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Background: Syphilis is a serious global public health challenge. Despite prior progress in syphilis control, incidence has been increasing in recent years. Syphilis is a common coinfection among people living with HIV (PLHIV). In Panama, few data describe syphilis prevalence among PLHIV. We describe syphilis antibody and high-titer (⩾1:8) active syphilis prevalence and associated factors among individuals who attended an antiretroviral clinic. Methods: A cross-sectional study was undertaken during February-March 2022 and September-October 2022 for adults (⩾18 year) assigned male and female at birth, respectively. Participants provided peripheral blood samples and self-administered a questionnaire. Samples were screened using immunochromatography; antibody-positive samples were tested using rapid plasma regain to 1:512 dilutions. Logistic regression was used to identify factors associated with syphilis antibody and high-titer active syphilis. Results: In all, 378 participants gave blood samples; 377 individuals participated in the questionnaire (216 self-reported male sex [males], 158 female [females], and three intersex individuals). Median age was 36 years (interquartile range: 28-45 years). Overall, syphilis antibody prevalence was 32.3% (122/378) (males, 50.7% [108/2013]; females, 5.7% [9/158]; intersex individuals, 100.0% (3/3)], p < 0.01. High-titer active syphilis was found among 24.6% (n = 30) of samples with positive antibody test (males 27.8% [n = 30], females 0.0% [0/9], intersex individuals 0.0% [0/3]). Antibody positivity was associated in the multivariable model with males (50.7%, AOR = 24.6, 95%CI: 1.57-384.53). High-titer active syphilis was associated with younger participant age (18-30 years, 13.2%, OR = 4.82, 95%CI: 1.17-19.83); 31-40 years, 7.8%, OR = 4.24, 95%CI: 1.04-17.21 versus 3.2% >40 years), homosexual identity (16.0% OR = 34.2, 95%CI: 4.50-259.27 versus 0.6% among heterosexual identity); in the multivariable model, associated with sexual identity (bisexual 19.1%, AOR = 10.89, 95%CI: 1.00-119.06) compared to heterosexual identity (0.6%) and weakly associated with concurrency (⩾1 ongoing sexual relationships, 15.9%, AOR = 3.09, 95%CI: 0.94-10.14). Conclusion: This study found very high prevalence of syphilis antibodies and high-titer syphilis among PLHIV in Panama. Those most affected are males, younger in age, those who practice concurrent sexual relationships, and those who reported homosexual and bisexual identity. Targeted interventions should include repetitive testing and treatment, especially among individuals who may be at increased infection risk.
Prevalence of syphilis among people living with HIV who attend a large antiretroviral therapy clinic, Panama, 2022 Syphilis is a significant health challenge worldwide. On a global scale, yearly syphilis incidence is increasing, including in Panama. However, there are no current data to explain syphilis prevalence and who is most affected among people living with HIV in Panama. In order to understand syphilis in Panama and create targeted interventions among specific groups of people, it is important to describe how many people are infected, and who is most affected by this infection. Therefore, we conducted a study among 378 people living with HIV at a treatment clinic in Panama City, Panama. Blood samples and demographic data were collected. In all, syphilis antibodies were found in 32.3% of individuals (50.7% of those who self-report as males, 5.7% as females, and 100% of those who self-report as intersex. Of those with positive antibody tests, 24.6% of individuals also had active syphilis. Only individuals who identify as male had active syphilis. Our findings show high syphilis prevalence among people with HIV in Panama City, particularly among males, those who are younger, those who report sexual identity as homosexual or bisexual, and those with ongoing sexual relationships with more than one individual. Targeted interventions are needed among people living with HIV, especially among the groups most affected. These interventions could include testing more often for syphilis and providing timely treatment, especially among individuals who may be at increased risk of infection.
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The Comarca Ngäbe-Buglé (CNB), home to >200,000 Indigenous people, is one of the poorest regions in Panama. We describe transactional sex (TS) behaviours, normative beliefs and factors associated with TS among Indigenous adolescents(14-19years) in the CNB. We conducted a mixed-methods study in the CNB between January and November 2018, which included a qualitative study with participant observation and semi-structured interviews that focused on descriptive norms related to TS; and a cross-sectional study among public-school-going adolescents using self-administered questionnaire to report sexual behaviour and injunctive norms related to TS. Participants in the epidemiological study were also asked to submit samples for HIV, syphilis, chlamydia, and gonorrhoea testing. Qualitative thematic analysis was used to organise and analyse field notes and semi-structured interviews. Quantitative analysis included four models: TS experience and acceptance of a TS offer and the associations of these outcome variables with demographic and behavioural variables and HIV/STI infections. In the qualitative study among 20 adolescents, we found that people offering TS were reported to be from within and outside of the community, and included older men and women, and disturbingly, teachers. Participants reported feeling individual and collective agency in the decision to engage in TS and described little social sanctions for participation. In the quantitative study among 700 adolescents(309 girls[45.1%],379 boys[54.9%]), we found that girls(18.8%;58/309) and boys(15.5%;58/379) reported similar levels of having been offered TS, and of acceptance among those offered(girls 81.4% [35/43]; boys 77.8% [35/45]). TS was found to be associated with the reported forced sex and HIV/syphilis seropositivity. Due to widespread acceptance and feelings of agency, interventions would not be effective if they focused on eliminating the transactional component of sexual encounters. Instead, interventions should focus on individual and household economic stability, increasing violence reporting, bringing perpetrators to justice, and adopting condom use during all sexual encounters.
