Prevalence of high-risk human papilloma virus types and cervical smear abnormalities in female sex workers in Chandigarh,India

Purpose: Cervical cancer is the most common cancer among women in developing nations. Nearly 90% of the cases have been linked to the presence of high-risk human papillomavirus (hrHPV) types 16 and 18. The risk of cervical cancer may be high in female sex workers (FSWs) due to multiple sexual partners. This study aimed to determine the prevalence of cytological abnormalities and hrHPV types 16 and 18 in FSWs in Chandigarh, North India using the liquid-based cytology (LBC) approach. Materials and Methods: The cervical brush samples were collected from 120 FSW and 98 age-matched healthy controls (HCs). These were subjected to pap smear using conventional method, LBC and the detection of hrHPV types 16 and 18 was carried out using polymerase chain reaction. Results: The LBC samples showed better cytological details and also reduced the number of unsatisfactory smears from 11% in Pap to 1.5% in the LBC. A significantly higher number of inflammatory smears were reported in FSWs (51.7% vs. 34.7%, P = 0.01). The hrHPV types 16/18 were detected in 33/120 (27.5%) FSW versus 23/98 (23.5%) HCs. The risk of acquiring hrHPV was higher in FSWs, who had age at first sex ≤25 years, higher income and the habit of smoking. Conclusion: The high prevalence of hrHPV among FSWs and HCs suggests the need for the implementation of effective National Screening Programme for early detection of hrHPV types to decrease the burden of cervical cancer, especially in high-risk population.     

Trafficked female sex workers awaiting deportation: comparison with brothel workers

Summary In 2002, we researched the psychosocial characteristics of 55 women working in the commercial brothel-based sex industry in three Israeli cities. This previous social epidemiological study focused exclusively on women working in brothels and the brothel owners consented to their interviews, suggesting that this might be a sample of the most organized brothels with the best social conditions. We therefore decided to study a second sample obtained by different referral methods. The sample consisted of 49 women in a detention center who are awaiting judicial hearings for deportation. This prison sample of sex workers is strikingly similar to the previously studied sample of sex workers working in brothels in terms of demographic features and working conditions. A higher percentage of the prison sample reported depression and somatic symptoms. However, this finding is consistent with a reaction to being arrested and awaiting deportation. Guided by a life course perspective, in the combined sample, we examined whether early exposure to trauma, motherhood and early entry into sex work affected current health and mental health. Those who were mothers were likely to have entered sex work at a later age but no other aspect of their working conditions differed from the non-mothers suggesting that motherhood per se did not appreciably change the experience of these mostly trafficked women sex workers. Early exposure to trauma increased the likelihood for work-related trauma, poor health and mental health outcomes.     

Adherence to oral HIV pre-exposure prophylaxis among female sex workers in Kampala,Uganda

IntroductionIn Kampala Uganda, female sex workers (FSWs) have high HIV prevalence (33%). Oral PrEP is a novel HIV prevention intervention that offers hope to decrease HIV incidence in key populations especially among FSWs. Studies have shown that with poor adherence, oral PrEP has no efficacy, and therefore adherence to PrEP is critical among FSWs to maximize HIV prevention. However, implementation data on adherence to PrEP among FSWs is limited so this study sought to assess adherence to PrEP. Specifically, we sought to 1) determine the level of adherence to PrEP among FSWs, and 2) determine factors associated with PrEP adherence.MethodsThis cross-sectional study was conducted from November to December 2018; 126 FSWs using PrEP were interviewed using a questionnaire. Adherence was categorically defined as high adherence and low adherence. Logistic regression was done.ResultsUsing long-term contraception methods (OR 0.06, 95% CI: 0.04–0.77) and not using condoms with clients (OR 0.07, 95% CI: 0.01–0.42) were negatively associated with high PrEP adherence.ConclusionBarriers to PrEP adherence need to be addressed for successful PrEP implementation to improve adherence going forward. Service care providers should reinforce positive behaviors such as use of condoms devotedly during PrEP breaks.     

Level of stigma among female sex workers: comparison of two surveys of HIV behavioral data, Ethiopia

Background

HIV and AIDS stigma and discrimination is widespread in Africa. We did a secondary data analysis of HIV and AIDS behavioral surveillance surveys (BSS) on female sex workers residing in three major cities in Ethiopia.

