Prevalence estimates of HIV, syphilis, hepatitis B and C among female sex workers (FSW) in Brazil, 2016

Abstract

Background:Female sex workers (FSW) bear a high burden of sexually transmitted infections (STI). In this paper, we estimate the prevalence of human immunodeficiency virus (HIV), HBV = hepatitis B virus (HBV), HCV = hepatitis C virus (HCV), syphilis and co-infections in the second Biological and Behavioral Surveillance Survey among FSW in Brazil.Method:The survey was conducted in 12 Brazilian cities from July to November 2016. We used respondent-driven sampling (RDS) to recruit 350 FSW in each city. Rapid tests were used for screening HIV, syphilis, HCV, and HBV. Confirmatory tests were performed on all samples with reactive rapid test result. All testing algorithms and interpretations were done according to the recommendations of the Department of STI/AIDS and viral hepatitis, Ministry of Health. The STI diagnoses were given by: confirmed HIV infection by a positive result on Western blot; active syphilis infection, defined by a RPR titer equal or greater than 1/8; viremia period of HBV and HCV infections, characterized by a detectable (or quantifiable) viral load. Prevalence estimates and standard errors were calculated using statistical procedures suitable for data collected by RDS.Results:Excluding the seeds, 4245 FSW were enrolled. Prevalence estimates were: HIV 5.3% (95% CI: 4.4%–6.2%); active syphilis 8.5% (95% CI: 7.3%–9.7%); HBV 0.4% (95% CI: 0.2%–0.7%); and, HCV 0.9% (95% CI: 0.6%–1.3%). Among the 4154 FSW tested for the 4 infections, 13.3%; (95% CI 12.0%–14.8%) were diagnosed with at least one of the infections, of which 87.6% (95% CI: 83.3%–90.9%) had single infections. The prevalence of HIV/syphilis co-infection was 1.09% (95% CI: 0.7%– 1.6%) and of HIV/HCV or HBV infections was 0.4% (95% CI: 0.2%–0.7%).Conclusions:Our results reveal the need to conduct more studies to estimate the prevalence of STI and co-infections among FSW in Brazil. Longitudinal trends in the prevalence estimates of HIV and other STI provide information to monitor changes in this high-risk population. Additionally, the study highlights the importance of measuring the hepatitis burden among FSW living with HIV, and the need of including FSW in all aspects of STI prevention, care, and treatment programs.

Hepatitis C Virus among Female Sex Workers: A Cross-Sectional Study Conducted along Rivers and Highways in the Amazon Region

“…Overall, the socio-demographic and economic profile of FSWs in this study is consistent with the characteristics of FSWs accessed in other Brazilian cities and in different locations around the world [6,[39][40][41][42][43][44][45]. Poor education and low monthly income are clear indications of the vulnerability of women who offer sexual services on highways and rivers in the Amazon region.…”

“…Currently, illicit drug use is a major risk factor for HCV infection [2,3]. Risky sexual behavior may also be a risk factor for HCV infection, and has been reported as an important route of viral transmission among people who use illicit drugs (PWUDs), female sex workers (FSWs), and men who have sex with other men (MSMs) [5][6][7].…”

Prevalence of syphilis in female sex workers in three countryside cities of the state of Pará, Brazilian Amazon

“…The high prevalence of syphilis among FSWs has been reported in lowincome countries, such as the Dominican Republic (5.1-11.1%), Honduras (1.3-6.0%), Guatemala (1.1-11.8%), El Salvador (2.7-15.0%) and Peru (2.2-4.1%) [15]. The prevalence of syphilis was high (14.1%), which was 65% higher than a recent study that evaluated a similar population of FSWs from 12 Brazilian cities (8.5%) [16], and 3.5 higher than the prevalence found in the city of Botucatu (4%), southeast Brazil [17] using rapid qualitative test and ELISA. These results indicate the disparity on syphilis prevalence among FSWs in Brazil, as well as the need for syphilis control and preventive measures in marginalized populations, such as the observed in this Amazon region and other populations worldwide.…”

HIV testing coverage among female sex workers, Brazil, 2016

“…From an epidemiological point of view, unprotected sexual practices and the multiplicity of partnerships are important determinants for a greater exposure to HIV 2 . In addition, other STIs act as co-factors for HIV transmission 3,4 . From social perspective, structural characteristics, including environment, violence, stigma, cultural contexts and contexts of illegality of sex work continue to be a crucial part in determining the risk of infection among sex workers and their clients 5 .…”