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População Rural , Comportamento Sexual , Saúde Sexual , Normas Sociais , Humanos , Adolescente , Feminino , Masculino , Panamá/epidemiologia , Adulto Jovem , Estudos Transversais , Comportamento Sexual/psicologia , Povos Indígenas/psicologia , Trabalho Sexual/psicologia , Infecções por HIV/epidemiologia , Infecções por HIV/psicologia , Infecções Sexualmente Transmissíveis/epidemiologia , Inquéritos e QuestionáriosRESUMO
Background: Unprecedented numbers of migrant people transiting through the Darién Gap at the Panama-Colombia border were recorded in 2021 and 2022. Data on sexual and reproductive health (SRH) needs and service provision among migrant people in transit is generally extremely sparse. This study aimed to collect personal accounts of sexual behaviours and SRH needs and access to services among migrant people in transit through Panama. Methods: We conducted a rapid-assessment qualitative study using semi-structured interviews during June-July 2022. Participants were migrant people in transit at three locations across Panama: (i) at the Migrant Reception Station (MRS) in Darién province at the Panama-Colombia border, (ii) in the city of David near the Costa Rica-Panama border, and (iii) at the Costa Rica-Panama border. Migrant peoples (>18 years) were invited to participate using purposive sampling. Results: Overall, 26 adult migrant people (16 men, 10 women) across the three sites participated in the study. We identified three overarching themes from the interviews: (1) increased need for SRH service provision, (2) experiences of sex, relationships, and transactional sex, and (3) vulnerability to exploitation and sexual violence. All accounts reported that no formal SRH care was present during the journey through the Gap and described as inconsistent at the MRS in Darién. Provision of gynaecological or genital examinations, laboratory testing for urinary tract or STI, and prenatal care were mentioned to be the most pressing needs. Participants reported a change in their sexual behaviour while travelling, whether a decline in sexual libido or preference towards short-term partners. Most female participants recounted constantly fearing sexual violence during the journey through the Gap and several respondents reported witnessing incidents of sexual and other forms of violence. Conclusion: There are significant unmet needs regarding SRH care during the journey of migrant people transiting through the Darién Gap, at the MRS in the Darién province, and across Panama. Provision of antenatal care, rapid testing for HIV/STI, condom distribution, and care for victims of sexual violence would significantly reduce adverse SRH outcomes and improve the well-being of migrant people, even when in transit.
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Background: Adolescent dating violence (ADV) can have lasting effects on youth's well-being and development. However, few studies in Latin America have described its prevalence and risk factors for having experienced ADV. Methods: We conducted a multisite, cross-sectional study using two-stage cluster sampling among adolescents (14-19 years) attending public high schools in the urban districts of Panama, San Miguelito, Colón, and Arraiján/La Chorrera from 2015 to 2018 (N = 2469). All completed a tablet-based, self-administered questionnaire. Random effects logistic regression was used to identify risk factors for each ADV type among adolescent boys and girls separately. Findings: Participants reported experiencing a range of ADV at least once (girls: emotional 61.6%, physical 7.9%, sexual 21.0%; boys: emotional 73.4%, physical 24.1%, sexual 28.9%). In adjusted models, participants with a history of sexual intercourse had greater odds of ADV than those without such history across types (boys: emotional and sexual; girls: emotional, physical, and sexual). Additionally, participants who reported three or more romantic partners in the past year had greater odds of ADV than those with one partner (boys: emotional, physical; girls: physical). Girls with an earlier sexual debut (≤14 years vs ≥15 years) had greater odds of reporting ADV (emotional and sexual violence). No associations were found between reporting dating violence survival and the sex of romantic partners in the past year or the age of the current/most recent sex partner. Interpretation: This study reveals a high prevalence of ADV among adolescents in urban public schools in Panama. These findings support the need for program implementation to address ADV. Funding: Funding to undertake this study was acquired from Panama's Ministry of Economics and Finance, project number 009044.049.
