Sero Prevalence of Hiv, Hcv, Hbv and Syphilis (Vrdl) in Transgender Male Sex Workers from Rural, Urban Sindh and Punjab, Pakistan

BackgroundMale sex work in the western countries has changed, including now a subculture of male sex workers who have paid sex with men arranged for via the internet. The men involved in this subculture do not easily identify themselves as sex workers nor as homosexual, and are therefore missed by regular health care and public health interventions. These male sex workers may form a hidden key population for sexually transmitted infections (STIs) and HIV, bridging towards other persons outside this context.MethodsThis clinic-based observational study included consultations by male sex workers (n = 212), female sex workers (n = 801) and in men having sex with men who did not report being paid for sexual contacts (MSM, n = 2703) who received STI and HIV testing and counselling at our clinic during the study period. In this study we compare the consultations in male sex workers to those in in female sex workers and MSM.Demographic characteristics and sexual behaviour of the male sex workers, female sex workers and MSM were compared using chi-square tests and non-parametric tests. Using univariate and multivariate regression analyses, determinants for STI positivity in male sex workers were evaluated.ResultsMale sex workers tested positive for STI (including HIV) in 40 % of the consultations; female sex workers and MSM respectively in 9 and 14 % of the consultations. A new HIV infection was found in 8 % of the consultations of male sex workers. Male sex workers were a young population of migrant sex workers from Eastern Europe. They reported more often to also have sex contacts with women and other sex workers. Male sex workers are at a higher risk for one or more new STI than female sex workers and other MSM, even after correction for age, ethnicity, known HIV positivity and behavioural variables.ConclusionsMale sex workers form a hidden key population that impacts the transmission of STI and HIV within the MSM population and, possibly, to the heterosexual population. They require specific targeted interventions. Although targeting male sex workers is labour intensive it is feasible and important to reduce STI transmission.

ObjectivesThe burden of HIV and other sexually transmitted infections (STIs) remains high in sex workers globally, calling for strengthening targeted prevention strategies, including HIV pre-exposure prophylaxis (PrEP). The study’s objective...

ABSTRACTThe barrier HIV-stigma presents to the HIV treatment cascade is increasingly documented; however less is known about female and male sex worker engagement in and the influence of sex-work stigma on the HIV care continuum. While stigma occurs in all spheres of life, stigma within health services may be particularly detrimental to health seeking behaviors. Therefore, we present levels of sex-work stigma from healthcare workers (HCW) among male and female sex workers in Kenya, and explore the relationship between sex-work stigma and HIV counseling and testing. We also examine the relationship between sex-work stigma and utilization of non-HIV health services. A snowball sample of 497 female sex workers (FSW) and 232 male sex workers (MSW) across four sites was recruited through a modified respondent-driven sampling process. About 50% of both male and female sex workers reported anticipating verbal stigma from HCW while 72% of FSW and 54% of MSW reported experiencing at least one of seven measured forms of stigma from HCW. In general, stigma led to higher odds of reporting delay or avoidance of counseling and testing, as well as non-HIV specific services. Statistical significance of relationships varied across type of health service, type of stigma and gender. For example, anticipated stigma was not a significant predictor of delay or avoidance of health services for MSW; however, FSW who anticipated HCW stigma had significantly higher odds of avoiding (OR = 2.11) non-HIV services, compared to FSW who did not. This paper adds to the growing evidence of stigma as a roadblock in the HIV treatment cascade, as well as its undermining of the human right to health. While more attention is being paid to addressing HIV-stigma, it is equally important to address the key population stigma that often intersects with HIV-stigma.

BackgroundCommercial sex workers (CSW) are particularly exposed to sexually transmitted infections (STI). To direct prevention measures, we estimated the prevalence of the three most common bacterial STI (chlamydia, gonorrhoea and...

Blood transfusion is an important mode of transmission of infections to recipients. The aim of the study was to assess the prevalence of transfusion-transmissible infections among blood donors. For this, a 3.5-year retrospective study, from October 2002 to April 2006 was conducted at the blood transfusion centre of Maharaja Agrasen Medical College, Agroha (Hisar) Haryana. Donors were screened for seroprevalence of HIV, HBV, HCV and syphilis. A total of 5849 donors were tested, out of which 4010 (68.6%) were replacement donors and 1839 (31.4%) were voluntary donors. The seroprevalence of HIV was 0.3% in the donors. No voluntary donor was found to be positive for HIV. The low sero-positivity among donors is attributed to pre-donation counseling in donor selection. The seroprevalence of HBV, HCV and syphilis was 1.7%, 1.0% and 0.9% respectively in total donors. The seroprevalence of hepatitis and syphilis was more in replacement donors as compared to voluntary donors.

