1. MSM in Brazil: baseline national data for prevalence of HIV L. Kerr, A. Pinho, M. Mello, I. Dourado, M. Guimarães, S. Batista, F. Abreu, A. Brito, A. Benzaken, L. Oliveira, A. Moraes, E. Hamann, G. Freitas, W. Mcfarland, G. Rutherford, C. Kendall, MSM group for HIV baseline in Brazil

2. Background Biological Behavior Surveillance Survey in higher risk populations is required by all national Monitoring & Evaluation plans Brazil has an active and successful surveillance program ongoing in many cities, but no baseline national data for MSM exist

3. Goal Provide a baseline to monitor HIV prevalence among MSM in Brazil

4. Methods Multicenter cross-sectional study Settings: –10 cities in all the 5 regions in Brazil

5. Campo Grande Santos Curitiba Manaus Recife Salvador Belo Horizonte Rio de Janeiro Itajaí Brasília Curitiba

6. Methods: Study Population Men who reported having had sex with men in the last 12 months, >18 years old, living in the chosen cities Respondent Driven Sampling –6 seeds of different socioeconomic status –3 coupons per participant –Primary incentive: US$ 8.00 –Secondary incentive: US$ 5.00 Sample size –3500 men: 350 in each city

7. Methods: Data collection Face-to-face questionnaire with handheld Rapid tests for HIV and Syphilis –If positive for HIV  blood for genotyping and BED Ethical issues –Signed Consent form –Proposal approved by National Ethical Committee

8. Methods: analysis To estimate HIV prevalence individuals were weighted Weight ih = (1/R ih )/∑(1/R ih ) x n) x M h –i = participant –h = city –R ih = degree –n = total sample size –M h = proportion of MSM in each municipality related to the sum of all in the 10 cities Formula developed by Dr Celia Landman Szwarcwald

9. Proportion of MSM in each municipality related to the sum of all in the 10 cities Region Site Male pop. (18 - 64) Calculated MSM %MSM in 2004* Brazil35551063,4 North25473,6 Northeast930233,6 Southest1578523,3 South544213,5 Center/west24931,8 * PCAP/Ministry of Health/Department of SDT/AIDS

10. Results 3,859 MSM participate in the study

11. % MSM testing for HIV in the last 12 months and know the result

12. % MSM who correctly identify ways of preventing sexual transmission, and reject misconceptions

13. % MSM who used a condom in their last sexual act with their regular partner

14. % MSM who used a condom in their last sexual act with a casual partner

15. % of MSM who think they are at low risk of HIV infection

16. HIV Seroprevalence rate

17. Conclusions MSM in Brazil are at very high risk of infection with HIV, although they do not perceive themselves at high risk Great disparities exist among cities and programs need to be adapted locally These data call for a major effort in these communities to engage MSM and health authorities

18. Acknowledgements Brazilian Ministry of Health/Health Surveillance Office/ Department of STD/AIDS and Virals Hepatites National Board for Scientific and Technological Development Institute for Global Health / University of San Francisco California Tulane University Center for Global Health Equity