INTRODUCTION
Chronic viral hepatitis B is a global affliction that imposes a
significant economic and medical burden on society. The persistence of
HBV infection in some individuals may result in chronic hepatitis B,
which can progress to cirrhosis and even liver
cancer[1]. HBV and
hepatitis C virus (HCV) are the primary etiologic agents of liver cancer
and overall mortality. Despite the efforts of the US government to
combat HBV, a considerable number of individuals remain infected with
the virus[2,
3]. Between 2001 and 2016, an estimated
7.6 million US adults aged 20-59 years were afflicted with HBV
infection[4]. The
challenge of eradicating HBV is formidable.
HBV, an infectious disease, can be transmitted through multiple routes.
The primary mode of transmission is from mother to neonate. Contaminated
blood products also pose a risk for HBV transmission. Furthermore, drug
use and sexual behavior are significant routes of
transmission[5].
Sexual behavior is a prevalent biological phenomenon in human beings,
serving various purposes such as the perpetuation of offspring,
expression of emotions, and others. Within society, the majority of
individuals identify as sexually heterosexual, while a sexual minority
exists, including those who identify as homosexual or
bisexual[6].
Furthermore, individuals have explored alternative forms of sexual
activity, such as oral and anal sex, as a means of avoiding vaginal sex,
satisfying male pleasure, and preventing unwanted
pregnancy[7,
8]. However, sexual behavior may also
result in the transmission of various diseases, including HIV, HCV, HPV,
and other sexually transmitted
infections[9-11], as
well as certain cancers, such as anal cancer and cervical
cancer[7,
8, 12,
13].
The transmission of HBV through sexual activity has been firmly
established, particularly in the context of anal sex among homosexual
individuals[14-16].
The European Union has recognized men who have sex with men as a
high-risk population for HBV
infection[17].
However, limited research has been conducted on the relationship between
sexual identity/type and HBV infection among homosexual, bisexual, and
heterosexual individuals. It was the first study to research the
association between sexual behavior and HBV infection among US adults,
stratified by sexual identity/type.