Acceptability of HPV vaccine and HPV prevalence among female sex workers in Lima, Peru

Objectives. While it may not be financially possible at this time to vaccinate all women in developing countries against HPV, a focus on high risk populations may be achievable, and may provide secondary protection to the general population. We examined sexual behaviors, cervical abnormalities, HPV prevalence and vaccine acceptability among female sex workers (FSWs).;Methods. Behavioral and vaccine knowledge data were collected from FSWs in Lima, Peru to determine their awareness of HPV, barriers to the acceptability of HPV vaccine, and sexual risk behaviors. HPV DNA testing was done on cervical and oral samples with Roche Linear Array. Pap smears were reported using the Bethesda system.;Results. FSWs were found to have low knowledge of HPV, HPV vaccine, and cervical cancer, but 97.5% wanted to receive HPV vaccine after being informed of cervical cancer. Participants reported a median of 120 clients for vaginal sex in the past month; 99.2% reported using condoms with clients and 29.7% used condoms with non paying sex partners. The prevalence of any HPV type in cervical samples was 65.8%; 34 (17.1%) participants had prevalent HPV 16 or 18, and 92 (46.2%) had a carcinogenic HPV type. Fifteen women had abnormal Pap smears. Fewer years since first sex was associated with oncogenic cervical HPV prevalence in a binary regression model adjusted for STD status in the past year and proportion of condom use with partners (PR=0.77, 95%CI=0.60--0.97). Overall oral HPV prevalence was 7.6%; with 28.9% of HPV genotypes detected being carcinogenic. Nearly all (N=182) participants reported having oral sex, with 95% reporting use of a condom with oral sex with clients and 9.5% using condoms for oral sex with partners.;Conclusions. FSWs in Peru have a high prevalence of cervical HPV in spite of reported high rates of condom use. The prevalence of oral HPV was relatively low given the high rates of oral sex practiced by these women. Cumulative HPV exposure is likely higher than the prevalence observed in our study, but could not be evaluated based on DNA detection methods. FSWs should be targeted for HPV education campaigns and barriers to vaccination, especially cost, need to be addressed to facilitate vaccination.