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Background: The foot transit of migrant peoples originating from the Caribbean, South America, Asia, and Sub-Saharan Africa through the Darién Forest (DF) in Eastern Panamá towards North America has increased in recent years from approximately 30,000 people/year to >133,000 in 2021. In the DF, there is no food/housing provision nor healthcare access. Very little is known of sexual and reproductive health (SRH) among this population. This study used rapid epidemiological methods to describe the SRH situation among migrant peoples in transit through the DF. Methods: This cross-sectional study randomly selected migrant people in transit (men and women) at a Migrant Reception Station in Darién, Panamá, between January 4-11, 2022. Data collection included a self-applied questionnaire (≥18 years); clinical screening (≥12 years); and HCG, treponemal antibodies, and HIV(I/II) lateral-flow tests with blood samples (≥12 years). Descriptive analyses were used to report findings. Results: In all, 69 men and 55 women participated in the self-applied questionnaire, 70 men and 51 women in clinical screening; 78 men and 63 women in HCG, treponemal antibody and HIV testing. Overall, 26.1% (18/69) men and 36.4% (20/55) women reported sexual intercourse within the past month. The last sex partner was casual among 43.0% (21/49) of men and 27.8% (10/36) of women; of those, 42.9% (9/21) of men and 80.0% (8/10) of women reported this sex was condomless. Among women, 20.0% (11/55) tested positive for pregnancy; 5 of these pregnancies were planned. Of those screened, a reproductive tract infection symptom was reported by 5.7% (4/70) of men and 58.8% (30/51) of women. A total of 32.7% (18/55) of men and 18.2% (8/44) of women reported no prior HIV testing. Of 78 men, HIV and treponemal antibodies were found among 1.3% (n = 1) and 2.6% (n = 2), and among 63 women, 3.2% (n = 2) and 3.2% (n = 2), respectively. Conclusions: This rapid epidemiological assessment found high recent sexual activity, low condom use with casual partners, and a need for increased HIV and syphilis testing and treatment. There is a need for increased testing, condom provision, and SRH healthcare access at migrant reception stations that receive migrant peoples in transit through Panamá.
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Objetivo: Describir la prevalencia del parto adolescente por cohorte a través de los años y su relación con factores sociodemográficos, en Panamá. Metodología: A partir de un análisis secundario de la "Encuesta nacional de salud sexual y reproductiva 2014-2015" de Panamá, utilizando cohortes por año de nacimiento (1966-1975, 1976-1985, 1986-1995 y 1996-2000), la relación enunciada se analizó mediante regresión logística. Se incluyeron 4795 adultas (20-49 años) y 821 adolescentes (15-19 años). Resultados: Se encontró un aumento en la prevalencia del parto adolescente entre cohortes, donde la prevalencia fue de 30,9 % en la cohorte mayor (1966-1975) y de 51,5 % en la cohorte de 1986-1995. En todas las cohortes, el parto adolescente estuvo asociado a la ruralidad (1966-1975, 42,3 % rural no indígena; 1976-1985, 56,6 % rural indígena; 1986-1995, 65,4 % rural no indígena y 58,2 % rural indígena). En todas las cohortes, el parto adolescente se relacionó con menor bienestar, encontrándose una prevalencia mayor que el 40 % en el quintil menor de riqueza en todas las cohortes. El parto adolescente se asoció a tener 4 o más hijos en las cohortes mayores (1966-1975 y 1976-1985), con prevalencias mayores que el 63 %. Conclusiones: La prevalencia del parto en adolescente en Panamá se ha mantenido en crecimiento. Las poblaciones rurales y de menor bienestar se han mantenido con mayor prevalencia de parto adolescente, indicando dónde enfocar las intervenciones preventivas.
Objective: To describe the prevalence of adolescent childbirth by cohort over time and its relationship with sociodemographic factors in Panama. Methodology: The analysis was conducted through logistic regression, based on a secondary analysis of the Panama "Encuesta nacional de salud sexual y reproductiva 2014- 2015" (2014-2015 National Survey on Sexual and Reproductive Health), using cohorts by year of birth (1966-1975, 1976-1985, 1986-1995, and 1996-2000). A total of 4795 adult women (20-49 years old) and 821 adolescent girls (15-19 years old) were included. Results: We found an increased prevalence of adolescent childbirth between cohorts, where prevalence was 30.9% in the older cohort (1966-1975) and 51.5% in the 1986- 1995 cohort. In all cohorts, adolescent childbirth was associated with rurality (1966-1975, 42.3% rural non Indigenous; 1976- 1985, 56.6% rural Indigenous; 1986-1995, 65.4% rural non Indigenous, and 58.2% rural Indigenous). Adolescent childbirth was also associated with lower well-being; across all cohorts, there was a prevalence of over 40% in the lowest wealth quintile. Adolescent childbirth was associated with having 4 or more children in the older cohorts (1966-1975 and 1976-1985), with a prevalence of over 63%. Conclusions: The prevalence of adolescent childbirth in Panama has continued to increase. Rural and lower well-being populations have continued to exhibit a higher prevalence of adolescent childbirth, which signals where to focus preventive interventions.
