{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T14:28:37Z","timestamp":1777904917617,"version":"3.51.4"},"reference-count":23,"publisher":"Public Library of Science (PLoS)","issue":"11","license":[{"start":{"date-parts":[[2025,11,19]],"date-time":"2025-11-19T00:00:00Z","timestamp":1763510400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100005564","name":"Gilead Sciences","doi-asserted-by":"publisher","award":["IN-EU-174-4402"],"award-info":[{"award-number":["IN-EU-174-4402"]}],"id":[{"id":"10.13039\/100005564","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>\n                      The most frequent transmission modes of blood-borne infections (BBI), including HIV, hepatitis B virus (HBV) and C (HCV), are well documented. South Africa, an HIV epicentre, with HBV endemicity and an additional HCV burden, raises the possibility of novel transmission means. A unique style of close shave haircut that can elicit\n                      <jats:italic>folliculitis keloidalis nuchea<\/jats:italic>\n                      (FKN), may produce bleeding during haircuts and possible BBI transmission. We designed a prospective case control study to evaluate the potential risk of BBI transmission.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Men with FKN and non-FKN controls were recruited from 2 centres in South Africa, Cape Town and Mthatha. The presence of FKN was diagnosed by a dermatologist and clinical photographs independently corroborated by 3 other dermatologists not involved in the study. A comprehensive confidential questionnaire was administered to each participant interrogating risk factors for potential HIV, HBV, and HCV infection. Each participant was screened for HIV 1\/2 (Alere Determine), HBsAg (Alere Determine) and HCV antibody (SD Bioline) using point of care tests. Positive HIV screens were confirmed with a second test, Vikia HIV 1\/2 test (bioMerieux). Logistic regression analysis adjusting for the relevant confounder was used to assess the associations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 1163 men, median age 33.4 years [IQR 27.8\u201342.0], were evaluated. Those who screened positive for any viral infections were significantly older than those who did not, 37.1 [IQR 31.0\u201344.4) vs. 32.3 [IQR 26.9\u201341.0] years, p\u2009&lt;\u20090.001, respectively. Overall, the seroprevalence of HIV, HBV, and HCV, was 17.2%, 6.9% and 0.4%, respectively. There was no significant difference in seroprevalence for these potential BBIs between those with FKN and without, p\u2009=\u20090.33, 0.66 and 0.29, respectively. For HIV co-infection with HBV and HCV, findings were similar, p\u2009=\u20090.64 and 0.51, respectively. When controlled for whether participants knowingly bleed during haircuts, HIV seropositivity was significantly more likely in those who regularly bleed, OR = 2.51 [95% CI 1.16\u20135.42], p\u2009=\u20090.02. Other transmission risk factors for HIV, were also significantly more likely \u2013 reported sexually transmitted genital lesions or discharge, aOR = 1.58 [95% CI 1.13\u20132.22], p\u2009=\u20090.01; and a tattoo\/piercing informally done, aOR = 1.84, [95% CI 1.13\u20132.22], p\u2009=\u20090.01. Similarly, although overall HCV seroprevalence was low, those HIV\/HCV co-infection was more likely in those who usually bleed with a haircut, aOR = 2.43; [95% CI 1.13\u20135.25]; p\u2009=\u20090.02, those with a sexually transmitted genital lesion or discharge, aOR = 1.58 [95% CI 1.13\u20132.21]; p\u2009=\u20090.01 and those with a tattoo\/piercing informally done, aOR = 1.85 [95% CI 1.27\u20132.72]; p\u2009&lt;\u20090.01. This was not so for HBV mono-infection, p\u2009=\u20090.89. Overall rates of known and recorded HBV vaccination in childhood were low, however in those with no viral infection, the rate of known vaccination was higher, 25.0% vs. 16.2%; p\u2009=\u20090.01 respectively.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Haircut related bleeding but not FKN was associated with a higher prevalence of HIV and HIV\/HCV co-infection. HBV risk was not increased and related to either vaccination and\/or dominant early childhood acquisition risk of HBV in sub-Saharan Africa. HIV and HBV prevalence remains concerningly high. Risk reduction through public education is key to prevention.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0336213","type":"journal-article","created":{"date-parts":[[2025,11,19]],"date-time":"2025-11-19T18:24:50Z","timestamp":1763576690000},"page":"e0336213","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":1,"title":["Scalp haircuts, keloids and blood-borne virus transmission risk in South Africa\u2014The SHAKA study"],"prefix":"10.1371","volume":"20","author":[{"given":"Nonhlanhla","family":"Khumalo","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Avumile","family":"Mankahla","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stephen","family":"Korsman","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Freedom","family":"Gumedze","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4006-1858","authenticated-orcid":true,"given":"Wisdom","family":"Basera","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anthia","family":"Ndyenga","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lwazi","family":"Mhlanti","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mashiko","family":"Setshedi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ruanne","family":"Barnabas","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"C. Wendy","family":"Spearman","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7128-8329","authenticated-orcid":true,"given":"Mark W.","family":"Sonderup","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2025,11,19]]},"reference":[{"key":"pone.0336213.ref001","unstructured":"UNAIDS. Global HIV Statistics. 2024. https:\/\/www.unaids.org\/sites\/default\/files\/media_asset\/UNAIDS_FactSheet_en.pdf"},{"issue":"10","key":"pone.0336213.ref002","doi-asserted-by":"crossref","first-page":"879","DOI":"10.1016\/S2468-1253(23)00197-8","article-title":"Global prevalence, cascade of care, and prophylaxis coverage of hepatitis B in 2022: a modelling study","volume":"8","author":"Polaris Observatory Collaborators","year":"2023","journal-title":"Lancet Gastroenterol Hepatol"},{"key":"pone.0336213.ref003","unstructured":"WHO. 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