{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T12:15:31Z","timestamp":1781007331754,"version":"3.54.1"},"reference-count":27,"publisher":"BMJ","issue":"9","funder":[{"DOI":"10.13039\/501100004892","name":"Agencia Espa\u00f1ola de Cooperaci\u00f3n Internacional para el Desarrollo","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100004892","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000200","name":"United States Agency for International Development","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000200","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Ag\u00e8ncia Catalana de Cooperaci\u00f3 i Desenvolupament"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2018,7,23]]},"published-print":{"date-parts":[[2018,9]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To describe and compare trends in prevalence, sexual behaviour and HIV transmission knowledge data related to sexually transmitted infections (STI) and HIV in patients attending three STI clinics over an 8-year period in Escuintla Department, Guatemala.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>STI clinic attendees were classified into transmission groups as follows: female sex workers (FSW), men who have sex with men (MSM) and \u2018high-risk heterosexuals\u2019 (HRH). Annual cross-sectional analysis and multivariable Poisson regression adjusted for sociodemographic variables were used for prevalence comparisons and adjusted prevalence trends for HIV\/STI outcomes and used for adjusted trends in proportions in sexual behaviour and HIV transmission knowledge outcomes. Endocervical swabs were obtained to detect trichomonas, chlamydia and neisseria infections. Serologies for syphilis and HIV were performed using rapid tests. For reactive HIV samples, positivity was confirmed by an ELISA. All reactive syphilis samples were further confirmed for diagnosis of active syphilis disease.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>From a total of 4027 clinic attendees, 3213 (79.78%) were FSW, 229 (5.69%) were MSM and 585 (14.53%) were HRH. The proportion of FSW, MSM and HRH who had a single visit was 56.42%, 57.23% and 91.10%, respectively. Overall, HIV prevalence was 2.10% in FSW, 8.17% in MSM and 4.12% in HRH. Prevalence trends in HIV and syphilis decreased in FSW. Prevalence trends in gonorrhoea did not decrease over time neither in FSW nor in HRH. Chlamydia and trichomonas infections in HRH showed an increase prevalence trend. In FSW, trends in condom use in last sexual intercourse with regular and occasional clients were above 93%.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>FSW show a decreasing trend in HIV, syphilis and chlamydia prevalence. Gonorrhoea prevalence in FSW and HRH did not decrease over time. HRH is a hard to engage population with low follow-up rates and high potential to act as a bridge population.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2018-022632","type":"journal-article","created":{"date-parts":[[2018,9,20]],"date-time":"2018-09-20T10:52:06Z","timestamp":1537440726000},"page":"e022632","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":9,"title":["The UALE project: a cross-sectional approach for trends in HIV\/STI prevalence among key populations attending STI clinics in Guatemala"],"prefix":"10.1136","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8263-3140","authenticated-orcid":false,"given":"Juan Ignacio","family":"Garc\u00eda","sequence":"first","affiliation":[{"name":"Fundaci\u00f3 Sida i Societat, Technical Advisor Unit (UAT), Hospital Nacional de Escuintla, Escuintla, Guatemala"},{"name":"Center for Epidemiological Studies on HIV\/AIDS and STI of Catalonia (CEEISCAT), Generalitat de Catalunya, Badalona, Spain"},{"name":"Department of Paediatrics, Obstetrics and Gynaecology, Preventive Medicine, and Public Health. PhD Programme in Methodology of Biomedical Research and Public Health., Univeristat Aut\u00f2noma de Barcelona, Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meritxell","family":"Sabid\u00f3","sequence":"additional","affiliation":[{"name":"TransLab, Department of Medical Sciences, Universitat de Girona, Girona, Spain"},{"name":"CIBER Epidemiolog\u00eda y Salud P\u00fablica, Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mikhail","family":"Nikiforov","sequence":"additional","affiliation":[{"name":"Fundaci\u00f3 Sida i Societat, Technical Advisor Unit (UAT), Hospital Nacional de Escuintla, Escuintla, Guatemala"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adriana","family":"Smith","sequence":"additional","affiliation":[{"name":"Fundaci\u00f3 Sida i Societat, Technical Advisor Unit (UAT), Hospital Nacional de Escuintla, Escuintla, Guatemala"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabriela","family":"Hern\u00e1ndez","sequence":"additional","affiliation":[{"name":"Fundaci\u00f3 Sida i Societat, Technical Advisor Unit (UAT), Hospital Nacional de Escuintla, Escuintla, Guatemala"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rudy","family":"Ortiz","sequence":"additional","affiliation":[{"name":"Fundaci\u00f3 Sida i Societat, Technical Advisor Unit (UAT), Hospital Nacional de Escuintla, Escuintla, Guatemala"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luis","family":"Ardani","sequence":"additional","affiliation":[{"name":"Fundaci\u00f3 Sida i Societat, Technical Advisor Unit (UAT), Hospital Nacional de Escuintla, Escuintla, Guatemala"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alba","family":"Cajas","sequence":"additional","affiliation":[{"name":"Fundaci\u00f3 Sida i Societat, Technical Advisor Unit (UAT), Hospital Nacional de Escuintla, Escuintla, Guatemala"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elsy","family":"Camey","sequence":"additional","affiliation":[{"name":"Fundaci\u00f3 Sida i Societat, Technical Advisor Unit (UAT), Hospital Nacional de Escuintla, Escuintla, Guatemala"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jordi B","family":"Torrelles","sequence":"additional","affiliation":[{"name":"Texas Biomedical Research Institute, San Antonio, Texas, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shu-Hua","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Division of Infectious Diseases. 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