In Sub-Saharan Africa, limited data exist on the delivery of injectable HIV pre-exposure prophylaxis (PrEP). We explored service delivery preferences for injectable cabotegravir (CAB-LA) among heterosexual male sex workers (MSWs) and female sex workers (FSWs) in Uganda. We conducted a discrete choice experiment (DCE) among HIV-negative sex workers in two high HIV-prevalence Ugandan cities between October and December 2024. Participants selected from alternatives varying by location, waiting time, provider gender, and additional services. A mixed logit model identified the most valued attributes influencing preferences for CAB-LA delivery. We enrolled 251 sex workers (SWs), comprising 52 (20.7%) MSWs. MSWs were more likely to have higher education (26.9% vs 4.5%), while FSWs had been in the industry longer (24 months vs 18 months). PrEP awareness was lower among MSWs than FSWs (86.5% vs. 95.5%, p = 0.027). Overall, 39.4% reported current PrEP use. Injectable PrEP was the most preferred formulation (77.3%), and willingness to use PrEP among non-users was higher in MSWs (67.3% vs. 45.7%, p = 0.001). Regarding service delivery preferences, MSWs and FSWs both prioritized dispensing location (relative importance 81.1% MSWs, 82.9% FSWs) and provision of additional services (10.8% MSWs, 9% FSWs). In contrast, clinic waiting time and provider gender were considered the least important, with both groups assigning them a relative importance of 4%. Nevertheless, the three top-ranked CAB-LA delivery models prioritized access through private pharmacies or clinics with short waiting times, female or peer providers, and integrated health services. The preferred extra services included psychosocial support, cancer screening, and risk reduction counseling. Expanding injectable PrEP through private sector channels may improve access among SWs. Still, implementation research is needed to guide integration of supportive services and SWs' willingness to pay or co-pay for pharmacy or private clinic-based delivery.

In Sub-Saharan Africa, limited data exist on the delivery of injectable HIV pre-exposure prophylaxis (PrEP). We explored service delivery preferences for injectable cabotegravir (CAB-LA) among heterosexual male sex workers (MSWs) and female sex workers (FSWs) in Uganda. We conducted a discrete choice experiment (DCE) among HIV-negative sex workers in two high HIV-prevalence Ugandan cities between October and December 2024. Participants selected from alternatives varying by location, waiting time, provider gender, and additional services. A mixed logit model identified the most valued attributes influencing preferences for CAB-LA delivery. We enrolled 251 sex workers (SWs), comprising 52 (20.7%) MSWs. MSWs were more likely to have higher education (26.9% vs 4.5%), while FSWs had been in the industry longer (24 months vs 18 months). PrEP awareness was lower among MSWs than FSWs (86.5% vs. 95.5%, p = 0.027). Overall, 39.4% reported current PrEP use. Injectable PrEP was the most preferred formulation (77.3%), and willingness to use PrEP among non-users was higher in MSWs (67.3% vs. 45.7%, p = 0.001). Regarding service delivery preferences, MSWs and FSWs both prioritized dispensing location (relative importance 81.1% MSWs, 82.9% FSWs) and provision of additional services (10.8% MSWs, 9% FSWs). In contrast, clinic waiting time and provider gender were considered the least important, with both groups assigning them a relative importance of 4%. Nevertheless, the three top-ranked CAB-LA delivery models prioritized access through private pharmacies or clinics with short waiting times, female or peer providers, and integrated health services. The preferred extra services included psychosocial support, cancer screening, and risk reduction counseling. Expanding injectable PrEP through private sector channels may improve access among SWs. Still, implementation research is needed to guide integration of supportive services and SWs’ willingness to pay or co-pay for pharmacy or private clinic-based delivery.

Introduction: Viruses are implicated in the etiopathogenesis of malignancies. There is a high risk of reactivation of latent viral infections in persons with HMs. The sero-prevalence of some of these virus has not been reported in our environment. Objective: To determine the seroprevalence of HIV, HBV and HCV in subjects with HMs; to establish if any its association with specific HMs and blood transfusion history. Method: This is an ambispective study conducted at the University of Benin Teaching Hospital, Benin City. Fifty one patients with HMs were recruited for this study. Data on demographics, daignosis of HMs and transfusion history was obtained with an interviewer administered questionnaire. Sample was collected and analyzed for HBV, HCV and HIV status using rapid kit tests. Results were analyzed with SPSS version 16. Result: The subjects included 30 (58.8%) males and 21 (41.2%) females. The median age of the participants was 48 years. Non Hodgkins lymphoma and CLL are the commonest HMs in this centre. The seroprevalence of HBV, HCV and HIV were 9.8%, 2% and 2% respectively. HBV seropositivity was associated with NHL (p value =0.013). The odd of HBV seropositivity with blood transfusion prior to diagnosis is high (5.5). Conclusion: The seroprevalence of HBV, HCV and HIV in subjects with HMs seen in UBTH, Benin City were 9.8%, 2% and 2% respectively. HBV seropositivity was significantly associated with NHL.

