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RESEARCH ARTICLE

Hepatitis B virus and hepatitis C virus infections among female sex workers and men who have sex with men in Lebanon: prevalence, risk behaviour and immune status

Kassem Kassak A , Ziyad Mahfoud B , Khalil Kreidieh C , Sarah Shamra C , Rima Afifi D and Sami Ramia C E
+ Author Affiliations
- Author Affiliations

A Health Management and Policy Department, American University of Beirut, Beirut 1107, 2020, Lebanon.

B Epidemiology and Population Health Department, American University of Beirut, Beirut 1107, 2020, Lebanon.

C Medical Laboratory Sciences Department, American University of Beirut, Beirut 1107, 2020, Lebanon.

D Health Behavior and Education Department, American University of Beirut, Beirut 1107, 2020, Lebanon.

E Corresponding author. Email: sramia@aub.edu.lb

Sexual Health 8(2) 229-233 https://doi.org/10.1071/SH10080
Submitted: 1 July 2010  Accepted: 9 September 2010   Published: 18 May 2011

Abstract

Background: The aim of our study was to study the prevalence of and the risk behaviours associated with the hepatitis B virus (HBV) and hepatitis C virus (HCV) infections among two high-risk groups: female sex workers (FSW) and men who have sex with men (MSM). Furthermore, since vaccination is a key component of HBV prevention programs, the immune status of HBV infection in these two high-risk groups was evaluated. Methods: Participants included in this study were part of a bio-behavioural surveillance study done to assess HIV prevalence among four vulnerable groups in Lebanon. Participants were recruited using a respondent-driven sampling method. The total number of eligible participants were 101 MSM and 103 FSW. Blood samples were collected as dried blood spots and then eluted to be tested for HCV, HBV and HIV by enzyme-linked immunosorbent assay. Results: None of the 204 individuals tested has been exposed to HCV. In the 101 MSM, only one (0.99%) was an HBsAg carrier and one (0.99%) was confirmed as anti-HIV-positive. Among FSW, 30% showed they were immune to HBV compared with only ~10% among MSM. The distribution of socio-demographic characteristics and potential risk factors in both groups were shown. Conclusion: Our results highlight the urgent need to raise awareness among FSW and MSM and their health care providers of the availability and benefits of HBV vaccination in Lebanon. In addition, and due to the absence of vaccines against HCV and HIV, education programs aiming at behavioural changes should be intensified.

Additional keywords: HIV, liver disease, sexually transmissible infections, vaccination.


References

[1]  Haubrich R, Soriano V, Lafeuillade A. Statements from the 15th International Symposium on HIV and Emerging Infectious Diseases (ISHEID), Toulon, France, May 28–30, 2008. HIV Clin Trials 2008; 9 348–65.
Statements from the 15th International Symposium on HIV and Emerging Infectious Diseases (ISHEID), Toulon, France, May 28–30, 2008.Crossref | GoogleScholarGoogle Scholar | 18977724PubMed |

[2]  Frenkl TL, Potts J. Sexually transmitted infections. Urologic Clinics N Am 2008; 35 33–46.
Sexually transmitted infections.Crossref | GoogleScholarGoogle Scholar |

[3]  Cwikel JG, Lazer T, Press F, Lazer S. Sexually transmissible infections among female sex workers: an international review with an emphasis on hard-to-access populations. Sex Health 2008; 5 9–16.
Sexually transmissible infections among female sex workers: an international review with an emphasis on hard-to-access populations.Crossref | GoogleScholarGoogle Scholar | 18361849PubMed |

[4]  Bimbi DS. Male prostitution: pathology, paradigms and progress in research. J Homosex 2007; 53 7–35.
Male prostitution: pathology, paradigms and progress in research.Crossref | GoogleScholarGoogle Scholar | 18019068PubMed |

[5]  Center for Disease Control and Prevention. Viral hepatitis topics. Atlanta: CDC; 2009. Available online at: http://www.cdc.gov/hepatitis/statistics.htm [verified June 2009].

[6]  Armstrong GL, Alter MJ, McQuillan GM, Margolis HS. The past incidence of hepatitis C virus infection: implications for the future burden of chronic liver disease in the United States. Hepatology 2000; 31 777–82.
The past incidence of hepatitis C virus infection: implications for the future burden of chronic liver disease in the United States.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD3c7nt1SgsQ%3D%3D&md5=ed9a992b36e052849a612a4a7f4ac7e1CAS | 10706572PubMed |

[7]  Wilson BC, Moyer L, Schmid G, Mast E, Voigt R, Mahoney F, et al Hepatitis B vaccination of sexually transmitted disease (STD) clinics: a survey of STD programs. Sex Transm Dis 2000; 28 148–52.

