Globally the prevalence of HBV infection can be divided into high (> 8%), intermediate (2–8%) and low (< 2%). Hence as the prevalence of HBV among Female sex workers in this study area found to be 9.2%, the prevalence is labeled as high occurrence.
This study revealed that the overall prevalence of HBV among female sex workers in hawass city was 9.2% (CI: 95% 6.3–12.1). This is lower than the study conducted in Gondar which was 11.9%, 5 Nigeria 17.1%, 8 Cameroon 36%, 15 Argentina 14.4%,16Shanghai, China 12.3%, 17 in Goiânia, Brazil 17.1% 18 and Southern Brazil 23.1%. 19 On the other hand this study is higher than the study conducted in Mekelle, Ethiopia 6%, 6 Iran 1.2%, 20 Rwanda 2.5%, 21 Congo 7.3%, 7 Italy 3.5%, 22 Venezuela 3.8%, 23 and Afghanistan 6.54%. 11 This variation of findings across various studies might be due to diagnostic tools and reporting biases, differences in socio-demographic, differences in socio economic environments. Prevalence estimates also are likely to be influenced by stigma and discrimination and also study settings. Also unemployment status of the females might be enforced to engage in risky sexual services. 11 Also, the history of previous vaccination, high prevalence of HBV among general population, use of illegal injecting drugs, consumption of alcohol, breaking of the condom during sex, a long period of prostitute engagement, anal sex and the presence of other sexual transmitted infections among female sex workers may be contributed. 24,25
The major determinants of HBV were, low adherence to the condom use, history of genital ulcer, history of sexual transmitted infections, sexes during menses, sexual assault and shared use of sharp materials were statistically significant (p < 0.05). This is similar to the study conducted in Nigeria. 8
In agreement with WHO, 2014 Prevention and Treatment of HIV and other Sexually Transmitted Infections for Sex Workers in Low and Middle-income Countries and studies result from Teresina-PI, Northeastern Brazil, India and Afghanistan 26–29 this study indicated number of clients (> 5 clients (sexual partner) per week) significantly associated with HBV [AOR = 3.25, (1.59,7.47)]. The possible explanation may be multiple clients produce greater vulnerability to risks for low adherence to the use of condoms in all sexual relations. Also, clients of sex workers may practice risky behaviors like injectable drug use etc., thus increase the risk of acquiring STIs including hepatitis B virus.
Studies indicated that History of STI were predictors of exposure to HBV. 18,20,30 Consistently, result of this study reflected the odds of participants who have history of STI which were more than 2 times to be positive as compared with participants who don’t have [AOR = 2.15, (1.02,6.93)]. The most common history of STI was Neisseria gonorrhea and syphilis. Also genital ulcers were seen among 27.6% participants. These infections can cause inflammation and ulcer around the genital area. Thus, it may increase the risk of becoming infected with HBV.
In this study, educational status, history of blood transfusion and alcohol consumption were not statically significant association with HBV as other studies done in Teresina-PI, Northeastern Brazil among sex workers, in three Afghan cities among female sex workers, in Mekelle among commercial sex workers and in Tehran, Iran among female sex workers found out. 6,9,20,27,28
Even though the female sex workers who did not vaccinated previously for HBV were more in number for HBV infection than those who vaccinated, there is no statistical significant association in this study. However, similar studies were done in Argentina shown that none vaccinated people developed HBV infection more likely than vaccinated peoples.16 This indicates that vaccination is one of the prevention mechanisms of HBV infection.
According to this study, those who have previous sexual transmitted infection especially syphilis were statistically significant with the infection of HBV which is similar to the study done in, Iran and other different countries.18, 20, 30 Also Female sex workers who are not avoiding sex during menses were more than five times affected by HBV infection which is inconsistent with the study of Mekelle, Ethiopia. 6 This study also showed that previous sexual assaulted female sex workers had more than two times the probability to develop HBV infection than those of not harassed. This correlates with studies from North America and South Africa have shown that women who have experienced sexual abuse are more likely to acquire HBV infection. 12,13
As study done in Northeastern Brazil 27 sharing of sharp materials for tattooing and another purpose is significantly influencing HBV infection among female sex workers (p < 0.05) in this study area. Also history of genital ulcer and the habit of unsafe abortion was statistically significant among female sex workers to acquire HBV. 18
Also, age, marital status, residence, monthly income, presence of steady partners, and type of sex usually used has no statistically significant association in this study area. This is similar to the study of Mekelle, Ethiopia. 6,18