Objectives

To compare level of sigma among sex workers through the analysis of two data sources of BSS conducted in 2002 and 2005 in Ethiopia.

Methods

The BSS used standardized methodology to study the level of stigma among female sex workers. Female sex workers were sampled using two-stage probability sampling methods in each of the three cities. Data from a total of 2,888 female sex workers was analyzed and interpreted. We used Chi square to compare the socio-demographic variables of the two surveys and logistic regression to compare level of stigma between the two surveys.

Results

There is a significant difference in the level of stigma between the two surveys. This applies to most of the questions that were included in the surveys.

Conclusion

The proportion of female sex workers with a stigmatizing attitude is considerably high, posing threats to the HIV prevention program. Strengthening interventions on all aspects of stigma is recommended.     

Human T-cell lymphotropic virus in a population of pregnant women and commercial sex workers in South Western Nigeria

Background: Over 20 million persons are infected with HTLV-I/II globally. The virus is endemic in Africa and it is also transmitted sexually. Continued identification of high risk groups is important for the control of the disease. Objectives: To determine the prevalence of HTLV infection amongst two highly sexually active groups, pregnant women and CSWs in South Western Nigeria. Methods: Serum samples were tested for the presence of HTLV-I/II antibodies using the Vironostika((R)) HTLV-I/II micro ELISA system. Results: A total of 364 serum samples collected from pregnant women, commercial sex worker (CSW) and secondary school students (control group) from Ibadan. While only 4 (5.1%) of 78 secondary school students (average age: 13years) were reactive for HTLV infection, 20 (16.7%) of 120 pregnant women (average age: 26years) and 38 (22.9%) of 166 CSWs (average age: 23years) were found to have antibodies against HTLV in their sera. The results of this study thus show that HTLV infection is active in the population although higher in pregnant women (although not statistically significant) and CSWs (p>0.05). Pregnant women and CSWs are therefore at a higher risk of HTLV transmission than other members of the population. Conclusion: Routine screening for HTLV infection may go a long way to understanding the epidemiology of HTLV infection in Nigeria and subsequently provide tools for its prevention and control.     

柳州市性服务工作者艾滋病相关知识和相关危险行为因素分析

目的了解柳州市及柳江、柳城县娱乐场所性服务工作者（FSW）艾滋病相关知识和相关危险行为,为艾滋病行为干预提供依据。方法采用分层抽样方法抽取娱乐场所性服务工作者1047名,采用一对一匿名的问卷调查和采血。结果调查对象平均年龄为（25.8±6.4）岁,FSW艾滋病知识较缺乏,蚊虫叮咬会感染艾滋病正确率依然最低,为79.2%;不同对象安全套使用率有差异,最近一次与客人发生性关系时有80.3%的FSW使用安全套,而最近一次与配偶/同居男友发生性关系时安全套使用率为50.0%,两者差异有统计学意义（χ2=9.1,P〈0.05）。FSW感染艾滋病的有4例,占0.4%;感染梅毒的有28例,占2.7%。结论柳州市FSW艾滋病相关知识缺乏和性行为的反应因素,提示应加大性病知识宣传力度,以控制艾滋病、性病传播。     

Prevalence and genotype distribution of human papillomavirus infection among female sex workers in Guangxi, China: implications for interventions

Human papillomavirus (HPV) infection is a major public health concern in women, but information on HPV among female sex workers in China is limited. The aim of the study was to estimate the prevalence and genotype distribution of HPV infection among female sex workers in two cities in Guangxi, China. A total of 811 female sex workers were recruited from venues between July and September of 2009. Data on socio-demographic and behavior characteristics were collected, and cervical swabs were collected to determine HPV infection and genotype distribution. The overall prevalence of infection with any HPV type was 38.9%. HPV type 52 was the most prevalent type with prevalence of 11%, followed by HPV types 16, 58, 53, and CP8304, with prevalences of 6.5%, 5.7%, 5.6%, and 4.8%, respectively. HPV 16 or 18 accounted for 23.2% of all HPV positive cases. Age group <20 years was significantly associated with infection of the high-risk and multiple types of HPV infection. A higher prevalence of multiple HPV infection was observed among female sex workers from the outdoor venues (14.0%; 95%CI, 10.6%-17.3%). These findings have important implications for developing HPV prevention programs including HPV vaccination in female sex workers.     

