Prevalence of hepatitis B and hepatitis C Virus infections among male to female (MFT) transgenders in Rawalpindi (Pakistan)
Abstract
Background: Transgenders are the individuals, who due to certain psychological or physical requirement mismatch with their naturally received genders. Among transgender types, male to female (MTF) transgenders are highly prevalent in Indo-Pak and are feared to be at high risk for sexually transmitted viral (human immunodeficiency virus HIV, hepatitis B virus HBV, hepatitis C virus HCV and Epstein Barr virus EBV) and bacterial diseases (gonorrhea, syphilis, campylobacter, chancroid, shigella, granuloma inguinale and chlamydia). This sensitive issue, therefore, requires more attention of researchers, policy-makers, and non-governmental organizations (NGOs) in Pakistan.
Methods: Prevalence of HCV and HBV infection was studied in 306 transgender males with a median age of 29 years (range 15-64years) living in Rawalpindi, Pakistan. Molecular techniques such as ELISA and Nested PCR were performed to confirm the presence of the both viruses in each sample of subjects. Furthermore, logistic regression and chi-square test were used for statistical analysis.
Results: This study showed that occurrence of HCV infection was predominant among the studied group; whereas presence of HBV was insignificant and was not included for statistical analysis. PCR confirmed that 25.5% of the test group was HCV positive, with the highest percentage (83.33 %) of HCV positive among the individuals who claimed safe sex practices and had knowledge about the medical condition of their partners. 34.61% of the transgender men who shave outside their homes, were found to be HCV positive.
Conclusion: In light of these statistics, ignoring this threat could be dangerous not only for the transgender community but also for the society, in general.
Full Text:
PDFReferences
Shepard CW, Finelli L, Alter MJ. Global epidemiology of hepatitis C virus infection. Lancet Infectious Diseases, (2005); 5(9): 558-567.
Bowen DG, Walker CM. The origin of quasispecies: cause or consequence of chronic hepatitis C viral infection? Journal of Hepatology, (2005); 42(3): 408-417.
Lauer GM, Walker BD. Hepatitis C virus infection. New England Journal of Medicine, (2001); 345(1): 41-52.
Kao JH, Chen PJ, Lai MY, Chen DS. Occult hepatitis B virus infection and clinical outcomes of patients with chronic hepatitis C. Journal of Clinical Microbiology, (2002); 40(11): 4068-4071.
Purow DB, Jacobson IM. Slowing the progression of chronic hepatitis B. Early antiviral therapy can help minimize complications. Postgraduate Medicine, (2003); 114(1): 65-68, 73-66.
Baig S, Siddiqui AA, Ahmed W, Qureshi H, Arif A. The association of complex liver disorders with HBV genotypes prevalent in Pakistan. Virology Journal, (2007); 4: 128.
Khichi GQK CM. Prevalence of hepatitis B carriers among children in Bahawalpur urban slums. Pakistan Journal of Medical Sciences, (2000); 16(4): 238-241.
Khattak MF, Salamat N, Bhatti FA, Qureshi TZ. Seroprevalence of hepatitis B, C and HIV in blood donors in northern Pakistan. Journal of Pakistan Medical Association, (2002); 52(9): 398-402.
Nwokediuko S. Seroprevalence of Hepatitis C virus antibody in public servants of Enugu state of Nigeria. Journal of College of Medicine, (2010); 15(1): 40-43.
Ali NS, Jamal K, Qureshi R. Hepatitis B vaccination status and identification of risk factors for hepatitis B in health care workers. Journal of the College of Physicians and Surgeons Pakistan, (2005); 15(5): 257-260.
Luby SP, Qamruddin K, Shah AA, Omair A, Pahsa O, et al. The relationship between therapeutic injections and high prevalence of hepatitis C infection in Hafizabad, Pakistan. Epidemiology Infections, (1997); 119(3): 349-356.
Aziz H, Raza A, Murtaza S, Waheed Y, Khalid A, et al. Molecular epidemiology of hepatitis C virus genotypes in different geographical regions of Punjab Province in Pakistan and a phylogenetic analysis. International Journal of Infectious Diseases, (2013); 17(4): e247-253.
Ahmed F, Irving WL, Anwar M, Myles P, Neal KR. Prevalence and risk factors for hepatitis C virus infection in Kech District, Balochistan, Pakistan: most infections remain unexplained. A cross-sectional study. Epidemiology Infections, (2012); 140(4): 716-723.
Basu D, Kumar V, Sharma AK, Barnwal PK, Mattoo SK. Seroprevalence of anti-hepatitis C virus (anti-HCV) antibody and HCV-related risk in injecting drug users in northern India: comparison with non-injecting drug users. Asian Journal of Psychiatry, (2013); 6(1): 52-55.
