Prevention of HBV Exposure and Infection among Gay Men and other Men who have Sex with Men (MSM)

Abstract

It is a well-known fact that around 20 to 25% of new hepatitis B cases occur among men who have sexual intercourse with other men (MSM), whether they identify as gay or not. This excessive burden is related to several situations that require to be urgently addressed. Among the most important: i. The high viral load of HBV in semen among chronic carriers; ii. The very poor efforts undertaken by health authorities, institutions and organizations to raise awareness about the existence and severity of the problem among MSM populations and groups (gay, bisexual, or self-identified as heterosexuals with sexual intercourse with other men); iii. The possibility of frequent exposure can be associated to greater odds of acquiring HBV and of developing chronic infection and iv. The insufficient commitment and resources allocated to facilitate access to HBV vaccination by MSM. Background: Hepatitis B virus is shed in the semen of chronic surface antigen (HBsAg) carriers as DNA viral particles. Since HBV is a very infectious agent, exposure to this agent may result in an efficient transmission and further spreading of the infection. Although most people who have acquired the infection will clear the virus without any medical intervention, it is estimated that between 5 to 10% will progress to chronic infection. Chronic infection is associated to health conditions that vary in severity from long-term hepatitis to fulminant hepatic failure and/or hepatic cancer. The disproportionate toll of HBV infection MSM echoes the also disproportionate toll of the HIV epidemic among this population that encompasses diverse groups and subpopulations. Given that co-infection with HBV and HIV may result in complex situations with negative public health and clinical outcomes. Thus, efforts to promote primary prevention of infection with both agents, reduction of incidence of co-infections, and active detection of the presence of HIV and HBV are of paramount importance.1 While HIV is a rather well-known topic within the MSM communities and groups, there seems to be a diminished awareness about HBV (and other viral hepatitis) infections. Knowledge about HBV infection and strategies and practices to prevent or keep it under clinical control by gay men and other MSM doesn´t seem to have been deeply investigated. At least not in developing countries. In areas where hepatitis A is endemic, many people may assume that other hepatitis can be cleared by the system spontaneously as it does with HAV. Many MSM may even ignore that HAV is transmitted by contact with contaminated fecal residues and give little or no importance to sexual practices that involve exposure to feces. In conversations with gay men in Brazil, they describe the practice of “writing a check”, which is the withdrawal of a feces-covered penis from the anus of the receptive partner. Since this practice does not necessarily entails using a condom it may happen that the receptive partner passes HAV in his fecal particles while the penetrator transmits HBV in his sperm. In courses and seminars about health care for gay men, the topic of viral hepatitis arises as a big surprise for many members of the audiences. Yet, nothing can be said until the level of awareness and knowledge is more systematically quantified.2