High‐risk HPV types in lesions of the uterine cervix of female commercial sex workers in the Philippines

In order to prevent cervical cancer, vaccines against human papilloma virus types 16 (HPV‐16) and 18 (HPV‐18) have been implemented worldwide. However, the HPV types that cause cancer can differ according to geographical area and ethnicity. In this new era of the HPV vaccine, it is important to elucidate the prevalent HPV types in each area. Therefore, the prevalence of HPV infection and cervical abnormalities among 369 female commercial sex workers in the Philippines were examined. HPV L1 gene was amplified by polymerase chain reaction (PCR) using modified GP5+/6+ primers, and genotyping was performed by sequencing cloned PCR products. HPV DNA was detected in 211 (57.2%) women, among whom 46 HPV types were identified. HPV‐52 was most common and multiple‐type infection was observed in 44.5%. Among 56 women with abnormal cervical cytology (low‐ and high‐grade squamous intraepithelial lesions and adenocarcinoma in situ), HPV‐52 was most common (23.2%), followed by HPV‐16 (19.6%), ‐58 (10.7%), and ‐67 (10.7%). Only 27% of these women were positive for HPV‐16 and ‐18. Multivariate analysis revealed that HPV‐16, ‐39, ‐52, ‐67, and ‐82 were significantly associated with abnormal cytology. Repeated analysis of HPV‐52 single‐positive samples using the original GP5+/6+ PCR primers produced negative results in 57% of cases, suggesting that the prevalence of HPV‐52 infection may have been underestimated in previous studies, and the current vaccines may not be sufficient for preventing infection and the development of premalignant lesions of the cervix in women in the Philippines. J. Med. Virol. 81:545–551, 2009. © 2009 Wiley‐Liss, Inc.     

Prevalence of human papillomavirus,human immunodeficiency virus and other sexually transmitted infections among female sex workers in Togo: a national cross-sectional survey

ObjectivesSub-Saharan Africa is a region with high incidence of both human immunodeficiency virus (HIV) and cervical cancer. We conducted the first national study in Togo to assess prevalence of human papillomavirus (HPV), HIV and other sexually transmitted infections (STIs) among female sex workers (FSW).MethodsA multicentric cross-sectional study was conducted among FSW recruited in hot spots (clubs, streets) in four Togolese cities. HPV and STIs were tested from cervical and anal swabs. HIV and syphilis were screened with rapid tests.ResultsIn all, 310 FSW were recruited; HIV and cervical high-risk HPV (hrHPV) prevalence were 10.6% (33/310) and 32.9% (102/310), respectively. The most frequent hrHPV types were HPV58 (13.6%, 19/140), HPV35 (12.9%, 18/140), HPV31 (12.1%, 17/140) and HPV16 (10.7%, 15/140). Prevalence of hrHPV and multiple hrHPV infections showed higher rates in HIV-positive than in HIV-negative FSW (48.5% versus 31.0%, p 0.04 and 21.2% versus 9.0%, p 0.03; respectively). Prevalence of hrHPV was higher in cervical than anal swabs (34.1% versus 20.7%, p 0.0004). High-risk HPV anal infections were more frequent among HIV-positive than HIV-negative FSW (51.9% versus 17.3%, p 2 × 10⁻⁵). Concomitant anal and cervical hrHPV infections were present in 43.2% (41/95) of hrHPV-positive FSW. Overall prevalence in the cervix of Neisseria gonorrhoeae, Chlamydia trachomatis, Mycoplasma genitalium and Trichomonas vaginalis were 4.2%, 6.1%, 5.5% and 6.5%, respectively.ConclusionsThis first African study on paired cervical and anal samples showed a high prevalence of genital HPV infections with a rather high rate of concomitant HPV infections but low type concordance. We report an unusual distribution of hrHPV types. These findings highlight the critical need for implementation of a national HPV vaccination strategy.     