[8]  Trepka MJ, Weisbord JS, Zhang G, Brewer T. Hepatitis B virus infection risk factors and immunity among sexually transmitted disease clinic clients. Sex Transm Dis 2003; 30 914–8.
Hepatitis B virus infection risk factors and immunity among sexually transmitted disease clinic clients.Crossref | GoogleScholarGoogle Scholar | 14646641PubMed |

[9]  Page-Shafer KA, Cahoon-Young B, Klausner JD, Morrow S, Molitor F, Ruiz J, et al Hepatitis B virus infection in young, low-income women: the role of sexually transmitted infection as a potential cofactor for HCV infection. Am J Public Health 2002; 92 670–6.
Hepatitis B virus infection in young, low-income women: the role of sexually transmitted infection as a potential cofactor for HCV infection.Crossref | GoogleScholarGoogle Scholar | 11919070PubMed |

[10]  Vandelli C, Renzo F, Romanò L, Tisminetzky S, De Palma M, Stroffolini T, et al Lack of evidence of sexual transmission of hepatitis C among monogamous couples: results of a 10-year prospective follow-up study. Am J Gastroenterol 2004; 99 855–9.
Lack of evidence of sexual transmission of hepatitis C among monogamous couples: results of a 10-year prospective follow-up study.Crossref | GoogleScholarGoogle Scholar | 15128350PubMed |

[11]  Terrault N. Sex and hepatitis C. Am J Gastroenterol 2005; 100 825–6.
Sex and hepatitis C.Crossref | GoogleScholarGoogle Scholar | 15784026PubMed |

[12]  McDonald M, Crofts N, Kaldor J. Transmission of hepatitis virus: rates, routes and cofactors. Epidemiol Rev 1996; 18 137–48.
| 9021308PubMed |

[13]  Mesquita PE, Granato CFH, Castelo A. Risk factors associated with hepatitis C virus (HCV) infection among prostitutes and their clients in the city of Santos, Sao Paulo State, Brazil. J Med Virol 1997; 51 338–43.
Risk factors associated with hepatitis C virus (HCV) infection among prostitutes and their clients in the city of Santos, Sao Paulo State, Brazil.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK2s3kslyhtQ%3D%3D&md5=5be65cdaeb55b4db15b1f4ce866ba002CAS | 9093950PubMed |

[14]  Montella M, Crispo A, Grimaldi M, Angeletti C, Amore A, Ronga D, et al Prevalence of hepatitis C virus infection indifferent population groups in Southern Italy. Infection 2005; 33 9–12.
Prevalence of hepatitis C virus infection indifferent population groups in Southern Italy.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD2M7hvVCrtg%3D%3D&md5=9d823b47ca9e3d86e5a15eeafc349999CAS | 15750753PubMed |

[15]  DeJong J, Mahfoud Z, Khoury D, Barbir F, Afifi R. Ethical considerations in HIV/AIDS biobehavior surveys that use respondent-driven sampling: illustrations from Lebanon. Am J Public Health 2009; 99 1562–67.
Ethical considerations in HIV/AIDS biobehavior surveys that use respondent-driven sampling: illustrations from Lebanon.Crossref | GoogleScholarGoogle Scholar | 19608961PubMed |

[16]  Centers for Disease Control and Prevention. A comprehensive immunization strategy to eliminate transmission of hepatitis B virus infection in the United States: recommendations of the Advisory Committee on Immunizations Practice (ACIP) Part II: immunization of adults. MMWR Recomm Rep 2006; 55 1–33.

[17]  Centers for Disease Control and Prevention. Hepatitis B vaccination coverage among adults – United States, 2004. MMWR 2006; 55 509–11.
| 16691181PubMed |

[18]  Buffington J, Jones TS. Integrating viral hepatitis prevention into public health Programs serving people at high risk for infection: good public health. Public Health Rep 2007; 122 1–5.
| 17542445PubMed |

[19]  Heckathorn DD. Respondent driven sampling: a new approach to the study of hidden population. Soc Probl 1997; 44 174–99.
Respondent driven sampling: a new approach to the study of hidden population.Crossref | GoogleScholarGoogle Scholar |

[20]  Ishi K, Suzuku F, Saito A, Yoshimoto S, Kubota T. Prevalence of human immunodeficiency virus, hepatitis B and hepatitis C virus antibodies and hepatitis B antigen among commercial sex workers in Japan. Infect Dis Obstet Gynecol 2001; 9 215–9.
Prevalence of human immunodeficiency virus, hepatitis B and hepatitis C virus antibodies and hepatitis B antigen among commercial sex workers in Japan.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD387otlWjtg%3D%3D&md5=70a8aade5d84c9bbb831aa946876ab5aCAS | 11916178PubMed |

[21]  Laurent C, Henzel D, Mulanga-Kabeya C, Maertens G, Larouze B, Delaporte E. Seroepidemiological survey of hepatitis C virus among commercial sex workers and pregnant women in Kinshasa, Democratic Republic of Congo. Int J Epidemiol 2001; 30 872–7.
Seroepidemiological survey of hepatitis C virus among commercial sex workers and pregnant women in Kinshasa, Democratic Republic of Congo.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD3MrhtlGjtw%3D%3D&md5=e63b4d26105473ac04111ce2c4ff5259CAS | 11511619PubMed |

[22]  Terrault NA. Sexual activity as a risk factor for hepatitis C. Hepatology 2002; 36 S99–105.
Sexual activity as a risk factor for hepatitis C.Crossref | GoogleScholarGoogle Scholar | 12407582PubMed |

