HIV, HCV, HBV, HSV, and syphilis prevalence among female sex workers in Tehran, Iran, by using respondent-driven sampling

Determinants of sexually transmitted infections among female sex workers in Ethiopia: a count regression model approach

Background

Sexually transmitted infections (STIs) remain a major public health problem worldwide, with the burden of these infections being high among female sex workers (FSWs), who are often not aware of their infection status. This study aimed to determine the factors that are associated with the number of STIs among FSWs in Ethiopia.

Methods

A cross-sectional bio-behavioral study involving respondent-driven sampling (RDS) was conducted among 6,085 FSWs in 16 towns in Ethiopia. The hurdle Poisson regression model was fitted using STATA Version 16.2. The incident rate ratio and adjusted odds ratio with a 95% confidence interval were employed to show the strength and direction of the association. A p-value of ≤0.05 was used as a threshold for statistical significance.

Results

At least one STI was identified in 1,444 (23.64%) of the FSWs. Age group 35-49 years [IRR = 2.32; 95% CI (1.43, 3.74)], forced first sex [IRR = 1.32; 95% CI (1.01, 1.74)], condom breakage [IRR = 1.32; 95% CI (1.01, 1.74)], and a history of depression [IRR = 1.55; 95% CI (1.12, 2.18)] increase the number of STIs. FSWs aged 25-34 years [AOR = 2.99; % CI (2.54, 3.52)] and 35 = 59 years [AOR = 8.05; % CI (6.54, 9.91)], who were selling sex for 5-10 years [AOR = 1.30; 95% CI (1.1, 1.55)], and above 11 years [AOR = 1.21; 95% CI (1.03, 1.43)] were more likely to get STIs.

Conclusion

STIs are common in Ethiopia. The covariates age, educational status, monthly income, condom failure, age at the first sexual encounter, and long duration of sexual practice are significant predictors of STIs. Health interventions among FSWs need to include awareness generation about the prevention and control of STIs and address the determinants identified in this analysis.

HIV prevalence and associated factors among female sex workers in Iran: a bio-behavioral survey in 2020

Despite the overall decline in human immunodeficiency virus (HIV) prevalence, it remains unacceptably high in key populations. This study aimed to estimate prevalence of HIV infection and high-risk behaviors among female sex workers (FSWs). This study was a cross-sectional survey of FSWs conducted between December 2019 and August 2020 in eight geographically diverse cities in Iran. After providing informed consent, participants completed a bio-behavioral questionnaire and after completion of the interview, rapid diagnostic tests (RDT) and dried blood spots (DBS) were collected to determine HIV and syphilis status as per national guidelines, if the women consented. All analyzes were based on RDS adjustment. Weighting was done according to Giles'SS estimator. Among the 1515 FSWs, the overall prevalence of HIV and syphilis were 1.6% (95% CI: 0.8-2.3) and zero, respectively. The highest HIV prevalence was observed in Shiraz (5.1%) and Khorramabad city (1.6%). In addition, HIV-positive FSWs had a higher mean age at first sexual contact than HIV-negative FSWs (21.4 ± 5.6 vs. 17.2 ± 4.2 years). Injection drug use and a history of arrest or incarceration were associated with an increased odds of HIV infection (OR = 6.25; 95% CI: 1.90-20.55 and OR = 4.57; 95% CI: 1.64-12.72, respectively). Based on the results, strategies to improve early HIV diagnosis, harm reduction, and use of testing and treatment strategies are needed to reduce and control HIV infections.

Seroprevalence of Hepatitis B Virus, Hepatitis C Virus, Syphilis and Associated Factors Among Female Sex Workers in Gondar Town, Northwest Ethiopia

Background

Sexually transmitted infections (STIs) are a public health problem worldwide. Hepatitis B virus infection (HBV), hepatitis C virus infection (HCV), and syphilis are among the STIs. Female sex workers (FSWs) continue to be a high-risk group for STIs due to a variety of factors, including exposure to unsafe sexual practices. Therefore, this study determines the seroprevalence of HBV, HCV, Treponema palladium, and associated factors among FSWs in Gondar town, Northwest Ethiopia.

Methods

A cross-sectional study was conducted on 194 FSWs from March to June 2021 in Gondar town. Socio-demographic and behavioral data were collected using a questionnaire. Five milliliters (5mL) of venous blood was collected and tested for hepatitis B surface antigens, anti-hepatitis C antibodies, and anti-syphilis antibodies using an enzyme-linked immunosorbent assay. Logistic regression, univariate, and multivariate analyses were carried out. A p-value of < 0.05 at a 95% confidence interval was considered statistically significant.

Results

A total of 194 FSWs were included in the study. The seroprevalence rates of HBV infection, HCV infection, and syphilis were 23 (11.9%), 13 (6.7%), and 22 (11.3%), respectively. All three infections were statistically associated with inconsistent condom use (AOR = 1.72, 95% CI: 1.95-5.07, p = 0.03); (AOR = 10.51, 95% CI: 1.62-68.26, p = 0.014); and (AOR = 17.3, 95% CI: 4.55-65.6, p = 0.001). Whereas sex stimulant drug use (AOR = 9.4, 95% CI: 1.002-88.14), intravenous drug use (AOR = 15.53, 95% CI: 1.9-127.99, p=0.011), and sex while having a vaginal ulcer (AOR = 5.72, 95% CI: 1.13-28.9, p=0.035) were all statistically associated with HCV infection.

Conclusion

The prevalence of HBV infection, HCV infection, and syphilis was comparatively higher. Regular screening, health education, and other preventative strategies are advised to lower the STI burden among FSWs.

