High Prevalence of Sexually Transmitted Infections, and High-Risk Sexual Behaviors Among Indigenous Adolescents of the Comarca Ngäbe-Buglé, Panama

Abstract

Background There is scant information on sexually transmitted infection (STI) prevalence and risk factors among Latin American indigenous populations. We investigated STI prevalence and risk factors among adolescents of the Comarca Ngäbe-Buglé indigenous region of Panama. Methods A population-based cross-sectional study was conducted among school-going adolescents aged 14 to 19 years. Eligible consenting participants self-completed a questionnaire and provided blood and urine samples. Female participants provided additional self-administered genital swabs. Seroprevalences of human immunodeficiency virus (HIV), syphilis, hepatitis B (HBsAg, anti-HBc), and herpes simplex virus type 2 (HSV-2) were determined in all participants; genital Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) by PCR among participants who reported sexual experience or were seropositive for HIV/syphilis/HSV2/HBsAg; high-risk human papillomavirus (HPV) by qualitative DNA assay and bacterial vaginosis (BV) by Gram-stain among female participants. Risk factors were identified by estimating adjusted odds ratios (AOR) using random-effects logistic regression. Results We enrolled 700 participants (median age, 17 years [female participants]; 18 years [male participants]) from 20 schools. Sexual experience was reported by 536 participants (76.6%). The HIV/STI prevalences among females and males were: HIV 0.4% and 1.0%, high-titer active syphilis 1.3% and 6.6%, HSV-2 16.1% and 16.1%, HBsAg 1.3% and 1.4%, anti-HBc 3.2% and 1.4%, NG 1.8% and 1.7%, CT 17.5% and 10.7%; among females: BV 42.9% and HPV 33.2%. CT was independently associated with being female (AOR, 2.02; 95% confidence interval [CI], 1.20–3.41); high-titer active syphilis with being male (AOR, 4.51; 95% CI, 1.17–17.40). Bacterial vaginosis was associated with sexual behavior (≥3 lifetime sex partners: AOR, 3.81; 95% CI, 1.29–11.26), HPV with sexual experience (AOR, 4.05; 95% CI, 1.62–10.09). Conclusions School-going indigenous adolescents in rural Panama have substantial STI burden. Targeted STI screening is required.

Evolution of late presentation to care and advanced HIV in newly HIV diagnosed subjects in the Republic of Panama: 2012–2017

“…Of them, just 53% were on antiretroviral therapy (ART). 4 In Panama, the HIV epidemic is affecting key populations, such as men who have sex with men, 5 low-income population, 6 youth, and adult population (15-50 years old) collectively, adding more than half of new HIV infections annually. 7 Still, people older than 50 years old are arriving to care with more HIV related diseases.…”

Gender norms and sexual behaviours among Indigenous youth of the Comarca Ngäbe-Buglé, Panama

“…The HIV epidemic in the CNB is concentrated among young men and is influenced by lack of prevention in male same-sex relationships. Local epidemiological surveys indicate that men who have sex with men also have sex with women (Gabster et al 2019). We found strong beliefs that condoms are primarily used to prevent pregnancy, and therefore not needed within same-sex relationships.…”

“…Prevalence of HIV in the CNB is 2%, twice the national average, with most infections found among young-adult young men (Ministerio de Salud 2018). Among young people 14-19 years old in CNB, prevalence of other STIs have been found to vary between sexes, where active syphilis has been found to be more prevalent in males, however genital chlamydia infections are more common among young women (Gabster A et al 2019). A recent nationwide sexual and reproductive health survey found that among young people of CNB, 26.1% of young women and 26.5% of young men reported to have engaged in sexual relations before the age of 15; among 15-24 year-olds, 4.8% of young women and 0.6% of young men reported having used a condom at sexual debut; and finally 81.2% adult and young women in the CNB report they cannot deny sexual relations with their partner (De León et al 2018).…”

How did COVID-19 measures impact sexual behaviour and access to HIV/STI services in Panama? Results from a national cross-sectional online survey

“…In 2019, Panama had an estimated HIV prevalence of 0.6%, described as a concentrated epidemic among men who have sex with men (MSM) (6.9%) and transwomen (29.6%) populations [15]. Correspondingly, high STI prevalence has been found among MSM, female sex workers, and adolescents [16-19]. During COVID-19 measures, access to key services was interrupted, with over 50% of those needing a STI or HIV testing not getting it.…”