive anal and oral intercourse were commonly reported by men self-identifying as cross dressers or homosexuals, whereas nearly all of the remaining th ree groups practiced only insertive intercourse. Sexual contact with w omen was also commonly reported; overall, consistent condom use was in frequent. HIV antibodies were detected in 11.0% and serologic evidence of syphilis was found in 7.3%. Factors independently associated with HIV infection included serologic evidence of syphilis, having visited at least one of four local brothels in 1975-1985, and having had recep tive anal intercourse with four or more partners in the last 12 months . Conclusions: Syphilis, sexual practices and social context of sex (c ommercial sex), rather than sexual identity per se, were associated wi th HIV infection. The complex social networks of MSM in this setting, the tendency to practice either insertive or receptive sex, but not bo th, infrequent condom use, high rates of syphilis and the frequency of sex with women need to be taken into account for targeted HIV prevent ion programs to be successful.