Major Thalassemia, Screening or Treatment: An Economic Evaluation Study in Iran

BACKGROUND

Beta-thalassemia minor and thalassemia major are an autosomal recessive disease with hypochromic, microcytic anemia, and morbidities, Today, therapeutic advances have significantly improved the life expectancy of thalassemia major patients, but at the cost of financial toxicity. The present study aimed to investigate the possibility of increasing the funding for thalassemia screening programs and comparing the cost-effectiveness of screening for thalassemia in the treatment of the patients.

METHODS

In this study, screening for thalassemia minor was compared with the treatment of thalassemia major patients. A decision tree model was used for analysis. A hospital database, supplemented with a review of published literature, was used to derive input parameters for the model. A lifetime study horizon was used and future costs and consequences were discounted at 3%. The approach of purchases of services was used to evaluate the screening test costs for patients with thalassemia major. Also, a bottom-up method was applied to estimate other screening and treatment costs. All the costs were calculated over one year. The number of gained quality-adjusted life years (QALYs) was calculated using the EQ-5D questionnaire in the evaluated patients.

RESULTS

In this study, 26.97 births of patients with thalassemia major were prevented by screening techniques. On the other hand, total screening costs for patients with thalassemia major were estimated equal to US$ 879879, while the costs of preventing the birth of each thalassaemia major patient was US$ 32 624 by screening techniques. In comparison, the cost of managing a patient with thalassemia major is about US$ 136 532 per year. The life time QALYs for this is 11.8 QALYs. Results are presented using a societal perspective. Incremental cost per QALY gained with screening as compared with managing thalassaemia major was US$ 11 571.

CONCLUSION

Screening is a long-term value for money intervention that is highly cost effective and its long-term clinical and economic benefits outweigh those of managing thalassaemia major patients.

Prevalence of Hepatitis B Virus infection and associated factors among female sex workers using respondent-driven sampling in Hawassa City, Southern Ethiopia

Background

Female sex workers (FSWs) are a marginalized group notoriously having limited healthcare access and poor-quality care. Inevitably, they are vulnerable to sexually transmitted infections including hepatitis B virus. However; Hepatitis B virus infection is one of the most serious infections and major public health problem considered to be at soaring risk for transmission and acquisition of the infection. Hence, this study was aimed to assess the prevalence and associated factors of HBV infections among FSWs in southern Ethiopia.

Methods

A cross-sectional study was conducted from November to February 2019 at Hawassa city in ISHDO confidential clinic among 383 FSWs. Respondent-driven consecutive sampling was used to select study participants using a standardized questionnaire. Blood sample was collected and viral surface antigen was detected using ELISA from separated serum. Data were entered to SPSS version 21.0. Descriptive and logistic regression analyses were used.

Result

The overall prevalence of FSWs who were tested for HBV using ELISA was 35(9.2%) (95% CI: 6.3–12.1). Among 381 FSWs 249(65.4%) were stayed for 2–5 years in sexual work and 240(63%) of them were used condom consistently during sexual practice. In multivariate logistic regression analysis, FSWs who didn’t use condom were six and two times more risk full to acquire HBV than those who used condom commonly (AOR = 6.38, CI 2.04–18.51) and condom breakage (AOR = 2.10, CI 1.95–4.65), during sexual practice respectively. Similarly, use of stimulants (AOR = 3.25, CI 1.59–18.63), previous history of STI (AOR = 2.15, CI 1.02–6.93), genital ulcer (AOR = 4.64, CI 1.31–11.35), number of sexual partners (AOR = 3.25, CI 1.59–7.47), sex during menses (AOR = 5.85, CI (1.29–21.44), sexual assault (AOR = 2.93, CI 1.23–9.01), sharp material sharing, (AOR = 4.98, CI 1.34–10.95) and history of abortion, (AOR = 2.46, CI 1.18, 12.19), were statistically associated with HBV infection. Factors such as age, residence, and alcohol consumption were not associated with HBV infection.

Conclusion

The prevalence of HBV infection in this study was relatively high compared to the general population. Factors like sociodemographic, behavioral, and previous history-related information were associated with HBV infection shows the need for ongoing screening of high-risk population to inform planning for vaccination and preventive measures.

Condomless Sex With Partners and Clients Among Female Sex Workers in Iran: A Systematic Review and Meta-Analysis

ABSTRACT

Condomless sex is the most proximal risk for HIV acquisition among female sex workers (FSWs). We performed a systematic review and meta-analysis to summarize the evidence for the prevalence of condomless sex among FSWs in Iran. A random-effect meta-analysis model was used to pool the prevalence estimates and their 95% confidence intervals (CIs). The pooled prevalence of condomless sex at last sex with a paying client and a nonpaying partner was 34.23% (95% CI: 27.83-40.93) and 48.34 (95% CI: 38.43-58.32), respectively. Last-month inconsistent condom use was 49.01% (95% CI: 21.64-76.71) with paying clients and 60.21% (95% CI: 31.27-85.73) with nonpaying partners. The pooled prevalence of lifetime condom nonuse with any partners/clients was 15.26% (95% CI: 10.68-20.49). These findings indicate that a substantial proportion of FSWs engage in high-risk sexual practices. Community-led programs should be stimulated to improve consistent condom use among FSWs.

Determinants of safe sexual behavior of female sex workers in Tehran: the woman, her network, and the sexual partner

BACKGROUND

Despite the steady growth of sexual transmission of HIV, there is little evidence about safe sexual behavior of FSWs, and social network effects on this behavior, in Iran. Our aim in this study was to determine the effect of social network characteristics on condom use among FSWs, considering individual characteristics of the FSWs and of their sexual partners, characteristics of their relationship, and the FSW's personal network.

METHODS

A cross-sectional ego-centric network survey of 170 FSWs was carried out in Tehran between January and June 2017. A multilevel ordered logistic regression analysis was conducted to examine the effects of individual and relational characteristics simultaneously.

