International AIDS Society

HIV Rate Differs in Registered and Unregistered Panama Sex Workers

Author: Mark Mascolini

15 March 2013

HIV prevalence lay below 1% among female sex workers (FSWs) in Panama, but the rate was higher in unregistered FSWs. Almost 4% of FSWs had syphilis.

Panama regulates sex work and requires FSWs to register with the Social Hygiene Programme of the Ministry of Health. Lying in Central America, Panama has a population of 4.1 million and a UNAIDS-estimated HIV prevalence of 0.8% among 15- to 49-year-olds.

Researchers planned this cross-sectional analysis using venue-based, time-space sampling to recruit FSWs in 2009 and 2010. Using an anonymous structured questionnaire, health workers interviewed FSWs about sociodemographic characteristics, sexual risk behavior, health history, and drug use. Women gave blood samples to be tested for HIV and other sexually transmitted infections (STIs).

Overall HIV prevalence stood at 0.7%. Prevalence measured 1.6% in 379 unregistered FSWs and 0.2% in 620 registered FSWs.

Prevalence rates (and 95% confidence intervals [CI]) of other STI markers were 3.8% (2.7% to 5.2%) for syphilis antibody, 74.2% (71.4% to 76.9%) for herpes simplex virus type 2 antibody, 0.6% (0.2% to 1.3%) for hepatitis B surface antigen, 8.7% (7.0% to 10.6%) for hepatitis B core antibody, and 0.2% (0.0% to 0.7%) for hepatitis C antibody.

Multivariate analysis determined that sex work registration lowered the odds of active syphilis 65% (adjusted odds ratio [aOR] 0.35, 95% CI 0.16 to 0.74). Three factors raised chances of active syphilis:

• History of STI: aOR 2.37 (95% CI 1.01 to 5.58)
• Forced sex: aOR 2.47 (95% CI 1.11 to 5.48)
• Anti-HSV-2 antibody: aOR 10.05 (95% CI 1.36 to 74.38)

The researchers call for “programmes aimed at overcoming obstacles to registration, and HIV, STI and harm reduction among unregistered FSWs,” along with efforts to improve sexual and reproductive health.

Source: Shilpa Hakre, Griselda Arteaga, Aurelio E. Núñez, Christian T. Bautista, Aimee Bolen, Maria Villarroel, Sheila A. Peel, Gabriela Paz-Bailey, Paul T. Scott, Juan M. Pascale, the Panama HIV EPI Group. Prevalence of HIV and other sexually transmitted infections and factors associated with syphilis among female sex workers in Panama. Sexually Transmitted Infections. 2013; 89: 156-164.

For the study abstract

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