During the COVID-19 pandemic, sex workers (SW) were one of the vulnerable groups affected by lockdown measures. COVID-19 had also disrupted HIV/Sexually transmitted infection (STI) testing and treatment services for sex workers due to numerous restrictions in specialist medical care. This study aims to assess the seroprevalence of HIV, syphilis, HBV, and HCV and associated factors among SW as COVID-19 restrictions were lifted. The SW aged over 18 years residing in Chiangmai, Thailand, were recruited between March and December 2022. An interview-based questionnaire was administered. Blood was collected for HIV, syphilis, HBV, and HCV serological testing. Logistic regression models were used to examine factors associated with these serological markers. Of 264 SW recruited, 52.3% were male. The median age was 31 years. Male sex workers (MSW) had higher seroprevalence of HIV (13% vs. 4.8%), syphilis (23.9% vs. 6.4%) and HCV (6.5% vs. 2.4%). Female sex workers (FSW) had higher seroprevalence of HBsAg (9.5% vs. 4.4%). A high proportion were unaware of their HIV/STI infection. MSW reporting receptive anal sex were more likely to be HIV and Treponema Ab positive. MSW reporting drug injection history were more likely to be HCV Ab positive. FSW reporting younger age at first sex were more likely to be HIV Ab positive. In conclusion, SW remains particularly affected by HIV/STIs. Despite the lockdown, HIV/STIs continued to spread, highlighting the need to provide access to HIV/STIs testing, prevention, and treatment services for this population, particularly young men.

BackgroundMale sex workers are at high-risk for acquisition of sexually transmitted infections (STIs), including human immunodeficiency virus (HIV). We quantified incidence rates of STIs and identified their time-varying predictors among male sex workers in Mexico City.MethodsFrom January 2012 to May 2014, male sex workers recruited from the largest HIV clinic and community sites in Mexico City were tested for chlamydia, gonorrhea, syphilis, hepatitis, and HIV at baseline, 6-months, and 12-months. Incidence rates with 95% bootstrapped confidence limits were calculated. We examined potential time-varying predictors using generalized estimating equations for a population averaged model.ResultsAmong 227 male sex workers, median age was 24 and baseline HIV prevalence was 32%. Incidence rates (per 100 person-years) were as follows: HIV [5.23; 95% confidence interval (CI): 2.15–10.31], chlamydia (5.15; 95% CI: 2.58–9.34), gonorrhea (3.93; 95% CI: 1.88–7.83), syphilis (13.04; 95% CI: 8.24–19.94), hepatitis B (2.11; 95% CI: 0.53–4.89), hepatitis C (0.95; 95% CI: 0.00–3.16), any STI except HIV (30.99; 95% CI: 21.73–40.26), and any STI including HIV (50.08; 95% CI: 37.60–62.55). In the multivariable-adjusted model, incident STI (excluding HIV) were lower among those who reported consistently using condoms during anal and vaginal intercourse (odds ratio = 0.03, 95% CI: 0.00–0.68) compared to those who reported inconsistently using condoms during anal and vaginal intercourse.ConclusionsIncidence of STIs is high among male sex workers in Mexico City. Consistent condom use is an important protective factor for STIs, and should be an important component of interventions to prevent incident infections.

In South Africa, information on sex workers' characteristics, sexual behaviour and health needs is limited. Current social, legal and institutional factors impede a safe working environment for sex workers and their clients. To describe characteristics and sexual behaviour of female, male and transgender sex workers, and assess their risk factors for unprotected sex. Repeat cross-sectional surveys among sex workers were conducted in Hillbrow, Sandton, Rustenburg and Cape Town in 2010. Sex workers were interviewed once; any re-interviews were excluded from analysis. Unprotected sex was defined as any unprotected penetrative vaginal or anal sex with last two clients. Trained sex workers interviewed 1 799 sex workers. Sex work was a full-time profession for most participants. About 8% (126/1 594) of women, 33% (22/75) of men, and 25% (12/50) of transgender people had unprotected sex. A quarter of anal sex was unprotected. Unprotected sex was 2.1 times (adjusted odds ratio (AOR), 95% CI 1.2 - 3.7; p=0.011) more likely in participants reporting daily or weekly binge drinking than non-binge drinkers. Male sex workers were 2.9 times (AOR, 95%CI 1.6 - 5.3; p<0.001) more likely, and transgender people 2.4 times (AOR, 95% CI 1.1 - 4.9; p=0.021) more likely, than females to have unprotected sex. Sex workers in Hillbrow, where the only sex work-specific clinic was operational, were less likely to have unprotected sex than those in other sites. Tailored sex work interventions should explicitly include male and transgender sex workers, sex work-specific clinics, focus on the risks of unprotected anal sex, and include interventions to reduce alcohol harm.