RESULTS

Condom use in sexual relationships of the FSWs on average was rather low. Important determinants of safe sexual behavior were found both at the level of the individual FSW and at the level of the sexual partner. The main determinants at the level of the individual FSW were FSWs' age and HIV knowledge. At the level of the sexual partner, age and education of sexual partners, as well as intimacy, duration of tie, frequency of contacts with a given partner, frequency of contact, perceived social support, and perceived safe sex norms were significantly associated with condom use.

CONCLUSIONS

The findings highlighted that considering only the individual characteristics of female sex workers is not sufficient for effectively promoting condom use. Factors at the network and dyadic level should also be considered, especially the role of sexual partners. Network-based interventions may be useful which modify social relationships to create a social environment that can facilitate changes in sexual behavior.

Seroprevalence of Hepatitis B Virus and Associated Factors Among Female Sex Workers Using Respondent-Driven Sampling in Hawassa City, Ethiopia

BACKGROUND

Female sex workers (FSWs) are a marginalized group having limited healthcare access and poor-quality care. Inevitably, they are vulnerable to sexually transmitted infections including hepatitis B virus. It is one of the most serious and major public health problems, with an increased risk of transmission and acquisition of the infection. Hence, this study was aimed to assess the prevalence and associated factors of HBV infection among FSWs in southern Ethiopia.

METHODS

A cross-sectional study was conducted from November to February 2019 at Hawassa city among ISHDO confidential clinics among 383 FSWs using respondent-driven consecutive sampling techniques to select study participants using a standardized questionnaire. The blood samples were collected to detect viral surface antigen using ELISA. Data were entered into SPSS version 21. Descriptive and logistic regression analysis was used.

RESULTS

The overall prevalence of HBV was 35 (9.2%) (95% CI=6.3-12.1). Among 381 FSWs, 249 (65.4%) of them had stayed for 2-5 years in sexual work. A total of 240 (63%) of them used condoms consistently during sexual practice. In multivariate analysis, FSWs who did not use a condom during sexual practice were 6-times more at risk than those who used a condom (AOR=6.38, CI=2.04-18.51). Condom breakage (AOR=2.10, CI=1.95-4.65), use of stimulants (AOR=3.25, CI=1.59-18.63), history of STI (AOR=2.15, CI=1.02-6.93), and genital ulcer (AOR=4.64, CI=1.31-11.35), number of sexual partners (AOR=3.25, CI=1.59-7.47), sex during menses (AOR=5.85, CI=1.29-21.44), sexual assault (AOR=2.93, CI=1.23-9.01), sharp material sharing (AOR=4.98, CI=1.34-10.95), and history of abortion (AOR=2.46, CI=1.18-12.19) were statistically associated with HBV infection.

CONCLUSION

The prevalence of HBV infection in this study was relatively high compared to the general population. Factors like sociodemographic, behavioral, and previous information were associated with HBV infection. There is a need for ongoing screening of this high-risk population to inform planning for vaccination and preventive measures.

Seroprevalence of HBV and HCV in female sex workers from four cities in the state of Pará, northern Brazil

Female sex workers (FSWs) represent a high vulnerability group for the acquisition of sexual and parenteral infections such as hepatitis B virus (HBV) and hepatitis C virus (HCV) infections. The present study aimed to determine the prevalence of serological markers and risk factors associated with exposure to HBV and HCV among FSWs in the state of Pará, Brazil. A cross-sectional study using principles of the time location sampling (TLS) method was conducted in four cities (Belém, Bragança, Barcarena, and Augusto Corrêa) of the state of Pará, from 2005 to 2006. In total, 365 FSWs were interviewed using a standardized questionnaire. Blood samples were collected and tested for serological markers of exposure to HBV and HCV using an enzyme immunoassay. The overall prevalence of exposure to HBV and HCV was 36.7% and 7.7%, respectively. The prevalence of surface antigen of HBV was 3.0%. The prevalence of anti-HBc and anti-HBc+ anti-HBs antibodies were 6.3% and 27.4%. Very few (4.7%) FSWs had vaccine immunity against HBV (anti-HBs antibodies only). The prevalence of anti-HCV antibodies was 7.7%. Low monthly income, drug usage, and unprotected sex were some of the social characteristics associated with exposure to the viruses using different analysis. The seroprevalence of HBV and HCV infections among FSWs in four cities of the state of Pará is high when compared to the general population of Brazil, but similar to those found in FSWs in other nondeveloped countries. The prevalence of HBV was higher in Belém, while the prevalence of HCV was higher in the other three cities, highlighting the importance of establishing control and prevention programs to reduce the risk of acquiring these viruses in Pará.

Injection and non-injection drug use among female sex workers in Iran: A systematic review and meta-analysis

BACKGROUND

Illicit drug use is a prevalent risk behavior among female sex workers (FSWs) as it increases the vulnerability of this marginalized population to negative health outcomes, including HIV infection. This systematic review and meta-analysis aimed to estimate the prevalence of injection and non-injection drug use among FSWs in Iran.

METHODS

Systematic searches of PubMed, Embase, Web of Science, Scopus, and PsycINFO (for English records), along with Iranian databases including IranMedex, Iran Psych Magiran, Scientific Information Database, and Irandoc (for Farsi records) were conducted for studies published from inception through to July 2020. We included quantitative studies on injection and non-injection drug use among FSWs. The pooled prevalence and 95% confidence intervals (CI) of recent and lifetime drug injection and non-injection were estimated using random-effects meta-analysis.