Objetivo: Descrever a prevalência do parto adolescente por conjuntos estabelecidos por anos e sua relação com fatores sociodemográficos, em Panamá. Metodologia: A partir de uma análise secundária da "Enquete nacional de saúde sexual e reprodutiva 2014-2015" de Panamá, utilizando conjuntos por ano de nascimento (1966-1975, 1976-1985, 1986-1995 e 1996-2000), a relação enunciada foi analisada por meio de regressão logística. Incluíram-se 4795 adultas (29-49 anos) e 821 adolescentes (15-19 anos). Resultados: Achou-se um aumento na prevalência do parto adolescente entre conjuntos, onde a prevalência foi de 30,9% no conjunto mais velho (1966-1975) e de 51,5% no conjunto de 1986-1995. Em todos os conjuntos, o parto adolescente esteve associado à ruralidade (1966-1975, 42,3% rural não indígena; 1976-1985, 56,6% rural indígena; 1986-1995, 65,4% rural não indígena e 58C,2% rural indígena). Em todos os conjuntos, o parto adolescente relacionou-se com menor bem-estar, sendo achada uma prevalência maior ao 40% no quintil menor de riqueza em todos os conjuntos. O parto adolescente associou-se a ter 4 ou mais filhos nos conjuntos mais velhos (1966-1975 e 1976- 1985), com prevalências maiores ao 63%. Conclusões: A prevalência do parto em adolescentes em Panamá tem mantido seu crescimento. As populações rurais e com menor bem-estar mantêm a maior prevalência do parto adolescente, indicando onde enfocar as intervenções preventivas.
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INTRODUCTION: Panama's HIV epidemic is far from under control. One of the populations with the fastest-growing epidemic among the Indigenous peoples of the Comarca Ngäbe-Buglé (CNB). The CNB is an administratively autonomous Indigenous region in Western Panama that is home to over 200,000 individuals of Ngäbe and Buglé ethnicities. This population is unique and, in several ways, represents the early stages of the AIDS epidemics in high-income countries. The CNB is the most impoverished region in Panama and is relatively isolated from outside influences, with limited roads, electricity, and an internet connection, including medical assistance. Around 1.5% of all rapid HIV tests are positive, compared to a national prevalence of 0.9%; in CNB, diagnosis tends to be late. In CNB, 56.3% of individuals had an initial CD4 count of <350 cells/mm3. Antiretroviral treatment (ART) dropout in this region is five times higher than the national average; there is high early mortality due to opportunistic infections. Using the Social-Ecological Theory for Health as a framework, this study aims to describe the facilitators and barriers associated with ART adherence and retention in HIV care among people living with HIV (PLHIV) in the CNB. A better understanding of factors that obstruct adherence could lead to more effective HIV care and prevention in CNB. METHODS: We conducted 21 semi-structured interviews with PLHIV who reside across all three regions of the CNB and have attended an antiretroviral (ART) clinic at least once. Deductive thematic analysis was used to uncover themes related ART adherence and retention in HIV care at the individual, social and structural levels. DISCUSSION: This unique, isolated population of rural Indigenous peoples has high infection rates, late diagnosis, poor ART adherence, and high AIDS-related death rates. The CNB is an important region to examen ART adherence and retention in care. We determined that psychological health, social support, and discrimination acted as individual-level facilitators and barriers to adherence and retention. Notably, structural barriers included difficult access to ART care due to travel costs, ART shortages, and uncooperative Western/Traditional medical systems. Recommended interventions used in other Low- and Middle-Income settings include increasing peer and family-level support and community knowledge and understanding of HIV infection. Additionally, our study suggests structural interventions, including decreasing the cost and distance of traveling to the ART clinic, by decentralizing services, decreasing food scarcity, and increasing collaboration between Western and Traditional providers.
