{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T13:19:39Z","timestamp":1783084779522,"version":"3.54.6"},"reference-count":35,"publisher":"Pan American Health Organization","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,7,3]]},"abstract":"<title>ABSTRACT<\/title>\n                  <sec>\n                    <title>Objective:<\/title>\n                    <p>To estimate the prevalence of human immunodeficiency virus (HIV) in men who have sex with men (MSM) in Belize and identify behavioral and structural factors associated with infection.<\/p>\n                  <\/sec>\n                  <sec>\n                    <title>Methods:<\/title>\n                    <p>This mixed-methods study was a secondary analysis of data from the 2024 Integrated Biological and Behavioral Surveillance Survey. A total of 490 MSM were recruited using respondent-driven sampling. Data were collected using a structured behavioral questionnaire administered via computer-assisted self-interview. Qualitative data were collected through key informant interviews and focus group discussions.<\/p>\n                  <\/sec>\n                  <sec>\n                    <title>Results:<\/title>\n                    <p>HIV prevalence was 11.0%. Condom use was inconsistent: 70.4% reported consistent use, while 16.1% never used condoms. Transactional sex was common (18.8% received payment and 22.0% paid for sex). Condom use was higher in respondents who paid for sex (84.3%) than in those who were paid (64.1%). HIV testing was moderate: 74.5% had ever tested, but only 42.0% were tested in the past year and 6.5% had self-tested. Awareness of pre-exposure prophylaxis and post-exposure prophylaxis was low (8.6% and 8.4%, respectively). Among respondents who were aware, &lt; 20% had used prophylaxis in the past 6 months. Substance use was prevalent (high alcohol risk 56.7% and cannabis use 41.4%) and 50.4% engaged in risky sex under intoxication. Depression risk was 46.1%. Qualitative findings identified three themes: individual factors, health system factors, and stigma.<\/p>\n                  <\/sec>\n                  <sec>\n                    <title>Conclusion:<\/title>\n                    <p>MSM in Belize face a high HIV burden driven by behavioral and structural factors. Interventions should prioritize condom promotion, pre-exposure prophylaxis scale-up, mental health support, substance use prevention, and stigma reduction.<\/p>\n                  <\/sec>","DOI":"10.26633\/rpsp.2026.62","type":"journal-article","created":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T12:28:53Z","timestamp":1783081733000},"page":"1","source":"Crossref","is-referenced-by-count":0,"title":["Behavioral and structural drivers of HIV in men who have sex with men in Belize: a mixed-methods study"],"prefix":"10.26633","volume":"50","author":[{"given":"Olusola","family":"Oladeji","sequence":"first","affiliation":[{"name":"UNICEF, Belize City, Belize."},{"name":"ooladeji@unicef.org"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marvin L.","family":"Manzanero","sequence":"additional","affiliation":[{"name":"Ministry of Health and Wellness, Belmopan, Belize."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Enrique","family":"Romero","sequence":"additional","affiliation":[{"name":"National Aids Commission, Belize City, Belize."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Baffoe","sequence":"additional","affiliation":[{"name":"UNICEF Latin America and Caribbean Regional Office, Panama City, Panama."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"11167","reference":[{"key":"ref1","unstructured":"Joint United Nations Programme on HIV\/AIDS. 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