RESULTS

Of 458 screened records, 19 met the inclusion criteria. The pooled prevalence of recent non-injection drug use and injection drug use was 56.94% (95% CI: 44.68, 68.78) and 5.67% (95% CI: 2.09, 10.73), respectively. Opium (33.00%, 95% CI: 24.53, 42.05) and crystal methamphetamine (20.68%, 95% CI: 13.59, 28.79) were the most prevalent recent non-injection drugs used. Additionally, the pooled prevalence of lifetime non-injection drug use was 76.08% (95% CI: 66.81, 84.27) and injection drug use was 10.72% (95% CI: 7.02, 15.07).

CONCLUSIONS

This systematic review shows that drug use, both injection and non-injection, is prevalent among FSWs in Iran. These findings highlight the importance of evidence-based harm reduction and treatment programs to reduce the burdens of drug use and its associated potential consequences among these underserved women.

HIV and Other Sexually Transmitted Infections Among Female Sex Workers in Iran: A Systematic Review and Meta-Analysis

Given the high burden of HIV and other sexually transmitted infections (STIs) among female sex workers (FSW) and their potential role in bridging HIV/STIs into the general population, estimating the prevalence of HIV/STIs among FSW is essential for future research and policy developments. This systematic review and meta-analysis synthesize the available HIV/STIs data among FSW in Iran. We searched MEDLINE, PsycINFO, CINAHL, Embase, Web of Science, Google Scholar, and Iranian databases from inception through to January 2018. Inclusion criteria were original quantitative studies that measured HIV/STIs prevalence among FSW. Pooled prevalence estimates were calculated using random-effects meta-analyses. Out of a total of 299 screened studies, 12 were included with total study participants of 4328 FSW. Heterogeneity was present but meta-regression analyses revealed no significant association between HIV prevalence and year of publication, city, and age. Pooled HIV prevalence was 2.23% (95% confidence interval [CI] 0.82, 3.64). We estimated the prevalence of other STIs as 0.77% (95% CI 0.01, 1.53) for hepatitis B, 6.18% (95% CI 1.32, 11.04) for hepatitis C, 0.33% (95% CI 0.00, 0.66) for syphilis, 1.47% (95% CI 0.22, 2.71) for gonorrhea, 9.80% (95% CI 4.70, 14.91) for chlamydia, and 6.18% (95% CI 4.92, 7.43) for trichomonas vaginalis. Based on the existing evidence, HIV and STIs prevalence among FSW are relatively low in Iran. Strategies for timely diagnosis and treatment of HIV and other STIs among FSW and their sexual and injecting partners are needed to reduce the burden of HIV/STIs among these vulnerable populations in Iran.

The Prevalence of Human Immunodeficiency Virus Infection in Patients with Sexually Transmitted Diseases

Background:

Human immunodeficiency virus (HIV) transmission pattern in Iran has been changed from injection drug to sexual contact. Lack of accurate assessment of HIV in people with sexually transmitted diseases (STDs) in Iran prompted us to conduct this study to determine the frequency of HIV infection in these patients.

Materials and Methods:

In this cross-sectional study which conducted in 2016–2017, overall, 190 patients with STDs referring to two hospitals of Hamadan were enrolled in the study. All of the patients were examined for HIV in the first visit by rapid test and then 1 and 4 months later by the 4^th generation ELISA. A questionnaire including demographic data, clinical manifestations, and high-risk behaviors was completed for all of the referring people. The collected data were analyzed using appropriate statistical tests.

Results:

Of 190 patients, 126 (66.3%) were female with a mean age of 34.1 ± 10.1 years and 64 (33.7%) were male with a mean age of 30.8 ± 7.8 years. One hundred twenty-eight (67.4%) got married, 73 (38.4%) and 76 (40%) had a diploma and postgraduate education, respectively, 32 (16.8%) mentioned the history of unsafe sex, and 23 (12.1%) had used condoms continuously during sexual contacts. The most common STDs were reported genital warts, 107 patients (56.3%), vaginal discharge (28, 14.7%), and genital ulcer (33, 17.4%). Two (1%) patients were positive for HIV at the first visit.

Conclusion:

Patients with STDs should be considered as an important source of HIV transmission, so clinicians should pay more attention to screening these patients for HIV infection.

Declining trends in HIV and other sexually transmitted infections among female sex workers in Iran could be attributable to reduced drug injection: a cross-sectional study

OBJECTIVE

The HIV trend among female sex workers (FSWs) is understudied. We assessed the prevalence and trend of HIV and five other STIs among FSWs in Iran.

METHODS

We recruited FSWs (1337 in 2015, 1005 in 2010) from 21 sites in 13 cities in two cross-sectional biobehavioural surveys. Eligible FSWs were women aged ≥18 years who reported selling sex to more than one male client in the past 12 months. Consenting FSWs were interviewed using a behavioural questionnaire and tested for HIV and five other STIs. We considered study sites as clusters in the analysis and two-sided Fisher's exact test to compare the HIV prevalence between the two survey rounds.

RESULTS

HIV prevalence was 2.1% in 2015 (vs 4.0% in 2010, p=0.007). Lifetime drug injection was reported by 6.1% of participants in 2015 (vs 14.6% in 2010, p=0.003). In 2015, among FSWs with history of lifetime drug injection, HIV prevalence was 8.6% (vs 9.8% in 2010, p=0.425). The prevalence of other STIs in 2015 was 0.4% (95% CI 0.2 to 1.0) for syphilis, 1.3% (95% CI 0.8 to 2.1) for gonorrhoea, 6.0% (95% CI 4.8 to 7.4) for chlamydia, 11.9% (95% CI 8.5 to 16.5) for trichomoniasis and 41.8% (95% CI 39.2 to 44.5) for human papillomavirus.