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Síndrome da Imunodeficiência Adquirida , Ajuga , Fármacos Anti-HIV , Infecções por HIV , Síndrome da Imunodeficiência Adquirida/tratamento farmacológico , Fármacos Anti-HIV/uso terapêutico , Antirretrovirais/uso terapêutico , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , Infecções por HIV/psicologia , Humanos , Adesão à MedicaçãoRESUMO
OBJECTIVE: To describe reported changes in sexual behaviours, including virtual sex (sexting and cybersex), and access to HIV/STI testing and care during COVID-19 measures in Panama. METHODS: We conducted an online cross-sectional survey from 8 August to 12 September 2020 among adults (≥18 years) residing in Panama. Participants were recruited through social media. Questions included demographics, access to HIV/STI testing and HIV care, and sexual behaviours 3 months before COVID-19 social distancing measures and during social distancing measures (COVID-19 measures). Logistic regression was used to identify associations between variables and behavioural changes. RESULTS: We recruited 960 participants; 526 (54.8%) identified as cis-women, 366 (38.1%) cis-men and 68 (7.1%) non-binary or another gender. The median age was 28 years (IQR: 23-37 years), and 531 of 957 (55.5%) were of mixed ethnicity (mixed Indigenous/European/Afro-descendant ancestry). Before COVID-19 measures, virtual sex was reported by 38.5% (181 of 470) of cis-women, 58.4% (184 of 315) cis-men and 45.0% (27 of 60) non-binary participants. During COVID-19 measures, virtual sex increased among 17.2% of cis-women, 24.7% cis-men and 8.9% non-binary participants. During COVID-19 measures, 230 of 800 (28.8%) participants reported decreased casual sex compared with pre-COVID-19 measures. Compared with pre-COVID-19 measures, decreased casual sex was reported more frequently during COVID-19 measures by cis-men compared with cis-women (39.2% vs 22.9%, urban/rural adjusted OR (AOR)=2.17, 95% CI 1.57 to 3.01), and by Afro-descendant compared with participants of mixed ethnicity (40.0% vs 29.8%, AOR=1.78, 95% CI 1.07 to 2.94). Compared with no change in virtual sex (16.8%), increased virtual sex (38.5%, AOR=1.78, 95% CI 1.10 to 2.88) and decreased virtual sex (86.7%, AOR=16.53, 95% CI 7.74 to 35.27) were associated with decreased casual sex encounters. During COVID-19 measures, HIV/STI testing could not be obtained by 58.0% (58 of 100) of the participants who needed a test, and interrupted HIV care was reported by 53.3% (8 of 15) of participants living with HIV. CONCLUSIONS: COVID-19 measures in Panama were associated with a decrease in casual sex among cis-men and Afro-descendant people, while access to HIV/STI testing and care was seriously disrupted.
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COVID-19 , Infecções por HIV , Minorias Sexuais e de Gênero , Infecções Sexualmente Transmissíveis , Adulto , COVID-19/epidemiologia , COVID-19/prevenção & controle , Estudos Transversais , Feminino , Infecções por HIV/diagnóstico , Infecções por HIV/epidemiologia , Infecções por HIV/prevenção & controle , Homossexualidade Masculina , Humanos , Masculino , Comportamento Sexual , Infecções Sexualmente Transmissíveis/diagnóstico , Infecções Sexualmente Transmissíveis/epidemiologia , Infecções Sexualmente Transmissíveis/prevenção & controleRESUMO
BACKGROUND: The world is currently unprepared to deal with the drastic increase in global migration. There is an urgent need to develop programs to protect the well-being and health of migrant peoples. Increased population movement is already evident throughout the Americas as exemplified by the rising number of migrant peoples who pass through the Darien neotropical moist broadleaf forest along the border region between Panama and Colombia. The transit of migrant peoples through this area has an increase in the last years. In 2021, an average of 9400 people entered the region per month compared with 2000-3500 people monthly in 2019. Along this trail, there is no access to health care, food provision, potable water, or housing. To date, much of what is known about health needs and barriers to health care within this population is based on journalistic reports and anecdotes. There is a need for a comprehensive approach to assess the health care needs of migrant peoples in transit. This study aims to describe demographic characteristics, mental and physical health status and needs, and experiences of host communities, and to identify opportunities to improve health care provision to migrant peoples in transit in Panama. STUDY DESIGN AND METHODS: This multimethod study will include qualitative (n = 70) and quantitative (n = 520) components. The qualitative component includes interviews with migrant peoples in transit, national and international nongovernmental organizations and agencies based in Panama. The quantitative component is a rapid epidemiological study which includes a questionnaire and four clinical screenings: mental health, sexual and reproductive health, general and tropical medicine, and nutrition. CONCLUSION: This study will contribute to a better understanding of the health status and needs of migrant peoples in transit through the region. Findings will be used to allocate resources and provide targeted health care interventions for migrant peoples in transit through Darien, Panama.
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OBJECTIVES: To determine the prevalence and risk factors of genital Chlamydia trachomatis (CT) among school-going sexually experienced male and female adolescents in Panama. METHODS: We conducted two multisite cross-sectional studies using two-stage cluster sampling to select adolescents aged 14-19 years attending urban public high schools (URB) in Panama City, San Miguelito, Colón and Panama Oeste from 2015 to 2018, and in the rural Indigenous Comarca Ngäbe-Buglé (CNB) from July-November 2018. CT testing was performed by real-time PCR on urine samples. Random-effects logistic regression accounting for sample clustering was used to identify risk factors. RESULTS: We enrolled 3166 participants (54.3% females), median age 17 years (IQR: 15.9-18.1), with no difference by sex. Sexual experience was reported by 1954 (61.7%) participants. Combined CT prevalence was 15.8% (95% CI: 14.2 to 17.4), with no significant differences by region (URB=16.5%, 95% CI: 14.7% to 18.6%; CNB=13.6%, 95% CI: 10.9% to 16.8%; p=0.12). In an age-and-region-adjusted analysis, CT prevalence was higher among female participants compared with males (21.6% vs 9.1%, adjusted OR (AOR)=2.87, 95% CI: 1.62 to 5.10). Among sexually experienced females, CT prevalence was higher among those who reported ≥3 lifetime sex partners compared with one partner (33.5% vs 15.3%, AOR=2.20, 95% CI: 1.09 to 4.07); and among those reporting at least one pregnancy compared with nulligravidae participants (30.9% vs 13.8%, AOR=1.89, 95% CI: 1.05 to 3.43). In unadjusted analyses among males, CT was associated with older age (11.5% among those aged 18-19 years vs 3.4% among those aged 14-15 years, OR=3.69, 95% CI: 1.10 to 12.33). CONCLUSIONS: We report high CT prevalence among sexually experienced, school-going adolescents in Panama. Female adolescents, particularly those with multiple sex partners and a history of pregnancy, were at highest risk. Adolescent-targeted CT screening should be implemented in Panama. Additionally, evidence-based comprehensive sexuality education will be imperative.
