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.