CONCLUSIONS

HIV prevalence among FSWs in Iran decreased, but remains considerably high. The decrease in HIV prevalence compared with 2010 might be explained by a decrease in drug injection. Other STIs are also high in this population. Harm reduction programmes need to be continued and scaled up among this underserved population in Iran.

Epidemiology of Treponema pallidum, Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis, and herpes simplex virus type 2 among female sex workers in the Middle East and North Africa: systematic review and meta-analytics

BACKGROUND

The epidemiology of sexually transmitted infections (STIs) and the role of commercial heterosexual sex networks in driving STI transmission in the Middle East and North Africa (MENA) region remain largely unknown.

OBJECTIVE

To characterize the epidemiology of Treponema pallidum (syphilis), Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis, and herpes simplex virus type 2 (HSV-2) among female sex workers (FSWs) in MENA using an in-depth quantitative assessment.

METHODS

A systematic review on ten international, regional, and country-level databases was conducted, and reported following PRISMA guidelines. Pooled prevalences of current and/or ever infection for each STI were estimated using random-effects meta-analyses. Sources of between-study heterogeneity were investigated through random-effects meta-regressions.

RESULTS

One T. pallidum incidence study and 144 STI prevalence studies were identified for 45 812 FSWs in 13 MENA countries. The pooled prevalence of current infection was 12.7% (95% confidence interval (CI) = 8.5%-17.7%) for T. pallidum, 14.4% (95% CI = 8.2%-22.0%) for C. trachomatis, 5.7% (95% CI = 3.5%-8.4%) for N. gonorrhoeae, and 7.1% (95% CI = 4.3%-10.5%) for T. vaginalis. The pooled prevalence of ever infection (seropositivity using antibody testing) was 12.8% (95% CI = 9.4%-16.6%) for T. pallidum, 80.3% (95% CI = 53.2%-97.6%) for C. trachomatis, and 23.7% (95% CI = 10.2%-40.4%) for HSV-2. The multivariable meta-regression for T. pallidum infection demonstrated strong subregional differences, with the Horn of Africa and North Africa showing, respectively 6-fold (adjusted odds ratio (AOR): 6.4; 95% CI = 2.5-16.7) and 5-fold (AOR = 5.0; 95% CI = 2.5-10.6) higher odds of infection than Eastern MENA. There was also strong evidence for declining T. pallidum odds of infection at 7% per year (AOR = 0.93; 95% CI = 0.88-0.98). Study-specific factors including diagnostic method, sample size, sampling methodology, and response rate, were not associated with syphilis infection. The multivariable model explained 48.5% of the variation in T. pallidum prevalence.

CONCLUSIONS

STI infection levels among FSWs in MENA are considerable, supporting a key role for commercial heterosexual sex networks in transmission dynamics, and highlighting the health needs of this neglected and vulnerable population. Syphilis prevalence in FSWs appears to have been declining for at least three decades. Gaps in evidence persist for multiple countries.

HIV epidemiology among female sex workers and their clients in the Middle East and North Africa: systematic review, meta-analyses, and meta-regressions

BACKGROUND

HIV epidemiology among female sex workers (FSWs) and their clients in the Middle East and North Africa (MENA) region is poorly understood. We addressed this gap through a comprehensive epidemiological assessment.

METHODS

A systematic review of population size estimation and HIV prevalence studies was conducted and reported following PRISMA guidelines. Risk of bias (ROB) assessments were conducted for all included studies using various quality domains, as informed by Cochrane Collaboration guidelines. The pooled mean HIV prevalence was estimated using random-effects meta-analyses. Sources of heterogeneity and temporal trends were identified through meta-regressions.

RESULTS

We identified 270 size estimation studies in FSWs and 42 in clients, and 485 HIV prevalence studies in 287,719 FSWs and 69 in 29,531 clients/proxy populations. Most studies had low ROB in multiple quality domains. The median proportion of reproductive-age women reporting current/recent sex work was 0.6% (range = 0.2-2.4%) and of men reporting currently/recently buying sex was 5.7% (range = 0.3-13.8%). HIV prevalence ranged from 0 to 70% in FSWs (median = 0.1%) and 0-34.6% in clients (median = 0.4%). The regional pooled mean HIV prevalence was 1.4% (95% CI = 1.1-1.8%) in FSWs and 0.4% (95% CI = 0.1-0.7%) in clients. Country-specific pooled prevalence was < 1% in most countries, 1-5% in North Africa and Somalia, 17.3% in South Sudan, and 17.9% in Djibouti. Meta-regressions identified strong subregional variations in prevalence. Compared to Eastern MENA, the adjusted odds ratios (AORs) ranged from 0.2 (95% CI = 0.1-0.4) in the Fertile Crescent to 45.4 (95% CI = 24.7-83.7) in the Horn of Africa. There was strong evidence for increasing prevalence post-2003; the odds increased by 15% per year (AOR = 1.15, 95% CI = 1.09-1.21). There was also a large variability in sexual and injecting risk behaviors among FSWs within and across countries. Levels of HIV testing among FSWs were generally low. The median fraction of FSWs that tested for HIV in the past 12 months was 12.1% (range = 0.9-38.0%).

CONCLUSIONS

HIV epidemics among FSWs are emerging in MENA, and some have reached stable endemic levels, although still some countries have limited epidemic dynamics. The epidemic has been growing for over a decade, with strong regionalization and heterogeneity. HIV testing levels were far below the service coverage target of "UNAIDS 2016-2021 Strategy."