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Infecções por Chlamydia/epidemiologia , Chlamydia trachomatis , Estudantes/estatística & dados numéricos , Adolescente , Estudos Transversais , Feminino , Humanos , Povos Indígenas , Masculino , Panamá/epidemiologia , Prevalência , Fatores de Risco , População Rural , Instituições Acadêmicas , Comportamento Sexual/estatística & dados numéricos , População Urbana , Adulto JovemRESUMO
The Comarca Ngäbe-Buglé, an administratively autonomous Indigenous region in western Panama, is home to a significant population rural Indigenous people of Ngäbe and Buglé ethnicity. HIV prevalence in the Comarca is two times higher than the national average, and the great majority of cases are concentrated in young men. Yet, there is little data regarding socio-cultural and sexual behaviour factors that may drive this high prevalence. Understanding such factors would enable the development of relevant prevention interventions. We conducted a qualitative study between January and March 2018, consisting of 20 semi-structured interviews with male and female young people aged 14-19 years, complemented with ethnographic observations of one month's duration each in two communities within the Comarca, to identify potential factors that could increase risk of HIV and other sexually transmitted infections (STIs). We suggest that interventions to prevent HIV and other STIs should focus on increasing open communication between sex partners, especially with respect to condom use, as well as facilitating people-driven change in gender norms that are harmful to both young women and young men.
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Identidade de Gênero , Povos Indígenas/psicologia , Comportamento Sexual , Normas Sociais , Adolescente , Adulto , Antropologia Cultural , Feminino , Infecções por HIV/epidemiologia , Infecções por HIV/prevenção & controle , Humanos , Entrevistas como Assunto , Masculino , Panamá/epidemiologia , Pesquisa Qualitativa , Assunção de Riscos , População Rural , Fatores Sexuais , Infecções Sexualmente Transmissíveis/epidemiologia , Infecções Sexualmente Transmissíveis/prevenção & controle , Adulto JovemRESUMO
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.
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Saúde do Adolescente , Povos Indígenas/estatística & dados numéricos , Saúde das Minorias , Comportamento Sexual/estatística & dados numéricos , Infecções Sexualmente Transmissíveis/epidemiologia , Adolescente , Estudos Transversais , Feminino , Humanos , Masculino , Panamá/epidemiologia , Prevalência , Fatores de Risco , Instituições Acadêmicas , Comportamento Sexual/etnologia , Infecções Sexualmente Transmissíveis/diagnóstico , Infecções Sexualmente Transmissíveis/etnologia , Adulto JovemRESUMO
BACKGROUND: The purpose of the study was to recognize the social representation of the Guna indigenous population by identifying cultural elements related to malaria, in order to create an intercultural approach to any health intervention to control and prevent the disease. METHODS: This qualitative study has an anthropological focus that used participant observation, informal conversations, focus groups, interviews, in-depth interviews with key actors. Analyses included review, classification and categorization of interviews. RESULTS: Malaria within the Guna culture is in harmony with several cultural factors, such as magic, religion, beliefs, myths, and nature. The health system must include these factors in its intercultural approach to ensure the sustainability of anti-malarial intervention measures. Until this is not properly addressed, the Guna population of Madungandi will remain a permanent source of risk for malaria transmission in this region and for the rest of the country. CONCLUSION: The findings of this study contribute new variables that can facilitate an intercultural approach to improve the perception of malaria in the indigenous population of Comarca Guna de Madungandi, Panama.
