Oral human papillomavirus prevalence in Brazilian sex workers

OBJECTIVES: To estimate the prevalence of oncogenic oral HPV among sex workers in Brazil and examine socio-behavioral covariates. METHODS: A cross-sectional, multicenter study was conducted from 2019 to 2023 and recruited male and female sex workers from all Brazilian regions using respondent-driven sampling (RDS). Trained professionals conducted structured interviews assessing sociodemographic characteristics and sexual behaviors. Oral samples were tested for HPV genotypes using PCR-based methods. RDS-II estimation accounted for sampling design, with robust Poisson regression estimating crude and adjusted prevalence ratios. RESULTS: Most participants were female (84.2% [95% CI: 78.1-90.4]), worked in commercial sex for under 5 years (54.2% [48.3-60.2]), and reported consistent condom use (53.4% [47.3-59.6]). Among 940 participants, high-risk HPV prevalence was 7.2% (95% CI: 4.1-10.3), with significantly higher rates among sex workers in Central-west/Southeast/South regions (adjusted PR 4.39 [1.89-10.2]) and those with >15 weekly sexual partners (adjusted PR 4.11 [1.54-11.0]). CONCLUSION: Disparities in oral HPV prevalence among Brazilian sex workers suggest that structural and behavioral factors influence infection risk. These findings highlight the need for interventions tailored for this high-risk population, including HPV vaccination and sexual health education.