Sood A, Sarin SK, Midha V, Hissar S, Sood N, et al. Prevalence of hepatitis C virus in a selected geographical area of northern India: a population based survey. Indian Journal of Gastroenterology, (2012); 31(5): 232-236.
Sarma MP, Asim M, Medhi S, Bharathi T, Kar P. Hepatitis C virus related hepatocellular carcinoma: a case control study from Indian Journal of Medical Virology, (2012); 84(7): 1009-1017.
Sood A, Midha V, Bansal M, Sood N, Puri S, et al. Perinatal transmission of hepatitis C virus in northern India. Indian Journal of Gastroenterology, (2012); 31(1): 27-29.
Ott JJ, Stevens GA, Groeger J, Wiersma ST. Global epidemiology of hepatitis B virus infection: new estimates of age-specific HBsAg seroprevalence and endemicity. Vaccine, (2012); 30(12): 2212-2219.
Firnhaber C, Chen CY, Evans D, Maskew M, Schulz D, et al. Prevalence of hepatitis B virus (HBV) co-infection in HBV serologically-negative South African HIV patients and retrospective evaluation of the clinical course of mono- and co-infection. International Journal of Infectious Diseases, (2012); 16(4): e268-272.
Khuwaja AK, Qureshi R, Fatmi Z. Knowledge about hepatitis B and C among patients attending family medicine clinics in Karachi. Eastern Mediterranean Health Journal, (2002); 8(6): 787-793.
Kane A, Lloyd J, Zaffran M, Simonsen L, Kane M. Transmission of hepatitis B, hepatitis C and human immunodeficiency viruses through unsafe injections in the developing world: model-based regional estimates. Bull World Health Organ, (1999); 77(10): 801-807.
Alberti A, Pontisso P, Chemello L, Fattovich G, Benvegnu L, et al. The interaction between hepatitis B virus and hepatitis C virus in acute and chronic liver disease. Journal of Hepatology, (1995); 22(1 Suppl): 38-41.
Rajabali A, Khan S, Warraich HJ, Khanani MR, Ali SH. HIV and homosexuality in Pakistan. Lancet Infectious Diseases, (2008); 8(8): 511-515.
Raimondo G, Saitta C. Treatment of the hepatitis B virus and hepatitis C virus co-infection: still a challenge for the hepatologist. Journal of Hepatology, (2008); 49(5): 677-679.
Lehman EM, Wilson ML. Epidemic hepatitis C virus infection in Egypt: estimates of past incidence and future morbidity and mortality. Journal of Viral Hepatitis, (2009); 16(9): 650-658.
Khan S, Rai MA, Khanani MR, Khan MN, Ali SH. HIV-1 subtype A infection in a community of intravenous drug users in Pakistan. BMC Infectious Diseases, (2006); 6164.
Naeem MA WUZT, Usman M and Sabeen K. Seroprevalence And Demography Of Hepatitis B And C Among Healthy Young Males Of Northern Areas Of Pakistan. International journal of pathology, (2008); 1(1).
Mohd Hanafiah K, Groeger J, Flaxman AD, Wiersma ST. Global epidemiology of hepatitis C virus infection: New estimates of age-specific antibody to HCV seroprevalence. Hepatology, (2013); 57(4): 1333-1342.
Sievert W, Altraif I, Razavi HA, Abdo A, Ahmed EA, et al. A systematic review of hepatitis C virus epidemiology in Asia, Australia and Egypt. Liver International, (2011); 31 Suppl 261-80.
Nguyen LH, Nguyen MH. Systematic review: Asian patients with chronic hepatitis C infection. Alimentary Pharmacology & Therapeutics, (2013).
Randriamanantany ZA, Rajaonatahina DH, Razafimanantsoa FE, Rasamindrakotroka MT, Andriamahenina R, et al. Prevalence and trends of hepatitis C virus among blood donors in Antananarivo, from 2003 to 2009. Transfusion Clinical Biology, (2012); 19(2): 52-56.
Gutierrez Domingo I, Pascasio Acevedo JM, Alcalde Vargas A, Ramos Cuadra A, Ferrer Rios MT, et al. Prevalence of hepatitis B and A virus markers and vaccination indication in cirrhotic patients evaluated for liver transplantation in Spain. Transplantation Proceedings, (2012); 44(6): 1502-1504.
Morris MD, Shiboski S, Bruneau J, Hahn JA, Hellard M, et al. Geographic Differences in Temporal Incidence Trends of Hepatitis C Virus Infection Among People Who Inject Drugs: The InC3 Collaboration. Clinical Infectious Diseases, (2017); 64(7): 860-869.