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Malária/etnologia , Cultura , Feminino , Grupos Focais , Humanos , Entrevistas como Assunto/métodos , Malária/epidemiologia , Malária/prevenção & controle , Masculino , Observação , Panamá/epidemiologia , Grupos Populacionais , Inquéritos e QuestionáriosRESUMO
BACKGROUND: Sexually transmitted infections (STIs) are common in adolescents worldwide. Vulnerability to STIs increases with risky sexual practices. This study described the sexual practices, estimated the prevalence of STIs, and identified correlates associated with STIs among participants, enrolled in public high schools, in the District of Panama, Panama. METHODS: A cross sectional study, using multistage cluster sampling, was conducted among participants, aged 14-18 years, enrolled in public high schools, in the District of Panama, Panama City, Panama, from August to November, 2015. Participants completed a self-administered questionnaire and provided biological samples. The samples of those reporting sexual activity (oral, vaginal, and/or anal intercourse) were tested for STIs. Odds ratios were used to identify correlates of STIs in this population. RESULTS: A total of 592 participants were included, of whom, 60.8% reported a history of sexual activity, and 24.4% tested positive for least one STI. STIs were more common in female participants, (33.5%). Compared to those without STIs, higher proportions of those with at least one STI reported ≥3 sexual partners in their lifetime (60.0%) and current sexual activity (76.3%). In the multivariable model, correlates of STI included female participants (Adjusted Odds Ratio (AOR) = 5.8, 95% Confidence Interval (CI) 2.3-14.6) and those who engaged in sexual intercourse with casual partners (AOR = 3.0, 95% CI: 1.2-7.5). CONCLUSIONS: We report a high STI prevalence among adolescents attending public high schools, in the District of Panama. Reported risky sexual practices were common and correlated with STIs. Female participants and those reporting sexual intercourse with casual partners were more likely test positive for at least one STI. Our study identified a need for effective interventions to curb future infections in this population.
RESUMO
Tick-borne rickettsiosis is an important emerging disease in Panama; to date, there have been 12 confirmed cases, including eight fatalities. To evaluate the distribution of rickettsiae in Panamanian ticks, we collected questing and on-host ticks in urban and rural towns in elevations varying between 0 and 2300 m. A total of 63 sites (13 urban and 50 rural towns) were used to develop models of spatial distributions. We found the following tick species: Rhipicephalus sanguineus s.l. (present in 54 of 63 towns and cities), Amblyomma mixtum (45/63), Dermacentor nitens (40/63), A. ovale (37/63), Rhipicephalus microplus (33/63), A. oblongoguttatum (33/63), Ixodes affinis (3/63), and Ixodes boliviensis (2/63). Rhipicephalus sanguineus s.l. was present in urban and rural towns, and other species were present only in rural towns. DNA was extracted from 408 R. sanguineus s.l., 387 A. mixtum, 103 A. ovale, and 11 A. oblongoguttatum and later tested for rickettsiae genes using PCR. Rickettsia DNA was detected in ticks from 21 of 63 localities. Rickettsia rickettsii was detected in five A. mixtum (1.29%), and Candidatus "Rickettsia amblyommii" was found in 138 A. mixtum (35%), 14 R. sanguineus (3.4%), and one A. ovale (0.9%). These results suggest that much of rural Panama is suitable for the expansion of tick populations and could favor the appearance of new tick-borne rickettsiosis outbreaks.
Assuntos
Infecções por Rickettsia , Rickettsia/isolamento & purificação , Carrapatos , Animais , Ixodidae , Panamá , Reação em Cadeia da Polimerase , População Rural , População UrbanaRESUMO
This work emphasizes the detection of Candidatus "Rickettsia amblyommii" in questing Haemaphysalis juxtakochi and Amblyomma mixtum. From February 2009 to December 2012, questing ticks were collected from the vegetation and leaf-litter of four protected forests and two grassy areas around the Panama Canal basin. DNA was extracted from Amblyomma mixtum, Amblyomma naponense, Amblyomma oblongoguttatum, Amblyomma pecarium, Amblyomma tapirellum, Haemaphysalis juxtakochi, and unidentified immature Amblyomma. Specific primers of citrate synthase gene gltA were used to detect and identify the rickettsiae. Amplicons with the expected band size were purified and sequenced. DNA of C. "R. amblyommii" was found in A. mixtum, H. juxtakochi and Amblyomma immatures. To our knowledge, these finding represent the first report of C. "R. amblyommii" in free-living ticks in the wilderness of Central America.
RESUMO
Introduction: Since the middle of last century, cases of rickettsiosis have been found in Panamá when outbreaks of murine typhus and spotted fever were reported. Since then, little information exists about its prevalence in this country, since it is most often is misdiagnosed as another disease. Objectives: The aim of this paper is to demonstrate the presence of Rickettsia infections in humans in three locations in Panamá. These locations are agricultural areas, near forested areas or those who work in zoo. Materials and methods: Three locations where chosen for this study: Tortí, El Valle de Antón and workers in the Summit Municipal Park in Panamá City. All volunteers signed an informed consent and answered a questionnaire. The samples were analyzed for the detection of rickettsial spotted fever and typhus group by the indirect immunofluorescence (using commercial kits) and antigens of Rickettsia rickettsii and R. amblyommii. Results: Blood samples were taken from 97 volunteers in Tortí (25), El Valle de Anton (37) and Summit Municipal Park (35). Of these, a total of 38 (39%) samples reacted to one of the two methods: eight (32%) in Tortí, 18 (48%) in El valle and 12 (34%) in Summit Municipal Park. Conclusion: The results show a high prevalence of antibodies to Rickettsia belonging to the spotted fever group in each of the three study areas, in addition to presenting evidence of the typhus group Rickettsia in El Valle de Anton. These areas could be considered endemic for rickettsiosis as there are conditions for maintaining them.