From Marianism to terrorism: the many faces of violence against women in Latin America

Summary ¶Violence against women is widespread and highly tolerated in Latin America. In this paper, I will argue that this is because violence stems from deep cultural roots and because women are brought up in a patriarchal familial organization which promotes passivity and dependence. Traditional religious culture, which poses the Virgin Mary figure as role model, is ambivalent and distorted, repressing sex while overvaluing motherhood and self denial and demeaning women who do not conform to the established stereotypes. Patriarchal violence has serious emotional consequences for women. The stressful violent circumstances in womens lives lead to increased drug abuse that further exposes them to police and institutional violence. Political instability and civil wars in South America have caused many deaths, and have left many women with traumatic sequelae. Efforts at improving quality of life and diminishing violent conditions for women and girls in Latin America should include consideration of local cultural, political and economic peculiarities.Received December 18, 2002; accepted January 26, 2003 Published online April 17, 2003     

Towards action research with trans women sex workers: Policy,space and social challenges

Trans women face multiple social, economic and health inequalities and the impact of gender oppression and violence is even more profoundly experienced by trans women sex workers, although in culturally specific ways. This paper presents a pilot study conducted to explore and engage with the context of trans women sex workers in Lido Tre Archi, Italy. In line with the community psychology values of social justice, social change and participation, we outline our engagement process and key challenges observed when attempting action research with such a highly marginalised group. Data were collected in the form of ethnographic notes from informal consultations with different stakeholders and participant observations, and of documents (newspaper articles, picture captions) and were analysed using thematic analysis. Findings are organised in three themes relating to the social, policy and physical context in Lido Tre Archi demonstrating evidence of the contextual challenges and how they intertwine to generate a spiral of marginalisation and social exclusion for the participants. We take a collaborative and reflexive stance in our work and conclude with recommended steps and potential limitations to initiate an action research project.     

Influence of the history of abuse and suicidal attempts behavior among women victims of violence in Nicaragua

Suffering traumatic experiences linked to violence seems to be related to suicide attempts, especially, when the physical or sexual abuse has been experienced at an early age. This study examines the relationship between the history of abuse and suicide attempts among women victims of violence living in poverty in Nicaragua. This sample was subjected to a particularly serious range of stressful situations and experiences related to violence throughout their lives. The results show that women who experienced abuse during childhood were more likely to report a history of suicide attempts than women without a history of childhood abuse. Therefore, suicide attempts seem to be related more to those traumatic experiences during childhood than to violence suffered afterward. Identifying this type of abuse is particularly important because of its implications for the victims' health, as suicide attempts are maladaptive behaviors with which the women in the sample could have been addressing the trauma they experienced in their childhood. It is, therefore, necessary to highlight this problem in a developing country, which has been the focus of a limited number of studies, and where there are no support mechanisms for victims whose rights have been violated.     

Health professionals’ perceptions of intimate partner violence against women in Serbia: Opportunities and barriers for response improvement

Objective

The aim of this study was to determine the perceptions and attitudes of health professionals toward violence against women in intimate relationships, and to discuss them as opportunities and barriers for improving health professionals’ response.

Methods

Six focus groups were conducted with 71 health professionals employed in the public primary health care centers in Belgrade (Serbia). The data were analyzed according to the direct approach of the qualitative content analysis.

Results

Findings suggest that the majority of health professionals perceive IPV as an unjustifiable act. They showed an understanding for women; see their role as providing support to women and collaborating with other institutions. They are willing to help, but do not know how. However, some health professionals appeared to be judgmental in terms of what preceded violence, and would insist on extracting a woman's disclosure that violence had occurred. As barriers, they emphasized the lack of training and specific education on IPV, a weak support network, and overall social insecurity.

Conclusion

There is a gap between health professionals’ willingness to help and resources needed, along with prejudice and interrogative attitudes. Barriers appeared at individual, organizational and societal levels.

Practice implications

Proper education and protocols are priorities in strengthening health professionals’ response to IPV.     

