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Evaluating sexual health in sex workers and men who have sex with men: the SMESH cross-sectional protocol study
  1. Eliana Marcia Wendland1,2,
  2. Marina Bessel1,
  3. Juliana Comerlato1,
  4. Jaqueline Driemeyer Correia Horvath1,
  5. Frederico Falcetta1,
  6. Gerson Fernando Mendes Pereira3,
  7. Flávia Moreno Alves de Souza3,
  8. Carla Domingues4,
  9. Ana Goretti Kalume Maranhão4,
  10. Natalia Luiza Kops1
  1. 1Escritório de Projetos PROADI-SUS, Hospital Moinhos de Vento, Porto Alegre, Rio Grande do Sul, Brazil
  2. 2Department of Public Health, Universidade Federal de Ciencias da Saude de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
  3. 3Department of STIs, AIDS and Viral Hepatitis, Ministry of Health, Brasilia, DF, Brazil
  4. 4National Immunization Program, Ministry of Health, Brasilia, DF, Brazil
  1. Correspondence to Dr Eliana Marcia Wendland; elianawend{at}


Introduction Human papillomavirus (HPV) infection is transmitted through skin-to-skin contact, and vaginal and anal sex are the most common transmission routes. Sex workers and men who have sex with men (MSM) are more exposed to the virus, and therefore, a higher frequency of this infection would be expected. The prevalence of HPV infection types and the forms and factors of transmission must be investigated to control infection-related outcomes. This protocol study will be the first nationwide study with a uniform methodology to evaluate HPV prevalence of and infection types among sex workers and MSM in Brazil.

Methods and analysis This multicentre cross-sectional study will be conducted with a respondent-driven sampling method to recruit 1174 sex workers and 1198 MSM from all regions of Brazil. The study will consist of preliminary interviews to verify the eligibility criteria and characterise the network size as well as a second questionnaire to obtain sociodemographic, behavioural and sexual information. Specimens from the oral cavity and anal and cervical or penile/scrotal sites will be collected. All HPV samples will be processed in a certified central laboratory. Other sexually transmitted infections will be evaluated by interview and by rapid testing for HIV and syphilis. Strict quality control will be conducted using different procedures, including the training and certification of the health professionals responsible for acquiring data and monitoring visits.

Ethics and dissemination The project was approved by the research ethics committee of the main institution and the corresponding ethics committees of the recruitment sites. Due to the literature gap on the sexual health of sex workers and MSM and the intense stigma surrounding these populations, a critical analysis of the study results will contribute to epidemiological knowledge and will be useful for the development of strategies against virus morbidities.

  • papillomavirus infections
  • sex workers
  • men who have sex with men
  • sexually transmitted diseases
  • syphilis
  • HIV infections

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  • Contributors EMW conceived the project and participated in all phases of the manuscript preparation; NLK, MB, JDCH and FF participated in the protocol development and helped write the manuscript; MB participated in the data analyses and statistics; JC participated in the laboratory protocol development. All authors reviewed the final version of the manuscript, with GFMP, FMAdS, CD and AGKM primarily responsible for revising the drafts for publication. The corresponding author had full access to all data in the study and had the final responsibility for the decision to submit the study publication.

  • Funding This work is financed by Hospital Moinhos de Vento through the Institutional Development Support Program of the Brazilian National Health System (PROADI-SUS), supported by the Ministry of Health of Brazil.

  • Disclaimer The funders of the study had no role in the study design, data collection, data analysis, data interpretation or report writing.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval This project was approved by the research ethics committee of the proposing institution (Hospital Moinhos de Vento, number 2.837.840).

  • Provenance and peer review Not commissioned; externally peer reviewed.

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