Epidemiology of HIV, syphilis, and hepatitis B and C among manual cane cutters in low-income regions of Brazil

• Published in: BMC infectious diseases Vol. 18; no. 1; p. 546
• Main Authors: de Castro Rocha, Déborah Ferreira Noronha, da Cunha Rosa, Luana Rocha, de Almeida Silva, Carla, de Oliveira, Brunna Rodrigues, Martins, Thaynara Lorrane Silva, Martins, Regina Maria Bringel, de Matos, Marcos André, Dos Santos Carneiro, Megmar Aparecida, Soares, Juliana Pontes, de Oliveira E Silva, Ana Cristina, de Souza, Márcia Maria, Cook, Robert L, Caetano, Karlla Antonieta Amorim, Teles, Sheila Araujo
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 03-11-2018; BioMed Central; BMC
• Subjects: Acquired immune deficiency syndrome; Adult; Adults; Agricultural laborers; AIDS; Alcohol; Alcoholic beverages; Antiviral agents; Brazil - epidemiology; Cross-Sectional Studies; Cutters; Demographic aspects; Diseases; Epidemics; Epidemiology; Farmers; Female; Hepatitis; Hepatitis B; Hepatitis B - epidemiology; Hepatitis B Antibodies - blood; Hepatitis B surface antigen; Hepatitis C; Hepatitis C - epidemiology; Hepatitis C Antibodies - blood; HIV; HIV Antibodies - blood; HIV infections; HIV Infections - epidemiology; Human immunodeficiency virus; Humans; Immunization; Infections; Low income groups; Male; Occupational health; Occupational safety; Odds Ratio; Population; Poverty areas; Prevalence; Reagents; Risk Factors; Risk taking; Rural areas; Rural population; Rural populations; Sexual Behavior; Sexual intercourse; Sexual partners; Sexually transmitted diseases; STD; Sugarcane; Syphilis; Syphilis - epidemiology; Vaccination; Vaccines; Viral hepatitis vaccines; Viruses; Workers; Working conditions; Brazil; Poverty areas; Sexually transmitted diseases; Viral hepatitis vaccines; Rural population
• ISSN: 1471-2334; 1471-2334
• DOI: 10.1186/s12879-018-3439-4

In recent decades the epidemic of asymptomatic sexually transmitted infections has extended deep into Brazil, including small towns and rural areas. The purpose of this study was to investigate the epidemiology of HIV, syphilis, and hepatitis B (HBV) and hepatitis C viruses (HCV), and to evaluate immunization coverage against hepatitis B in a group of rural workers in Brazil.
In 2016, a cross-sectional study was conducted with 937 manual sugarcane cutters of the Midwest and Northeast Regions of Brazil. All individuals were interviewed and screened for HIV, syphilis, HBV and HCV. Correlating factors with lifetime HBV infection were investigated using logistic regression. Positive Predictive Values, Negative Predictive Values, sensitivity and specificity were also calculated relative to vaccination against Hepatitis B, comparing anti-HBs titers to vaccination reports.
Most reported previous hospitalization (55%), occupational injuries (54%), sharing of personal items (45.8%), alcohol consumption (77.2%), multiple sexual partners in previous 12 months (39.8%), and no condom use during sexual intercourse in last 12 months (46.5%). Only 0.2% reported using injection drugs. Anti-HIV-1 was detected in three individuals (0.3%). Serological markers of lifetime syphilis (treponemal test) were detected in 2.5% (95% CI: 1.6-3.6) of participants, and active syphilis (treponemal test and VDRL) present in 1.2%. No samples were positive for anti-HCV. The prevalence of lifetime HBV infection (current or past infection) was 15.9%, and 0.7% (95% CI 0.4 to 1.5) were HBsAg-positive. Previous hospitalization (OR 1.53, CI 1.05-2.24, p < 0.01) and multiple sexual partners in the last 12 months (OR 1.80, CI 1.25-2.60, p < 0.01) were predictors for lifetime HBV infection. Although 46.7% (95% CI 43.4-49.9) of individuals reported having been vaccinated against hepatitis B, only 20.6% (95% CI 18.1-23.3) showed serological evidence of previous hepatitis B vaccination (positive for anti-HBs alone).
The high prevalence of syphilis and HBV compared to the general population and the high frequency of risk behaviors show the potential for sexual and parenteral dissemination of these agents in this rural population. In addition, the low frequency of hepatitis B vaccinated individuals suggests a need for improved vaccination services.