Prevalence and Risk Factors of Human Herpes Virus Type 8 (HHV-8), Human Immunodeficiency Virus-1 (HIV-1), and Syphilis among Female Sex Workers in Malindi, Kenya

The prevalence of Human Herpes Virus type 8 (HHV-8), Human Immunodeficiency virus (HIV), and syphilis is high in Sub-Saharan Africa. Studies on HHV-8 in Kenya are few and data on its coinfection with HIV and syphilis scanty. This cross-sectional study among female sex workers (FSWs) in Malindi, Kenya, aimed to determine the prevalence of HHV-8, HIV, and syphilis mono/coinfections and identify associated risk factors. A total of 268 FSWs consented and were administered a structured questionnaire and screened for antibodies against HHV-8, HIV, and syphilis following the National Guidelines. FSWs positive for HHV-8 were 67/268 (25%), HIV 44/268 (16.4%), and 6/268 (2.24%) for syphilis. Eight out of 67 (12%) tested positive for HHV-8/HIV and 2/67 (3%) for HHV-8/syphilis coinfections. Married FSWs had higher odds of HHV-8 infection (OR 2.90, 95%, and P=0.043). Single marital status was inversely associated (OR 0.46, 95% CI 0.23-0.94, and P=0.034) with HIV infection. HIV was associated with increasing age (OR 14.79, P<0.001), inconsistent condom use (OR 2.69, P=0.004), increased duration as sex worker ≥6 (OR 3.0, P=0.002) and clients ≥4 (OR 4.0, P<0.001), intravenous drug use (OR 2.5, P=0.043), and early sex debut (P=0.049) unlike HHV-8 which was not associated with high risk sexual behavior. HHV-8/HIV coinfection was associated with increasing age (OR 11.21, P=0.027). Infection by HHV-8 was not significantly associated with HIV (OR 0.62; P=0.257) or syphilis (OR 1.52; P=0.636). There was a high likelihood of infection with HHV-8 compared to HIV (OR 8.6, P=0.014) and syphilis (OR 14.6, P<0.001). The lack of association of HHV-8 with high risk sexual behavior suggests that sexual transmission may not play a significant role in transmission of HHV-8 among FSWs in Malindi.

Hepatitis B, C and Delta Viruses’ Infections and Correlate Factors Among Female Sex Workers in Burkina Faso, West-Africa

Background:

Female Sex Workers (FSW) have increased vulnerability to viral hepatitis B, C and D transmission. Our study aimed to assess the seroprevalence of hepatitis B, C and D viruses and their associated factors among FSW in Ouagadougou, Burkina Faso.

Methods:

This is a cross-sectional study among FSW at least 18 years old in Ouagadougou, Burkina Faso. Data were collected from February 2013 to May 2013 using Respondent-Driven Sampling (RDS). Hepatitis B, C, and D tests were performed on FSW storage serums using fourth generation ELISA kits. Survey-weighted bivariate and multivariate logistic regression analyses were performed using Stata version 14 to identify factors associated with viral hepatitis infections.

Results:

Population-weighted prevalence of viral hepatitis infections in FSW was respectively 18.2% (95%CI: 14.4-22.9) for Hepatitis B Virus (HBV), 10.6% (95%CI: 07.5-14.8) for Hepatitis C Virus (HCV) and 1.5% (95Cl: 0.2-10.3) for Hepatitis D Virus (HDV). Factors independently associated with HCV include positive HIV status, inconsistent condom use during the last 12 months, condom reuse with clients, sex with clients in the street, bars or public gardens. No sociodemographic or behavioral factors were independently associated with HBV infection.

Conclusion:

The prevalence of HBV and HCV was high among FSW and the prevalence of HDV was relatively low in this group in Burkina Faso. These findings suggest urgent and comprehensive prevention of these viruses through education for safer sex and behaviors, and immunization against HBV for FSW.

Drug use patterns and associated factors among female sex workers in Iran

OBJECTIVE

This study examines the prevalence of drug and poly-drug use and their associated factors among female sex workers (FSW) in Iran.

METHODS

We analyzed data from a bio-behavioral surveillance survey of 1347 FSW across 13 major cities in Iran in 2015. Two outcome measures were defined: i) past-month "any drug use", a binary variable defined as none or any; and ii) a three-category past-month "poly-drug use" variable defined as none, only one drug, and more than one drug. Correlates of these two study outcomes were assessed using multivariable logistic regression and multinomial logistic regression, respectively. Adjusted odds ratios (AOR) and 95% confidence intervals (CI) were reported.

RESULTS

We found that 24.9% (95% CI: 16.1, 36.4) and 13.5% (95% CI: 8.1, 21.5) of FSW reported past-month any drug use and poly-drug use, respectively. Longer sex work career (AOR 2.44 [95% CI: 1.28, 4.63]), unstable housing (AOR 2.56 [1.17, 5.64]), past-year experience of sexual violence (AOR 1.61 [1.15, 2.27]), and incarceration (AOR 2.02 [1.23, 3.32]) were positively associated with any drug use. Similarly, FSW who were unstably housed (AOR 3.4 [1.06, 10.95]), reported past-year experience of sexual violence (AOR 2.06 [95% CI: 1.24, 3.41]) and incarceration (AOR 2.82 [1.60, 4.97]) were positively associated with past-month poly-drug use.

CONCLUSION

Drug use is frequent among Iranian FSW, particularly among those who experienced sexual violence, unstable housing or incarceration. Programs to reduce harms associated with drug and poly-drug use should target FSW as a priority population.

Gonorrhea and syphilis co-infection and related risk factors in HIV patients from Shiraz, South of Iran

Background:

Neisseria gonorrhea and Treponema pallidum as an obligate human pathogen are two common causes of sexually transmitted diseases (STDs). The present study aimed to determine the prevalence of N. gonorrhoeae and T. pallidum among human immunodeficiency virus (HIV) patients in the southwest Iran.

