High hepatitis B prevalence and vaccination needs among transgender women and men sex workers in Barcelona, Spain

Abstract

Transgender women sex workers (TWSW) and men sex workers (MSW) are especially vulnerable to acquiring hepatitis B virus (HBV) infection. We aimed to describe HBV prevalence (HBsAg and HBcAb) and associated risk factors for HBV exposure (HBcAb), to assess vaccination status and risk factors for no prior vaccination and to compare HBV prevalence and vaccination status between TWSW and MSW. The SexCohort study was advertised to TWSW and MSW through several communication channels. At cohort entry through two community-based organizations in Barcelona, the study population was screened for HBV and other STIs, and an epidemiological questionnaire was administered (N=271). Overall, 93.0% of participants were migrants, mostly from South and Central American countries. HBsAg prevalence was 1.9% (TWSW, 2.4% vs. MSW, 0.9%; p=0.42), and previous exposure to HBV was 31.8% (TWSW, 38.5% vs. MSW, 20.8%; p=0.002). Over five years of sex work (aOR=9.35), prior exposure to Treponema pallidum (aOR=3.49) and treatment with anxiolytic drugs (aOR=3.23) were associated with HBV exposure. Overall, 33.7% of participants exhibited immunity from vaccination (TWSW, 30.8% vs. MSW, 38.61%; p<0.001), while 34.4% were candidates to HBV vaccination (TWSW, 30.8% vs. MSW, 40.6%; p<0.001). Never having been on PrEP for HIV (OR=4.23) and non-Spanish origin (OR=5.00) were associated with no prior HBV vaccination. There is a need to reinforce screening and vaccination programs aimed at TWSW and MSW as integrated services offered at the community centers commonly accessed by these populations.