Ethnicity and HIV Risk in Guatemala
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Author(s): Taylor TM, Hembling J, Bertrand JT
Mayans and other indigenous groups make up approximately half of the population in Guatemala, and previous research shows them to be highly disadvantaged on nearly every indicator of health and well-being (Gragnolati and Marini, 2003). Little is known, however, about the HIV risk profile of these groups, or how it may differ from that of the non-indigenous population. Evidence of these differences could inform resource allocation and be used to improve HIV prevention intervention strategies in the country.
Data on 16,205 women aged 15–49 and 6,822 men aged 15–59 who participated in the 2008–2009 Encuesta Nacional de Salud Materno Infantil (ENSMI) were used to describe differences between ethnic groups on a variety of demographic and HIV variables. We then controlled for age, education, wealth and other background factors in a logistic regression model investigating the association between ethnicity and respondents’ odds of early sexual debut, higher numbers of sexual partners, condom use, HIV testing, comprehensive HIV knowledge, and accepting attitudes towards people living with HIV (PLHIV).
The data show low reported levels of risky sexual behavior among indigenous women and men, compared to other respondents. However, the indigenous group also exhibited markedly less HIV awareness, more limited understanding of HIV transmission, lower prevention knowledge, and more negative attitudes toward PLHIV. When controlling for other socio-demographic factors, ethnicity was associated with women’s early sexual debut, 3+ lifetime sexual partners, comprehensive HIV knowledge, accepting attitudes, and HIV testing. It was not associated with women’s condom use at last sex. Among men, ethnicity was associated with early sexual debut, 10+ lifetime sexual partners, lifetime history of sex worker patronage, and comprehensive HIV knowledge. It was marginally associated with men’s odds of having 3+ sexual partners in the past 12 months, using a condom during most recent sexual encounter, and HIV testing. Among men ethnicity was not associated with condom use at last sex with a sex worker, or with accepting attitudes towards PLHIV.
We conclude that the indigenous population in Guatemala, while broadly socially vulnerable, does not appear to be at elevated risk for HIV. We recommend that prevention efforts continue to focus on key populations at higher risk. Nonetheless, low rates of HIV testing coupled with limited prevention knowledge, particularly among the indigenous, are cause for concern. Programs working in indigenous communities may wish to focus on basic HIV education and address barriers to testing. Finally, while our analysis of risk factors strongly suggests that the epidemic in Guatemala remains concentrated in traditional key populations, the addition of HIV biomarker data to the next national health survey would provide definitive evidence. Researchers working with other health datasets from Guatemala should also be encouraged to present their results by ethnic group, so that programs and policies can be designed with indigenous communities’ unique needs in mind.
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