Introducción. Desde mediados del siglo pasado, se conocen en Panamá casos de rickettsiosis, cuando fueron reportados brotes de tifus en ratones y de fiebres manchadas. A partir de entonces, poca información se tiene sobre su prevalencia en este país, lo cual se debe principalmente a que son confundidos con otras enfermedades. Objetivos. El objetivo de este trabajo fue demostrar la presencia de rickettsiosis en humanos provenientes de tres localidades de Panamá, que corresponden a zonas agropecuarias, cercanas a bosques, o que trabajaban en zoológicos. Materiales y métodos. Se escogieron tres localidades para este estudio: Tortí (provincia de Panamá), El Valle de Antón (provincia de Coclé) y el Parque Municipal Summit en Ciudad de Panamá. Los voluntarios firmaron un consentimiento informado, además de responder un cuestionario. De cada voluntario se extrajo sangre venosa, la que fue analizada por medio de inmunoflorescencia indirecta, utilizando kits comerciales y láminas sensibilizadas con antígenos cultivados de Rickettsia rickettsii y Rickettsia amblyommii . Resultados. Se tomaron muestras de 97 voluntarios, 25 en Tortí, 37 en El Valle de Antón y 35 en el Parque Municipal Summit. De estos, 38 (39 %) de las muestras fueron positivas en algunas de las dos técnicas practicadas: 8 (32 %) en Tortí, 18 (48 %) en El Valle y 12 (34 %) en el Parque Municipal Summit. Conclusión. Se demuestra una alta prevalencia de anticuerpos contra Rickettsia del grupo de las fiebres manchadas en las tres áreas de estudio, además de presentarse evidencia de títulos para Rickettsia del grupo tifus en El Valle de Antón. Estas zonas podrían considerarse como endémicas por rickettsiosis, ya que existen condiciones que permiten el mantenimiento de las mismas.
Assuntos
Animais , Humanos , Anticorpos Antibacterianos/sangue , Infecções por Rickettsia/epidemiologia , Rickettsia/imunologia , Doenças dos Trabalhadores Agrícolas/epidemiologia , Animais de Zoológico/parasitologia , Antígenos de Bactérias/imunologia , Vetores Aracnídeos/microbiologia , Reservatórios de Doenças/parasitologia , Doenças Endêmicas , Exposição Ambiental , Técnica Indireta de Fluorescência para Anticorpo , Florestas , Imunoglobulina G/sangue , Imunoglobulina G/imunologia , Ixodidae/microbiologia , Exposição Ocupacional , Panamá/epidemiologia , Animais de Estimação/parasitologia , População Rural , Infecções por Rickettsia/imunologia , Rickettsia rickettsii/imunologia , Estudos Soroepidemiológicos , Especificidade da Espécie , Inquéritos e Questionários , Picadas de Carrapatos/microbiologia , Infestações por Carrapato/epidemiologia , Infestações por Carrapato/prevenção & controle , Infestações por Carrapato/veterinária , População UrbanaRESUMO
INTRODUCTION: Since the middle of last century, cases of rickettsiosis have been found in Panamá when outbreaks of murine typhus and spotted fever were reported. Since then, little information exists about its prevalence in this country, since it is most often is misdiagnosed as another disease. OBJECTIVES: The aim of this paper is to demonstrate the presence of Rickettsia infections in humans in three locations in Panamá. These locations are agricultural areas, near forested areas or those who work in zoo. MATERIALS AND METHODS: Three locations where chosen for this study: Tortí, El Valle de Antón and workers in the Summit Municipal Park in Panamá City. All volunteers signed an informed consent and answered a questionnaire. The samples were analyzed for the detection of rickettsial spotted fever and typhus group by the indirect immunofluorescence (using commercial kits) and antigens of Rickettsia rickettsii and R. amblyommii. RESULTS: Blood samples were taken from 97 volunteers in Tortí (25), El Valle de Anton (37) and Summit Municipal Park (35). Of these, a total of 38 (39%) samples reacted to one of the two methods: eight (32%) in Tortí, 18 (48%) in El valle and 12 (34%) in Summit Municipal Park. CONCLUSION: The results show a high prevalence of antibodies to Rickettsia belonging to the spotted fever group in each of the three study areas, in addition to presenting evidence of the typhus group Rickettsia in El Valle de Anton. These areas could be considered endemic for rickettsiosis as there are conditions for maintaining them.