Pinto RM, Melendez RM, Spector AY. Male-to-Female Transgender Individuals Building Social Support and Capital From Within a Gender-Focused Network. Journal of Gay & Lesbian Society Services, (2008); 20(3): 203-220.
Ramirez-Valles J, Garcia D, Campbell RT, Diaz RM, Heckathorn DD. HIV infection, sexual risk behavior, and substance use among Latino gay and bisexual men and transgender persons. American Journal of Public Health, (2008); 98(6): 1036-1042.
Mayer KH, Bradford JB, Makadon HJ, Stall R, Goldhammer H, et al. Sexual and gender minority health: what we know and what needs to be done. American Journal of Public Health, (2008); 98(6): 989-995.
Herbst JH, Jacobs ED, Finlayson TJ, McKleroy VS, Neumann MS, et al. Estimating HIV prevalence and risk behaviors of transgender persons in the United States: a systematic review. AIDS Behaviour, (2008); 12(1): 1-17.
Chakrapani V, Newman PA, Shunmugam M, Dubrow R. Barriers to free antiretroviral treatment access among kothi-identified men who have sex with men and aravanis (transgender women) in Chennai, India. AIDS Care, (2011); 23(12): 1687-1694.
Sahastrabuddhe S, Gupta A, Stuart E, Godbole S, Ghate M, et al. Sexually transmitted infections and risk behaviors among transgender persons (Hijras) of Pune, India. Journal of Acquired Immune Deficiency Syndrome, (2012); 59(1): 72-78.
Gupte S, Daly C, Agarwal V, Gaikwad SB, George B. Introduction of rapid tests for large-scale syphilis screening among female, male, and transgender sex workers in Mumbai, Indian Journal of Sexually Transmitted Diseases (2011); 38(6): 499-502.
Raj A, Saggurti N, Cheng DM, Dasgupta A, Bridden C, et al. Transactional sex risk and STI among HIV-infected female sex workers and HIV-infected male clients of FSWs in India. AIDS Care, (2011); 23(11): 1374-1381.
Lipovsek V, Mukherjee A, Navin D, Marjara P, Sharma A, et al. Increases in self-reported consistent condom use among male clients of female sex workers following exposure to an integrated behaviour change programme in four states in southern India. Sexually Transmitted Infections, (2010); 86 Suppl 1i25-32.
Bakshi S. A comparative analysis of hijras and drag queens: the subversive possibilities and limits of parading effeminacy and negotiating masculinity. Journal of Homosexuality, (2004); 46(3-4): 211-223.
Hawkes S, Collumbien M, Platt L, Lalji N, Rizvi N, et al. HIV and other sexually transmitted infections among men, transgenders and women selling sex in two cities in Pakistan: a cross-sectional prevalence survey. Sexually Transmitted Infections, (2009); 85 Suppl 2ii8-16.
Platt L, Vickerman P, Collumbien M, Hasan S, Lalji N, et al. Prevalence of HIV, HCV and sexually transmitted infections among injecting drug users in Rawalpindi and Abbottabad, Pakistan: evidence for an emerging injection-related HIV epidemic. Sexually Transmitted Infections, (2009); 85 Suppl 2ii17-22.
Khan S KT (2002) Pakistan enhanced HIV/AIDS program: social assessment and mapping of men who have sex with men (MSM) in Lahore, Pakistan. In: International NF, editor. 1 ed. London. pp. 31.
Phillips AE, Molitor J, Boily MC, Lowndes CM, Gurav K, et al. Informal confidential voting interviewing in a sexual risk assessment of men who have sex with men (MSM) and transgenders (hijra) in Bangalore, India. Sexually Transmitted Infections, (2013); 89(3): 245-50.
Rizwan Hashim ABH, Khalil ur Rehman. Seroprevalence of Hepatitis-C Virus Antibodies Among Healthy Young Men in Pakistan. Pakistan Journal of Medical Research, (2005); 44(4): 140-142.
Afridi SQ, Zahid MN, Shabbir MZ, Hussain Z, Mukhtar N, et al. Prevalence of HCV genotypes in district Mardan. Virology Journal, (2013); 10(1): 90.
Lavanchy D. The global burden of hepatitis C. Liver International, (2009); 29 Suppl 174-81.
Idrees M, Riazuddin S. Frequency distribution of hepatitis C virus genotypes in different geographical regions of Pakistan and their possible routes of transmission. BMC Infectious Diseases, (2008); 8: 69.
Tariq WU, Hussain AB, Karamat KA, Ghani E, Hussain T, et al. Demographic aspects of hepatitis C in northern Pakistan. Journal of Pakistan Medical Association, (1999); 49(8): 198-201.
Khan AJ, Luby SP, Fikree F, Karim A, Obaid S, et al. Unsafe injections and the transmission of hepatitis B and C in a periurban community in Pakistan. Bulletin World Health Organization, (2000); 78(8): 956-963.
