Abstract
Female sex workers (FSWs) represent a key population for the acquisition of sexually transmitted infections (STI) due to their social vulnerability and the risks associated with their occupation. This study was conducted to describe the sociodemographic characteristics and sexual behavior among FSWs in cities in northern Brazil, to determine the prevalence of human immunodeficiency virus 1 (HIV-1) and human T-cell lymphotropic virus (HTLV-1/2) infections and to identify the circulating subtypes of these agents in this key population. A cross-sectional study using the Time Location Sampling (TLS) method was conducted among 339 FSWs in cities in the state of Pará from 2005 to 2006. Serological and molecular tests were performed to identify infections and viral subtypes, and bivariate and multivariate analyses were conducted to identify risk factors. Most FSWs were young, single, less educated and had at least one child. The prevalence of antibodies against HIV-1 and HTLV-1 was 2.3 and 1.7%, respectively. HIV-1 subtypes B (87.5%) and F1 (12.5%) were identified among FSWs, as were Cosmopolitan subtype (1a) and Transcontinental subgroup (A). Unprotected sex and illicit drug use were associated with HIV-1 and HTLV-1 infections using bivariate and multivariate analyses, and age ≥27 years was associated only with HIV. The important information highlighted here clearly indicates that the lack of actions to control and prevent pathogens in FSWs and the lack of strategies for health promotion in key populations can further aggravate the epidemiological scenario of viral infections in remote areas with low human development indices. Neglecting these facts may be causing the spread of these two viruses and their respective subtypes in the general population of northern Brazil.
Highlights
In South America, Brazil is highlighted for having the largest territorial extension, the largest population and immense economic importance
In spite of the importance of the population group, little information is available on Female sex workers (FSWs) in the North of Brazil and their role in the dissemination of human immunodeficiency virus 1 (HIV-1) and human T-cell lymphotropic virus (HTLV)-1/2
The absence of strategies for health promotion among key population groups certainly aggravates the epidemiological scenario of these two viral infections in remote areas with low human development indices
Summary
In South America, Brazil is highlighted for having the largest territorial extension, the largest population and immense economic importance Another important feature is the wide gap of socioeconomic inequality among Brazilians (Campello et al, 2018). The combination of large territorial area and socioeconomic inequality creates a big challenge for governments to provide social inclusion, access to appropriate education and healthcare (Campello et al, 2018; de Souza et al, 2020) An example of this challenge has been reports of the absence or precarious implementation of policies and strategies for the control and prevention of infectious agents among vulnerable population groups in Brazil, especially in remote areas (OliveiraFilho et al, 2019a, 2020). The present investigation was conducted to describe sociodemographic characteristics, sexual behavior, and the prevalence and circulating molecular subtypes of HIV-1 and HTLV-1/2 among FSWs of four cities in the State of Para
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