[23]  Kweon SS, Shin MH, Song HJ, Jeon DY, Choi JS. Seroprevalence and risk factors for hepatitis C virus infection among female sex workers in South Korea who are not intravenous drug users. Am J Trop Med Hyg 2006; 74 1117–21.
| 16760530PubMed |

[24]  Mahfoud Z, Kassak K, Kreidieh K, Shamra S, Ramia S. Distribution of hepatitis C virus genotypes among injecting drug users in Lebanon. Virology 2010; 7 96
Distribution of hepatitis C virus genotypes among injecting drug users in Lebanon.Crossref | GoogleScholarGoogle Scholar |

[25]  Shannon K, Kerr T, Marshall B, Li K, Zhang R, Strathdee SA, et al Survival sex work involvement as a primary risk factor for hepatitis C virus acquisition in drug-using youths in a Canadian setting. Arch Pediatr Adolesc Med 2010; 164 61–5.
Survival sex work involvement as a primary risk factor for hepatitis C virus acquisition in drug-using youths in a Canadian setting.Crossref | GoogleScholarGoogle Scholar | 20048243PubMed |

[26]  de Nishioka SA, Gyorkos TW, Joseph L, Collet JP, MacLean JD. Tattooing and transfusion diseases in Brazil: a hospital-based cross-sectional matched study. Eur J Epidemiol 2003; 18 441–9.
Tattooing and transfusion diseases in Brazil: a hospital-based cross-sectional matched study.Crossref | GoogleScholarGoogle Scholar | 12889691PubMed |

[27]  Shin HR, Kim JY, Kim JL, Lee DH, Yoo KY, Lee DS, et al Hepatitis B and C virus prevalence in a rural area of South Korea: the role of acupuncture. Br J Cancer 2002; 87 314–8.
Hepatitis B and C virus prevalence in a rural area of South Korea: the role of acupuncture.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD38vitFemsw%3D%3D&md5=8237431198b8e727d35f1c2fd8165ba0CAS | 12177801PubMed |

[28]  Daniels D, Grytdal S, Wasley A. Surveillance for acute viral hepatitis – United States, 2007. MMWR Surveill Summ 2009; 22 1–27.

[29]  Sharara AI, Ramia S, Ramlawi F, Eid-Fares J, Klayme S, Naman R. Genotypes of hepatitis C virus (HCV) among positive Lebanese patients: comparison of data with that from other Middle Eastern countries. Epidemiol Infect 2007; 135 427–32.
Genotypes of hepatitis C virus (HCV) among positive Lebanese patients: comparison of data with that from other Middle Eastern countries.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BD2sXksV2qurY%3D&md5=71e3989c2f0a9e1c8e3d0e2ecdd7a8ddCAS | 16848924PubMed |

[30]  Ramia S, Ramlawi F, Kanaan M, Klyme S, Naman R. Frequency and significance of antibodies against hepatitis B core (anti-HBc) antigen as the only serological marker for hepatitis B infection in Lebanese blood donors. Epidemiol Infect 2005; 133 695–9.
Frequency and significance of antibodies against hepatitis B core (anti-HBc) antigen as the only serological marker for hepatitis B infection in Lebanese blood donors.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BD2MXlsF2hsLw%3D&md5=5c2254d4767029f6c98326d89678dba7CAS | 16050516PubMed |

[31]  Diamond C, Thiede H, Perdue T, Secura G, Valleroy L, MacKellar F, et al Viral hepatitis among young men who have sex with men: prevalence of infection, risk behaviors and vaccination. Sex Transm Dis 2003; 30 425–32.
Viral hepatitis among young men who have sex with men: prevalence of infection, risk behaviors and vaccination.Crossref | GoogleScholarGoogle Scholar | 12916134PubMed |

[32]  Mast EE, Margolis HS, Fiore AE, Brink EW, Goldstein ST, Wang SA, et al A comprehensive immunization strategy to eliminate transmission of hepatitis B virus infection in the United States: recommendations of the Advisory Committee on Immunization Practices (ACIP) part 1: immunization of infants, children, and adolescents. MMWR Recomm Rep 2005; 54 1–31.
| 16371945PubMed |

[33]  Yusuf HR, Coronado VG, Averkoff FA, Maes EF, Rodewald LE, Battaglia MP, et al Progress in coverage with hepatitis B vaccine among US children 1994–1997. Am J Public Health 1999; 89 1684–9.
Progress in coverage with hepatitis B vaccine among US children 1994–1997.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD3c%2FitV2lsQ%3D%3D&md5=a0fbbe8a520e6f3a56cdd51e3a49b891CAS | 10553389PubMed |

[34]  Weinbaum C, Lyerla R, MacKellar D, Valleroy L, Secura GM, Behel SK, et al The young men’s survey Phase II: hepatitis B immunization and infection among young men who have sex with men. Am J Public Health 2008; 98 839–45.
The young men’s survey Phase II: hepatitis B immunization and infection among young men who have sex with men.Crossref | GoogleScholarGoogle Scholar | 18382012PubMed |