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Parenteral exposure is a well established risk factor for hepatits C virus (HCV) infection.1,2 However, the role of the sexual route in the transmission of hepatitis C has remained controversial.3 There are few studies carried out to evaluate these high risk groups in Iran. We conducted this study to survey the distribution of HCV infection as well as HBV and HIV infection in a female population with “illegal social behaviour.”
We surveyed 196 females arrested by the police force in an analytical cross sectional study during the summer of 2002. They were mostly suspected of drug addiction, drug dealing, prostitution, and vagrancy. It was emphatically stated that there would be no additional penalty if anyone among the study population was not cooperative. Ten cases out of 206 females who had been initially selected for the study refused to partake in the study. Another 196 females gave written informed consent. All individuals were asked about potential risk factors of blood borne virus’ acquisition in a voluntary interview. Then all were screened for anti-HCV antibody, HBsAg, and anti-HIV antibody.
Their mean age was 29.3 (SE 0.7) years. There was a history of prostitution in 79.0%, non-injecting drug use (IDU) in 15.3% and IDU in 2.0%. A total of six HCV positive cases (3.1%) and three HBsAg positive cases (1.5%) were found. There were no HIV positive cases. HCV prevalence was significantly higher in individuals with history of non-IDU and IDU (p = 0.01 and p = 0.005, respectively). Out of 149 sex workers, with the mean period of prostitution was 11.3 (SE 1.7) months; four cases (2.7%, 95% CI: 0.7 to 3.4) were HCV positive and one case (0.7%, 95% CI: 0 to 1.7) was HBsAg positive. There was no sexual contact related variable significantly associated with HCV seropositivity in the sex worker population (table 1). Only one of these four cases who were anti-HCV Ab positive had a history of non-IDU, and none of them had a history of IDU.
Although we have been unable to ascertain the source of the HCV positivity in these women with multiple sexual exposures, it seems that promiscuity is not an important risk factor for hepatitis C because of the low HCV prevalence rate in general population in Iran (0.12%),2 the low rate of promiscuity in Iran because of religion (Islamic) and social culture, the low mean period of prostituting in our study sample, or the regular use of condoms in almost all of the study population. However, it may be also be because of the low infectivity of HCV in heterosexual intercourse. Moreover, in our study, none of HCV positive cases in the sex worker population study had a history of IDU while many of the studies failed to carefully exclude HCV acquisition from non-sexual sources.4–6 However, IDU is a much more significant risk factor for HCV infection than extramarital sexual contact in Iran. Therefore, screening for HCV infection is advocated in injecting drug users in order to prevent the spread of HCV.
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