Background: Sub-Saharan Africa (SSA) bears the highest HIV burden worldwide with regional disparities between west and central Africa (WCA) and eastern and southern Africa (ESA). The HIV burden among men who have sex with men (MSM), transgender-women and -men, and male and transgender sex workers (SW) in SSA is largely unknown. We estimated the relative HIV risk and absolute HIV burden for these groups in SSA. Methods: We performed a systematic review of peer-reviewed literature, published between 2010 and 2020 that assessed HIV prevalence in MSM, transgender-women and -men, and male and transgender SW in SSA, following the PRISMA guidelines. The databases Embase, Medline Epub, Web of Science and Google Scholar were searched. Risk of bias was assessed using JBI critical appraisal checklist. We calculated HIV risk ratios (RRs) based on HIV prevalences from each study population and the geospatially matched HIV prevalence among the general population. We extrapolated results for MSM and transgender women to estimate HIV prevalence and number of HIV positives for each country in SSA. Findings: We found 44 articles assessing HIV prevalence in MSM, four in transgender women, five in male SW, and zero in transgender men and transgender SW. Prevalence among MSM, transgender women and male SW was significantly higher compared to the general population in both WCA (RRs: 9·3, 7·1, and 12·4 respectively) and ESA (RRs: 1·8, 1·4, and 8·6 respectively). Estimated HIV prevalence for MSM was 15% and 27% for transgender women, translating in into about 400,000-1,600,000 MSM and between 300,000-600,000 transgender women living with HIV in SSA. For male SW insufficient data was available for such extrapolation. Interpretation: HIV burden among MSM, transgender women and male SW throughout SSA are alarmingly high. Our findings further highlight the urgent need for scaling-up tailored HIV prevention and treatment interventions for these populations. Funding: Aidsfonds Netherlands. Declaration of Interest: None to declare.

Revitalizing the HIV response in Pakistan: A systematic review and policy implications

We investigated prevalence and correlates of sexual risk behaviours among male and female sex workers in Tijuana, Mexico, the busiest border crossing area on the US – Mexico border, analysing survey data from a purposive, cross-sectional sample of male and female sex workers who worked in a range of indoor and outdoor settings. Logistic regression was used to determine factors that were associated with sexual risk-taking, defined as failing to use a condom with last client. In bivariate regression models, gender, work setting (e.g., indoor vs. outdoor), poverty, engaging in survival sex, marital status and perceived drug addiction were correlated with sexual risk. When controlling for work location, housing insecurity, poverty, survival sex, marital status and perceived drug addiction, male sex workers were still 10 times more likely than female sex workers (FSW) to engage in sex without a condom during their last encounter with a client. And, although FSW were significantly more likely than males to have used a condom with a client, they were significantly less likely than males to have used a condom with their regular partner. Future research should further examine how gender shapes sexual risk activities in both commercial and non-commercial relationships.

The objective of this study was to describe the prevalence of sexually transmitted infections (STI), sociodemographic and behavioural characteristics in a population of male sex workers (MSW) in Antwerp, Belgium. Between September 1999 and March 2004, 129 MSW were reached by Gh@pro, an outreach programme providing preventive health care, free STI check-up and hepatitis B vaccination, to sex workers (SW). Sera were collected from 121 men, urine samples from 115 men and a questionnaire was filled in by 43 MSW. In 45.5% of MSW one or more STI were diagnosed (including hepatitis B), 76% on laboratory testing at first screening, 9% through symptomatology at first visit. The prevalence of HIV was 10.8%, hepatitis B virus (HBV) infection 28.9%, syphilis 12.5%, gonorrhoea 1.7% and Chlamydia trachomatis 9.7%. More than 50% of non-immune MSW completed their three-dose hepatitis B vaccination course. Prevalence of STI is concordant with published data on MSW; this population clearly requests and deserves particular attention and approach. There is an important difference in sociodemographic and behavioural characteristics between MSW working in the red light district and those working on the street. Health promotion should be tailored to the different subpopulations and outreach appears to be a successful tool.