Methods:

This retrospective study was performed from 2004 to 2013, on HIV patients who were tested for detection of gonorrhea and syphilis infection at Shiraz HIV/AIDS Research Center. ELISA technique was used for preliminary detection of HIV and confirmed by a Western Blotting test. Gonorrhea was routinely diagnosed using direct Gram-staining and culturing on selective agar. Syphilis was routinely diagnosed by RPR test.

Results:

Of the 806 HIV patients, 39 (2.6%) cases had co-infection with gonorrhea. Compared with mono-HIV infected patients, gonorrhea was significantly more likely among the males (69.4% vs. 92.3%, P=0.002). History of addiction and prison seems to be a significant risk factor for gonorrhea infection (P<0.05). Also, the mean of CD4+lymphocyte was higher among gonorrhea infected patients (368±238 vs. 415±328). Logistic regression analysis showed that sexual contact increased risk of gonococcal infection about 4 fold (OR: 4, CI: 1.7-9.39, P=0.001). None of the HIV patients had syphilis co-infection.

Conclusions:

As a preliminary survey, our findings provided unique information on the prevalence of gonorrhea and syphilis co-infections among HIV patients. Moreover, we introduced the main risk factors associated with gonorrhea co-infection in HIV patients in our region including gender, history of addiction and prison, CD4+lymphocyte count, and transmission routes for effective management of STDs.

Workplace violence among female sex workers who use drugs in Vancouver, Canada: does client-targeted policing increase safety?

Workplace violence, by clients or predators, poses serious negative health consequences for sex workers. In 2013, the Vancouver (British Columbia), Canada Police Department changed their guidelines with the goal of increasing safety for sex workers by focusing law enforcement on clients and third parties, but not sex workers. We sought to examine the trends and correlates of workplace violence among female sex workers (FSW) before and after the guideline change, using data collected from prospective cohorts of persons who use illicit drugs in Vancouver, Canada. Among 259 FSW, 21.0% reported workplace violence at least once during the study period between 2008 and 2014. There was no statistically significant change in rates of workplace violence after the guideline change. In our multivariable analysis, daily heroin use was independently associated with workplace violence. The 2013 policing guideline change did not appear to have resulted in decreased reports of workplace violence. Increased access to opioid agonist therapies may reduce workplace violence among drug-using FSW.

Prevalence of hepatitis C virus infection among high-risk groups in Iran: a systematic review and meta-analysis

OBJECTIVES

Determination of the true burden of hepatitis C virus (HCV) infection among high-risk groups relies heavily on occurrence measures such as prevalence, which are vital for implementation of preventive action plans. Nevertheless, up-to-date data on the prevalence of HCV infection remain scarce in Iran. This study aimed to review the relevant literature systematically and determine the pooled prevalence of HCV infection among high-risk groups in Iran.

STUDY DESIGN

Systematic review & meta-analysis.

METHODS

In 2016, electronic scientific databases including PubMed, Scopus, Web of Science and local databases were searched using a detailed search strategy with language restricted to English and Farsi. The reference lists of the studies included in this review were also screened. Data were reviewed and extracted independently by two authors. A random effects model was used to estimate the pooled prevalence. Sources of heterogeneity among the studies were determined using subgroup analysis and meta-regression.

RESULTS

In total, 1817 records were identified in the initial search, and 46 records were included in the meta-analysis. The overall prevalence of HCV among high-risk groups was 32.3%. The prevalence was 41.3% in injection drug users (IDUs), 22.9% in prisoners, 16.2% in drug-dependent individuals and 24.6% in drug-dependent prisoners. Subgroup and meta-regression analyses revealed that geographical location and year of publication were the probable sources of heterogeneity.

CONCLUSION

This meta-analysis found a high prevalence of HCV among high-risk groups in Iran, particularly among IDUs. There is a need for prevention strategies to reduce the burden of HCV infection among high-risk groups, particularly IDUs.

Epidemiological Profile and Risk Factors for Acquiring HBV and/or HCV in HIV-Infected Population Groups in Nepal

HBV and HCV infections are widespread among the HIV-infected individuals in Nepal. The goals of this study were to investigate the epidemiological profile and risk factors for acquiring HBV and/or HCV coinfection in disadvantaged HIV-positive population groups in Nepal. We conducted a retrospective study on blood samples from HIV-positive patients from the National Public Health Laboratory at Kathmandu to assay for HBsAg, HBeAg, and anti-HCV antibodies, HIV viral load, and CD4+ T cell count. Among 579 subjects, the prevalence of HIV-HBV, HIV-HCV, and HIV-HBV-HCV coinfections was 3.62%, 2.93%, and 0.34%, respectively. Multivariate regression analysis indicated that spouses of HIV-positive migrant labourers were at significant risk for coinfection with HBV infection, and an age of >40 years in HIV-infected individuals was identified as a significant risk factor for HCV coinfection. Overall our study indicates that disadvantaged population groups such as intravenous drug users, migrant workers and their spouses, female sex workers, and men who have sex with HIV-infected men are at a high and persistent risk of acquiring viral hepatitis. We conclude that Nepalese HIV patients should receive HBV and HCV diagnostic screening on a regular basis.

Seroepidemiological Study of Hepatitis B, C and HIV among Blood Donors in Kerman

Background:

Infections transmitted through blood transfusions are the most important issue associated with blood donation. We aimed to provide an assessment of the prevalence of hepatitis B virus (HBV), hepatitis C virus (HCV) and human immunodeficiency virus (HIV) among blood donors in Kerman province of Iran.

Methods:

Between 2014-2016, 99,187 samples were examined in a retrospective study in five blood transfusion centers in Kerman province. Serologic screening for HBsAg, anti-HCV and anti-HIV1/2 was conducted for all samples and positive cases were confirmed.

