Alejandra J Portillo-Romero1, Betania Allen-Leigh2, Alan G Nyitray3, Martha Carnalla1, Jorge Salmerón4, Leith León-Maldonado5, Elsa Yunes1, Leonor Rivera1, Carlos Magis-Rodríguez6, Galileo Vargas7, Anna R Giuliano8, Eiberth A Esquivel-Ocampo9, Eduardo Lazcano-Ponce10. 1. Center for Population Health Research, National Institute of Public Health, Cuernavaca, Mexico. 2. Reproductive Health Division, Center for Population Health Research, National Institute of Public Health, Cuernavaca, Mexico. 3. Clinical Cancer Center, Center for AIDS Intervention Research, Medical College of Wisconsin, Milwaukee, Wisconsin, USA. 4. Center for Research in Policy, Population and Health, School of Medicine, National Autonomous University of Mexico, Mexico City, Mexico. 5. National Council of Science and Technology (CONACYT)-National Institute of Public Health, Cuernavaca, Mexico. 6. School of Medicine, National Autonomous University of Mexico, Mexico City, Mexico. 7. Center for the Prevention and Comprehensive Care of HIV/AIDS in Mexico City, Condesa Clinic, Mexico City, Mexico. 8. Center for Infection in Cancer Research, Moffitt Cancer Center, Tampa, Florida, USA. 9. Coloproctology Unit of General Hospital of Cuernavaca, "Dr. José G. Parres," Cuernavaca, Morelos, México. 10. Academic Secretariat, National Institute of Public Health, Cuernavaca, Mexico.
Abstract
Purpose: The prevalence of high-risk human papillomavirus (hrHPV) infection among transgender women has been reported to be very high and sexually transmitted infection (STI) prevention strategies have focused on transgender women who engage in sex work. The purpose of our study was to describe hrHPV infection prevalence among a group of transgender women and to explore the differences according to sex work history (SW). Methods: The Condesa Study, an HPV vaccine, and screening study, recruited 207 transgender women without previous HPV vaccination, ages 18-60, from two clinics in Mexico City that provide HIV and transgender health care (May 2018-December 2019). At enrollment, they completed a questionnaire on sociodemographic and sexual behavior data. The hrHPV DNA genotyping was done on self-collected anal samples. Factors associated with hrHPV, stratified by presence or absence of SW, were assessed with multiple logistic regression. Results: A total of 43.5% of participants reported a history of SW. Anal hrHPV prevalence was 62.0% among participants with a history of SW and 52.0% among those without. Overall, 1 in 4 (26.6%) participants were living with HIV. Independent risk factors associated with hrHPV among transgender women with a history of SW were younger age, younger age at first anal intercourse (15-17 years), and greater number of sexual partners in the last 3 months. Among transgender women who had not done SW, greater number of sexual partners in the last 3 months and self-reported STIs were associated with hrHPV. Conclusions: Prevalence of anal infection with hrHPV was high among transgender women. Our results support that other sexual behaviors different from participating in SW contribute to the high prevalence of HPV and that there is an urgent need to include all transgender women in prevention programs for HPV and associated cancers, regardless of SW. Copyright 2021, Mary Ann Liebert, Inc., publishers.
Purpose: The prevalence of high-risk human papillomavirus (hrHPV) infection among transgender women has been reported to be very high and sexually transmitted infection (STI) prevention strategies have focused on transgender women who engage in sex work. The purpose of our study was to describe hrHPV infection prevalence among a group of transgender women and to explore the differences according to sex work history (SW). Methods: The Condesa Study, an HPV vaccine, and screening study, recruited 207 transgender women without previous HPV vaccination, ages 18-60, from two clinics in Mexico City that provide HIV and transgender health care (May 2018-December 2019). At enrollment, they completed a questionnaire on sociodemographic and sexual behavior data. The hrHPV DNA genotyping was done on self-collected anal samples. Factors associated with hrHPV, stratified by presence or absence of SW, were assessed with multiple logistic regression. Results: A total of 43.5% of participants reported a history of SW. Anal hrHPV prevalence was 62.0% among participants with a history of SW and 52.0% among those without. Overall, 1 in 4 (26.6%) participants were living with HIV. Independent risk factors associated with hrHPV among transgender women with a history of SW were younger age, younger age at first anal intercourse (15-17 years), and greater number of sexual partners in the last 3 months. Among transgender women who had not done SW, greater number of sexual partners in the last 3 months and self-reported STIs were associated with hrHPV. Conclusions: Prevalence of anal infection with hrHPV was high among transgender women. Our results support that other sexual behaviors different from participating in SW contribute to the high prevalence of HPV and that there is an urgent need to include all transgender women in prevention programs for HPV and associated cancers, regardless of SW. Copyright 2021, Mary Ann Liebert, Inc., publishers.
Entities:
Keywords:
HPV; HPV screening; HPV vaccine; sex work; transgender women
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