Butt G, Paterson BL, McGuinness LK. Living with the stigma of hepatitis C. Western Journal of Nursing Research, (2008); 30(2): 204-221.
Muhammad Umar MB. Hepatitis C, A Mega Menace: A Pakistani Perspective. Journal of poineering medical sciences, (2012); 2(2): 68-72.
Chaudhary IAS, Khan SS, Masood R, Sardar MA, Mallhi AA. Seroprevalence of Hepatitis B and C among the healthy blood donors at Fauji Foundation Hospital, Rawalpindi. Pak J Med Sci (2007); 23(1): 64-67.
(2010) Hepatitis control plan entering second phase. The Express Tribune. 23rd October ed. Pakistan.
Collumbien M, Qureshi AA, Mayhew SH, Rizvi N, Rabbani A, et al. Understanding the context of male and transgender sex work using peer ethnography. Sexually Transmitted Infections, (2009); 85 Suppl 2ii3-7.
Zaheer HA, Hawkes S, Buse K, O'Dwyer M. STIs and HIV in Pakistan: from analysis to action. Sexually Transmitted Infections, (2009); 85 Suppl 2ii1-2.
Mayhew S, Collumbien M, Qureshi A, Platt L, Rafiq N, et al. Protecting the unprotected: mixed-method research on drug use, sex work and rights in Pakistan's fight against HIV/AIDS. Sexually Transmitted Infections, (2009); 85 Suppl 2ii31-36.
Baqi S, Shah SA, Baig MA, Mujeeb SA, Memon A. Seroprevalence of HIV, HBV, and syphilis and associated risk behaviours in male transvestites (Hijras) in Karachi, Pakistan. International Journal of STD & AIDS, (1999); 10(5): 300-304.
Lubis I, Master J, Munif A, Iskandar N, Bambang M, et al. Second report of AIDS related attitudes and sexual practices of the Jakarta Waria (male transvestites) in 1995. Southeast Asian Journal of Tropical Medicine and Public Health, (1997); 28(3): 525-529.
Jenkins C (2004) Male Sexuality, Diversity and Culture: Implications for HIV prevention and care, Geneva. USA: UNAIDS.
Akhtar H, Badshah Y, Akhtar S, Kanwal N, Akhtar MN, et al. Prevalence of human immunodeficiency virus infection among transgender men in Rawalpindi (Pakistan). Virology Journal, (2012); 9229.
Banerjee SC, Ostroff JS, Bari S, D'Agostino TA, Khera M, et al. Gutka and Tambaku Paan Use Among South Asian Immigrants: A Focus Group Study. Journal of Immigrant and Minority Health, (2014); 16: 531-539.
Changrani J, Gany F. Paan and Gutka in the United States: an emerging threat. Journal of Immigrant and Minority Health, (2005); 7(2): 103-108.
Ahmad W, Ijaz B, Javed FT, Jahan S, Shahid I, et al. HCV genotype distribution and possible transmission risks in Lahore, Pakistan. World Journal of Gastroenterology, (2010); 16(34): 4321-4328.
Hyder Q, Burhan-ul-Haq M, Rashid R, Qazi S, Mehmood S, et al. Non-conventional transmission of hepatitis C: a true possibility ignored. Journal of Pakistan Medical Association, (2009); 59(7): 430-433.
( 2008) SPSS 16.0 for Windows. SPSS Inc. Chicago.
Clements-Nolle K, Guzman R, Harris SG. Sex trade in a male-to-female transgender population: psychosocial correlates of inconsistent condom use. Sex Health, (2008); 5(1): 49-54.
Lemon SM. Current status of antiviral therapy for chronic hepatitis C. Advances in Experimental Medicine and Biology, (1999); 45: 829-37.
Laxmi T GS, Payal K, Revati, Priya B, Jeeva R, Amitava S, Agniva L, Anindya H, Laxmi Bai, Pramod, Simran S, Abhina A, Rajan K, Sanjeev J, Mridu M, Govind B, J K Mishra, Ernest N (2011) Transgender – Hijra strategy. India: NACO, NACP IV working groups Hijras TG. pp. 1-16.
Perappadan BS (2012) Erasing the stigma of HIV.
Waheed Y, Safi SZ, Qadri I. Role of Potash Alum in hepatitis C virus transmission at barber's shop. Virology Journal, (2011); 8: 211.
THE DENTAL PANORAMA (2011). Smilekraft. India: Dental Clinic & Dental Hospital Chain, Delhi, Bangalore, Hyderabad, India.
DOI: http://dx.doi.org/10.62940/als.v5i2.368
Refbacks
- There are currently no refbacks.