Impact of sex work and behavior on the immunological milieu of young female sex workers in Mombasa, Kenya.

Thumbnail Image
Mwatelah, Ruth
Journal Title
Journal ISSN
Volume Title
HIV disproportionately affects adolescent girls and young women in Sub-saharan Africa and having a diverse microbiome has been associated with an increased risk of HIV acquisition. Among African women studies have shown that most women harbour diverse microbiome groups, and this is coupled by high recurrence rates even after successful treatment of BV. We hypothesize that sexual intercourse and sex work has a negative impact on the immunological and microbial milleu of the female genital tract and is associated with increased sexually transmitted infection risk in adolescent and young girls from Mombasa. Adolescent girls and young women were recruited from hotspot in Mombasa, Kenya and they self-triaged into 3 distinct groups using a triage questionnaire: Non-sex worker group, transactional group and female sex worker group. Cervicovaginal lavage and urine were collected from the study participants. The CVL sample was processed into a supernatant which was used to measure cytokines and soft cup pellet which was used to for microbiome sequencing and gene expression assays. The urine was used for qPCR of sexually transmitted infections. In the first sub study we analysed microbiome data for 168 samples and found that molecular-BV was common among the participants, and it was highly correlated with cytokines associated with increased risk of HIV acquisition (chapter 4). We further assessed cytokine receptor expression of the samples above and found that most receptors were downregulated especially those that contained diverse microbiome (chapter 5). In this chapter we further assessed whether there was a correlation between barrier marker E-cadherin and, receptors and epidemiological variables and found that participants in the female sex worker and transactional groups have lower levels of E-cadherin (p=0.015). A negative correlation was also observed between E-cadherin and some of the receptors; IL10RA (p=0.027, R= -0.259*), IL1RAP (p=0.046, R= -0.234*), GMCSFRA (p=0.023, R= -0.267*), IFNYR2 (p=0.013, R= -0.291*). In this cohort we found an interestingly low prevalence of sexually transmitted infections (Chapter 6) specifically Neisseria gonorrhea infections 0.5% (5). The most common STIs were Mycoplasma hominis 14.9% (114) and Ureaplasma urealyticum 18.9% (183) which are not classified as real STIs. When we further assessed whether having an STI or the combination of an STI and diverse microbiome has an impact on immune markers we found that the latter is associated with decreased expression of some receptors; CXCR1(p=0.012), GMCSFRA(p=0.045), IL2Rg (p=0.013), IFNyR2 (p=0.050) and CXCR3 (p=0.017). In conclusion, this study shows the importance of assessing behavior in studies that are focused in understanding the immunological and microbiological factors that contribute to the disparities of HIV infection especially among adolescent girls and young women.
Microbiome, Female genital tract, Sexually transmitted diseases, Cytokine receptor, Adolescent girls and young women