Background:Female sex workers (FSW) bear a high burden of sexually transmitted infections (STI). In this paper, we estimate the prevalence of human immunodeficiency virus (HIV), HBV = hepatitis B virus (HBV), HCV = hepatitis C virus (HCV), syphilis and co-infections in the second Biological and Behavioral Surveillance Survey among FSW in Brazil.Method:The survey was conducted in 12 Brazilian cities from July to November 2016. We used respondent-driven sampling (RDS) to recruit 350 FSW in each city. Rapid tests were used for screening HIV, syphilis, HCV, and HBV. Confirmatory tests were performed on all samples with reactive rapid test result. All testing algorithms and interpretations were done according to the recommendations of the Department of STI/AIDS and viral hepatitis, Ministry of Health. The STI diagnoses were given by: confirmed HIV infection by a positive result on Western blot; active syphilis infection, defined by a RPR titer equal or greater than 1/8; viremia period of HBV and HCV infections, characterized by a detectable (or quantifiable) viral load. Prevalence estimates and standard errors were calculated using statistical procedures suitable for data collected by RDS.Results:Excluding the seeds, 4245 FSW were enrolled. Prevalence estimates were: HIV 5.3% (95% CI: 4.4%–6.2%); active syphilis 8.5% (95% CI: 7.3%–9.7%); HBV 0.4% (95% CI: 0.2%–0.7%); and, HCV 0.9% (95% CI: 0.6%–1.3%). Among the 4154 FSW tested for the 4 infections, 13.3%; (95% CI 12.0%–14.8%) were diagnosed with at least one of the infections, of which 87.6% (95% CI: 83.3%–90.9%) had single infections. The prevalence of HIV/syphilis co-infection was 1.09% (95% CI: 0.7%– 1.6%) and of HIV/HCV or HBV infections was 0.4% (95% CI: 0.2%–0.7%).Conclusions:Our results reveal the need to conduct more studies to estimate the prevalence of STI and co-infections among FSW in Brazil. Longitudinal trends in the prevalence estimates of HIV and other STI provide information to monitor changes in this high-risk population. Additionally, the study highlights the importance of measuring the hepatitis burden among FSW living with HIV, and the need of including FSW in all aspects of STI prevention, care, and treatment programs.

Background:Female sex workers (FSWs) are one of the most-at-risk population groups for human immunodeficiency virus (HIV) infection. This paper aims at identifying the main predictors of HIV infection among FSW recruited in the 2nd Biological and Behavioral Surveillance Survey in 12 Brazilian cities in 2016.Method:Data were collected on 4245 FSW recruited by respondent driven sampling (RDS). Weights were inversely proportional to participants’ network sizes. To establish the correlates of HIV infection, we used logistic regression models taking into account the dependence of observations resultant from the recruitment chains. The analysis included socio-demographic sex work characteristics, sexual behavior, history of violence, alcohol and drug use, utilization of health services, and occurrence of other sexually transmitted infections (STIs).Results:HIV prevalence was estimated as 5.3% (4.4%–6.2%). The odds ratio (OR) of an HIV-positive recruiter choosing an HIV-positive participant was 3.9 times higher than that of an HIV-negative recruiter (P < .001). Regarding socio-demographic and sex work characteristics, low educational level, street as the main work venue, low price per sexual encounter, and longer exposure time as a sex worker were found to be associated with HIV infection, even after controlling for the homophily effect. The OR of being HIV infected among FSW who had been exposed to sexual violence at least once in a lifetime (OR = 1.5, P = .028) and the use of illicit drugs at least once a week were highly significant as well, particularly for frequent crack use (OR = 3.6, P < .001). Among the sexual behavior indicators, not using condoms in some circumstances were significantly associated with HIV infection (OR = 1.8, P = .016). Regarding the occurrence of other STI, the odds of being HIV infected was significantly higher among FSW with a reactive treponemal test for syphilis (OR = 4.6, P < .001).Conclusions:The main factors associated with HIV infection identified in our study characterize a specific type of street-based sex work in Brazil and provided valuable information for developing interventions. However, there is a further need of addressing social and contextual factors, including illicit drug use, violence, exploitation, as well as stigma and discrimination, which can influence sexual behavior.

Background:The present study aims at investigating the progress made toward controlling the human immunodeficiency virus (HIV)/AIDS epidemic among female sex workers (FSW) from 2009 to 2016.Methods:The baseline of respondent-driven sampling (RDS) study among FSW was carried out in 2009, in 10 Brazilian municipalities. In 2016, information on FSW were collected in 12 municipalities. The analyses took into account the dependence among observations, resulting from the recruitment chains, and the unequal probabilities of selection, resulting from the different network sizes. We analyzed changes in attitudes and risky behavior practices as well as variations in HIV and syphilis prevalence based on the comparison of 95% confidence intervals for each estimate.Results:Information on 2523 (2009) and 4245 (2016) FSW were analyzed. Commercial sex debut shifted to younger ages: while in 2009 the proportion of women who started sex work under 18 years old was 28.3%, in 2016 this percentage rose to 38.3%. The proportion of FSW affiliated to a nongovernmental organization (NGO) in defense of their rights (14.0%), in 2009, decreased to 7.8%, in 2016, as well as the proportion of FSW who received counseling on sexually transmitted infections (STI) in the past 6 months, from 47.5% to 24.4%. Relevant improvements were found for HIV testing in the last 12 months (from 20.3% to 39.3%). The proportions of those who were never tested for syphilis dropped from 57.9% to 48.5%. However, an opposite decreasing trend was found for the Pap smear examination in the last 12 months, decreasing from 43.6% to 31.5%. Regular condom use with clients significantly increased in the period. Regarding HIV prevalence, the 5% level was sustained and no significant differences were found, but syphilis prevalence was found to be more than 3 times higher in 2016 (8.5%) than in 2009 (2.4%).Discussion:Many are the challenges to be faced in attempting to reverse the upward trend of syphilis among FSW in Brazil. Despite the progress in condom distribution free of charge, it is necessary to increase awareness campaigns, emphasize the use, reaffirm STI counseling, and reiterate the need of regular syphilis screening in this key population group.