Abstract
ObjectivesSex workers (SWs) face an increased burden of sexually transmitted and blood-borne infections, yet little is known regarding hepatitis B virus (HBV) prevention and care. This study was performed to characterize cross-sectional and prospective correlates of HBV vaccination among SWs in Vancouver. MethodsQuestionnaire data were drawn from a community-based cohort of SWs (2010–2017). Multivariable logistic regression was used to examine correlates of lifetime self-reported HBV vaccination. Multivariable generalized estimating equation (GEE) regression was used to assess correlates of recent vaccination. ResultsAmong 855 participants, 68.3% reported lifetime HBV vaccination. Multivariable logistic regression showed that im/migrants (adjusted odds ratio (AOR) 0.50, 95% confidence interval (CI) 0.32–0.78) had lower odds of vaccination and that those using injection drugs (AOR 1.88, 95% CI 1.27– 2.78) and those who had undergone HIV testing (AOR 1.94, 95% CI 1.14–3.29) had higher odds of vaccination. In the multivariable GEE analysis, HIV seropositivity (AOR 1.93, 95% CI 1.26–2.97) and recent STI testing (AOR 2.95, 95% CI 1.99–4.39) correlated with recent HBV vaccination. ConclusionsIm/migrant SWs from HBV-endemic settings appear to face gaps in HBV prevention. Evidence-based interventions addressing gaps in voluntary HBV prevention and care are needed, including community-based and culturally safe services. Injection drug use and HIV testing were linked to enhanced vaccination, suggesting that harm reduction and HIV programmes may facilitate linkage to HBV prevention.
Highlights
Women sex workers face disproportionate social and health inequities, including those related to HIV and other sexually transmitted and blood-borne infections (STBBIs)
Despite increased efforts to evaluate and address inequities in STBBIs amongst sex workers, women who engage in sex work remain a persistently underserved population, with critical gaps in knowledge related to specific STBBIs, including hepatitis B virus (HBV)
68.3% of participants self-reported ever being vaccinated for HBV – a statistic that is similar to those reported in studies on sex workers in Belgium, England, and the Netherlands, which reported HBV vaccination rates of 67.9%, 59.8%, and 52.0%, respectively (Mak et al, 2003; Sethi et al, 2006; Verhaegh-Haasnoot et al, 2015)
Summary
Women sex workers face disproportionate social and health inequities, including those related to HIV and other sexually transmitted and blood-borne infections (STBBIs). These include risks conferred through unsafe work and living environments (Lazarus et al, 2011; Reed et al, 2011; Goldenberg et al, 2015a), higher rates of structural violence (criminalization, policing). The disproportionate burden of STBBIs faced by sex workers varies globally in prevalence due to social, political, economic, and cultural factors (Shannon and Csete, 2010). Despite increased efforts to evaluate and address inequities in STBBIs amongst sex workers, women who engage in sex work remain a persistently underserved population, with critical gaps in knowledge related to specific STBBIs, including hepatitis B virus (HBV). There have been major advancements in hepatitis C virus (HCV) treatment regimens, and while there is growing momentum towards finding a cure for HBV (2018), vaccination remains the cornerstone of prevention efforts
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