Sex Transm Infect 89:156-164 doi:10.1136/sextrans-2012-050557
  • Epidemiology
  • Original article

Prevalence of HIV and other sexually transmitted infections and factors associated with syphilis among female sex workers in Panama

Open Access
  1. the Panama HIV EPI Group
  1. 1Department of Epidemiology and Threat Assessment, United States Military HIV Research Program, Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA
  2. 2Genómica y Proteómica, Instituto Conmemorativo Gorgas para Estudios de la Salud, Panama, Panama
  3. 3National HIV/AIDS Control Program, Ministry of Health, Panama, Panama
  4. 4Department of Preventive Medicine, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA
  5. 5United States Military HIV Research Program, Walter Reed Army Institute of Research, Rockville, Maryland, USA
  6. 6Centro de Estudios en Salud, Del Valle University of Guatemala, Guatemala, Guatemala
  1. Correspondence to Dr Shilpa Hakre, Department of Epidemiology and Threat Assessment, US Military HIV Research Program, 6720-A Rockledge Drive, Suite 400, Bethesda, MD 20817, USA; shakre{at}
  • Received 28 February 2012
  • Revised 6 August 2012
  • Accepted 8 August 2012
  • Published Online First 21 September 2012


Objectives Biological and behavioural surveillance of HIV and sexually transmitted infections (STIs) among populations at highest risk have been used to monitor trends in prevalence and in risk behaviours. Sex work in Panama is regulated through registration with the Social Hygiene Programme, Ministry of Health. We estimated prevalence of HIV and STIs, and factors associated with active syphilis among female sex workers (FSWs).

Methods A cross-sectional study using venue-based, time-space sampling was conducted among FSWs in Panama from 2009 to 2010. FSWs were interviewed about sociodemographic characteristics, sexual risk behaviour, health history and drug use using an anonymous structured questionnaire. Blood was collected for serological testing of HIV and other STIs. Factors associated with active syphilis were studied using logistic regression analysis.

Results The overall HIV-1 prevalence of 0.7% varied by FSW category; 1.6% in 379 unregistered, and 0.2% in 620 registered FSWs. Overall prevalence (and 95% CI) of STIs were: syphilis antibody, 3.8% (2.7% to 5.2%); herpes simplex virus type 2 antibody (anti-HSV-2), 74.2% (71.4% to 76.9%); hepatitis B surface antigen, 0.6% (0.2% to 1.3%); hepatitis B core antibody, 8.7% (7.0% to 10.6%); and hepatitis C antibody, 0.2% (0.0% to 0.7%). In multivariate analysis, registration (adjusted OR (AOR)=0.35; 95% CI 0.16 to 0.74), having a 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), and anti-HSV-2 (AOR=10.05; 95% CI 1.36 to 74.38) were associated with active syphilis.

Conclusions Although HIV prevalence is low among FSWs in Panama, unregistered FSWs bear a higher burden of HIV and STIs than registered FSWs. Programmes aimed at overcoming obstacles to registration, and HIV, STI and harm reduction among unregistered FSWs is warranted to prevent HIV transmission, and to improve their sexual and reproductive health.

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