Result:

The positives with the initial serological screening tests for HBsAg , anti-HCV and HIV 1/2 numbered 524, 409 and 285, respectively, and based on confirmation tests, final results were 196 , 72 and 1. The highest prevalences of HBV and HCV were reported as 0.36% in Jiroft city and 0.1% in Rafsanjan city. Co- infection with HBV and HCV was observed in the city of Sirjan.

Conclusion:

Blood-borne viral infections in people with low education levels were more common. The prevalence in Kerman province was low as compared to previous studies carried out in other regions of Iran. Application of standard operating procedures, with updated equipment, as well as planning for the use of molecular methods are necessary for the Iranian Blood Transfusion Organization, to monitor blood-transmitted infections.

Prevalence of Sexually Transmitted Infections and Their Risk Factors among Female Sex Workers in Isfahan, Iran: A Cross-Sectional Study

OBJECTIVES

Female sex workers (FSWs) are at high risk of sexually transmitted infections (STIs) and form a core group to facilitate STI spreading. We aimed to estimate the prevalence of STIs among FSWs who attended Female Harm Reduction Center of Isfahan, Iran, and to determine the association between risky behaviors and STIs.

STUDY DESIGN

In a cross-sectional study, 99 FSWs were recruited and interviewed about demographic characteristics and risky behaviors. A trained midwife examined FSWs for genital ulcer, abnormal vaginal discharge, and cervicitis. Urine and genital specimens were collected and real-time polymerase chain reaction was performed to diagnose Neisseria gonorrhoeae, human papilloma virus (HPV), and Trichomonas Vaginalis. Data were analyzed via χ² test and logistic regression in StataCorp software (version 11) with 95% confidence interval.

RESULTS

Totally, 84.9% of FSWs reported STI symptoms, while 12.1% of them were infected with N gonorrhoeae, HPV, or T vaginalis. Human papilloma virus and gonorrhea prevalence rates were 5.7% and 8% in FSWs with STI-associated symptoms. Sexually transmitted infections showed significant association with duration of prostitution (odds ratio [OR]_HPV = 1.009 [95% confidence interval [95% CI: 1.004-1.01]; OR_gonorrhea = 1.01 [95% CI: 1.00-1.01]) and condom usage (OR_HPV = 0.11 [95% CI: 0.012-0.98]; OR_gonorrhea = 0.04 [95% CI: 0.005-0.33]).

CONCLUSION

Due to the literature gap on the Iranian FSWs' sexual health and the intense stigma around this subject, in Iran, our results would be useful for developing an efficient intervention program. The prevalence of STIs in Isfahan FSWs can be controlled with programs such as consistent condom use and STI treatment. In addition, as just one-tenth of FSWs with an STI symptom were positive for an STI, symptomatic diagnosis of STIs might be insufficient.

HCV prevalence can predict HIV epidemic potential among people who inject drugs: mathematical modeling analysis

BACKGROUND

Hepatitis C virus (HCV) and HIV are both transmitted through percutaneous exposures among people who inject drugs (PWID). Ecological analyses on global epidemiological data have identified a positive association between HCV and HIV prevalence among PWID. Our objective was to demonstrate how HCV prevalence can be used to predict HIV epidemic potential among PWID.

METHODS

Two population-level models were constructed to simulate the evolution of HCV and HIV epidemics among PWID. The models described HCV and HIV parenteral transmission, and were solved both deterministically and stochastically.

RESULTS

The modeling results provided a good fit to the epidemiological data describing the ecological HCV and HIV association among PWID. HCV was estimated to be eight times more transmissible per shared injection than HIV. A threshold HCV prevalence of 29.0% (95% uncertainty interval (UI): 20.7-39.8) and 46.5% (95% UI: 37.6-56.6) were identified for a sustainable HIV epidemic (HIV prevalence >1%) and concentrated HIV epidemic (HIV prevalence >5%), respectively. The association between HCV and HIV was further described with six dynamical regimes depicting the overlapping epidemiology of the two infections, and was quantified using defined and estimated measures of association. Modeling predictions across a wide range of HCV prevalence indicated overall acceptable precision in predicting HIV prevalence at endemic equilibrium. Modeling predictions were found to be robust with respect to stochasticity and behavioral and biological parameter uncertainty. In an illustrative application of the methodology, the modeling predictions of endemic HIV prevalence in Iran agreed with the scale and time course of the HIV epidemic in this country.

CONCLUSIONS

Our results show that HCV prevalence can be used as a proxy biomarker of HIV epidemic potential among PWID, and that the scale and evolution of HIV epidemic expansion can be predicted with sufficient precision to inform HIV policy, programming, and resource allocation.

Prevalence of HIV, HBV and HCV among street and labour children in Tehran, Iran

OBJECTIVES

The existence of street and working children in Iran is undeniable. The precarious conditions of these children (including disrupted family, poverty, high prevalence of crime among relatives, family members and peers) cause social harm and high-risk behaviours, including drug addiction, selling sex or having sex with adolescents or peers. Here we explore the HIV, hepatitis B and hepatitis C status of street and working children in Tehran.

METHODS

One thousand street and labour children, aged 10-18 years, were recruited by using the time-location sampling method, and semistructured questionnaires were used to find demographic information and information on HIV/AIDS-related high-risk sexual behaviours. Blood samples were collected from children, with use of the dried blood sampling method.

RESULTS

4.5% of children were HIV infected, 1.7% were infected with hepatitis B virus and 2.6% were infected with hepatitis C virus (HCV). Having parents who used drug, infected with HCV and having experience in trading sex significantly increased the likelihood of getting HIV among the street children of Tehran.

CONCLUSION

HIV prevalence among street children is much higher than general population (<0.1%), and in fact ,the rate of positivity comes close to that among female sex workers in Iran. These findings must be an alarm for HIV policymakers to consider immediate and special interventions for this at-risk group.