Evaluating sexual health in sex workers and men who have sex with men: the SMESH cross-sectional protocol study

Abstract

IntroductionHuman papillomavirus (HPV) infection is transmitted through skin-to-skin contact, and vaginal and anal sex are the most common transmission routes. Sex workers and men who have sex with men (MSM) are more exposed to the virus, and therefore, a higher frequency of this infection would be expected. The prevalence of HPV infection types and the forms and factors of transmission must be investigated to control infection-related outcomes. This protocol study will be the first nationwide study with a uniform methodology to evaluate HPV prevalence of and infection types among sex workers and MSM in Brazil.Methods and analysisThis multicentre cross-sectional study will be conducted with a respondent-driven sampling method to recruit 1174 sex workers and 1198 MSM from all regions of Brazil. The study will consist of preliminary interviews to verify the eligibility criteria and characterise the network size as well as a second questionnaire to obtain sociodemographic, behavioural and sexual information. Specimens from the oral cavity and anal and cervical or penile/scrotal sites will be collected. All HPV samples will be processed in a certified central laboratory. Other sexually transmitted infections will be evaluated by interview and by rapid testing for HIV and syphilis. Strict quality control will be conducted using different procedures, including the training and certification of the health professionals responsible for acquiring data and monitoring visits.Ethics and disseminationThe project was approved by the research ethics committee of the main institution and the corresponding ethics committees of the recruitment sites. Due to the literature gap on the sexual health of sex workers and MSM and the intense stigma surrounding these populations, a critical analysis of the study results will contribute to epidemiological knowledge and will be useful for the development of strategies against virus morbidities.

Gender, transactional sex, and HIV prevention cascade engagement among urban refugee and displaced adolescents and youth in Kampala, Uganda

“…In sum, findings point to urgent gaps in HIV testing among transactional sex engaged refugee and displaced youth and a need for gender tailored strategies to address HIV vulnerabilities, particularly among adolescent boys and young men. Findings corroborate research that documents unmet HIV prevention needs for transactional sex engaged young men (Ballester-Arnal et al, 2014;Okanlawon et al, 2013;Wendland et al, 2019). This could be due to intersecting stigma (e.g., sex work stigma, HIVrelated stigma) and a lack of tailored HIV outreach and services for refugee sex working men in Kampala.…”

“…Adolescent girls and young women who sell sex may have higher odds of depression (Svedin & Priebe, 2007) and sexual violence (Choudhry et al, 2014) compared with adolescent boys and young men who sell sex. Adolescent boys and young men who sell sex are understudied (Baral et al, 2015;Krisch et al, 2019;Wendland et al, 2019), although they share similar HIV vulnerabilities as adolescent girls and young women associated with condomless sex, multiple sex partners, co-occurring STIs, and substance use (Ballester-Arnal et al, 2014;Baral et al, 2015). Criminalization of same-sex sexual practices, HIV non-disclosure, and sex work contribute to stigma and poor sexual health outcomes among persons who sell sex (Baral et al, 2015;Brookfield et al, 2020;Okanlawon et al, 2013).…”

“…HIV prevention needs are understudied among refugee and displaced adolescents and youth engaged in transactional sexparticularly adolescent boys and young men (Ballester-Arnal et al, 2014;Ferguson et al, 2017;Okanlawon et al, 2013;Wendland et al, 2019). A systematic review on sex workers in conflict-affected and humanitarian settings found that sex workers remain underserved in HIV prevention, education, testing and treatment (Ferguson et al, 2017).…”

A comprehensive assessment of quality management methods in the SMESH study

“…Thus, the study successively reached more people from those populations. The inclusion criteria were described previously [ 11 ].…”

“…Therefore, seeking to instigate discussion and publication of methodologies applied to enhance quality management through comprehensive scientific reports, this paper aims to provide a detailed description of the design, implementation, and results of the quality control program employed in the SMESH study. This was a multicentre cross-sectional study designed to assess the national prevalence of human papillomavirus (HPV) and infection types in two key populations in Brazil, from 2019 to 2023 [ 11 ]. The respondent-driven sampling (RDS) method was used to recruit participants.…”