Prevalence of HIV-1 non-B subtypes, syphilis, HTLV, and hepatitis B and C viruses among immigrant sex workers in Madrid, Spain

Sexually transmitted disease (STD) remains a major public health challenge in developed countries, exacerbated by the advent of the HIV epidemic. The objectives of this study were to assess the prevalence of serological markers of syphilis, HIV-1/2, HTLV-I/II, HBV, and HCV infections among immigrant sex workers in Madrid, Spain and to characterize the HIV-1 variants in seropositive individuals. Sera from 762 immigrant commercial sex workers (75.3% from sub-Saharan Africa, 18.2% from South America, and 6.4% from Eastern Europe) were collected between 1998 and 2003 in Madrid and examined. Antibody detection was performed by screening assays (RPR, ELISAs) and confirmed by FTA-Abs, LIAs and Western-blot tests. HIV-1 subtyping was carried out by phylogenetic analyses of the protease and envelope genes. Antibodies to HIV-1 were found in 5.2%, while 3.5% tested positive for HBsAg, 3% for syphilis antibodies, 0.8% for HCV antibodies, and 0.2% for HTLV-I antibodies. None were reactive for HIV-2 or HTLV-II antibodies. HIV-1 seroprevalence among Africans and Ecuadorians was 4.5 and 10.9%, respectively. All HIV-1 seropositive Ecuadorians were transsexual men, and 28.6% had active syphilis infection. Up to 80% of HIV-1 positive specimens were characterized as non-B subtypes, with subtypes G, A, and G/A recombinants being the most frequent among African individuals. In contrast, South Americans with HIV-1 infection carried exclusively subtype B variants. A relatively high proportion of immigrant sex workers in Madrid were infected with HIV-1 and syphilis, whereas infections with hepatitis viruses or HTLV were uncommon.     

Gender-based violence during COVID-19 lockdown: case study of a community in Lagos,Nigeria

BackgroundGender-based violence (GBV) has been identified to be one of the ripple effects of the global pandemic. In countries like Nigeria, the situation is hypothesized to be worse because of widespread poverty and gender inequalities.ObjectiveTo examine the exposure of females to GBV during the first 3 months of the COVID-19 lockdown.MethodThis cross-sectional study was conducted in a low-income community in Lagos. Semi-structured questionnaires were administered to 130 respondents selected via systematic random sampling.ResultsThe mean age of the respondents was 26.89 ± 8.67 years. Majority worked informal jobs, while only 50% had attained beyond primary education. Within the period, the respondents had been subjected to sexual (54.6%), physical (52.3%), verbal assault (41.5%), and online sexual harassment (45.4%); of which only 30% reported to the police. Furthermore, respondents subjected to sexual (p=0.004) and physical assault (p=0.032) during the period earned significantly less money than other respondents.ConclusionThe fact that over 1 out of every 2 females was subjected to at least one form of GBV within the short timeframe shows how unsafe girls and women in low-income communities are. This calls for proactive community-level interventions to curb the GBV menace.     

Patent medicine vendors, community pharmacists and STI management in Abuja, Nigeria

Background

Increasingly, literature indicates that Patent Medicine Vendors (PMVs) and Community Pharmacists (CPs) provide sexual reproductive health services and products to their young patrons.

Objectives

This study explored the validity of literature claims, principally from CPs and PMVs perspective in Abuja, Nigeria.

Methods

Participants were recruited with convenience sampling based on their willingness to participate in the study and our judgement of their professional competence. They were administered a semi-structured questionnaire, which was modelled after McCracken''s long interview. We empirically assessed the validity of CPs and PMVs opinions with an exit interview of seven consenting patrons. Interviews were audio taped, transcribed verbatim and subjected to iterative thematic analysis.

Results

Participants'' accounts and our observations indicate that PMVs and CPs serve young people''s sexual reproductive healthcare needs in Abuja. CPs and PMVs provide young people with a seamless and non-judgemental access to contraceptives, sexual health advice and post-sexual risk exposure care.

Conclusion

The study corroborates literature claims that CPs and PMVs provide sexual reproductive health advice, services and products to young people. However, participants contend that the current pharmacy practice laws in Nigeria constrain the scope and quality of services that young unmarried people require. Because it is unlikely that Nigeria will reinvigorate her primary healthcare system soon, we call for the formal co-option of CPs and PMVs into the sexual reproductive health management system to standardize and improve services.