HIV, hepatitis B, and hepatitis C prevalence and associated risk behaviors among female sex workers in three Afghan cities

Abstract

Objective: To assess prevalence of HIV, syphilis, and hepatitis B (HBV) and C virus (HCV) and associated risk behaviors among female sex workers (FSWs) in three Afghan cities.

Design: Cross-sectional prevalence assessment.

Methods: Consented FSWs from Jalalabad, Kabul, and Mazar-i-Sharif completed an interviewer-administered questionnaire, pretest and posttest counseling, and rapid and confirmatory testing for HIV, HCV, HBV, and syphilis. Logistic regression was used to detect correlates associated with HBV infection.

Results: Of 520 participants, median age and age of initiating sex work were 29 and 23 years, respectively, and the median number of monthly clients was 12. Few FSWs reported ever having used illicit drugs (6.9%) or alcohol (4.7%). Demographic and risk behaviors varied significantly by enrollment site, with Kabul FSWs more likely to report sexually transmitted infection symptoms, longer sex work duration, and sex work in other cities. Prevalence of HIV was 0.19%, HCV was 1.92%, and HBV was 6.54%, with no cases of syphilis detected. HBV was independently associated with at least 12 clients monthly [adjusted odds ratio (AOR) = 3.15, 95% confidence interval (CI) 1.38-7.17], ever using alcohol (AOR = 2.61, 95%CI 1.45-4.69), anal sex (AOR = 2.42, 95%CI 1.15-5.08), and having children (AOR = 2.12, 95%CI 1.72-2.63) in site-controlled multivariable analysis.

Conclusion: Although prevalence of HIV, HCV, and syphilis is currently low in these three Afghan cities, risky sexual practices were common and associated with HBV. Programming inclusive of voluntary testing for HIV, viral hepatitis, and sexually transmitted infections, hepatitis vaccination, substance abuse prevention, and condom promotion for both FSWs and clients should be pursued in Afghanistan.