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How did COVID-19 measures impact sexual behaviour and access to HIV/STI services in Panama? Results from a national cross-sectional online survey
  1. Amanda Gabster1,2,
  2. Jennifer Toller Erausquin3,
  3. Kristien Michielsen4,
  4. Philippe Mayaud1,5,
  5. Juan Miguel Pascale2,6,
  6. Carles Pericas7,
  7. Michael Marks1,
  8. Jennifer Katz2,
  9. Gonzalo Cabezas Talavero2,
  10. Marilu de Argote2,
  11. Anet Murillo2,
  12. Joseph D Tucker1
  1. 1 Faculty of Infectious and Tropical Diseases, Clinical Research Department, London School of Hygiene and Tropical Medicine, London, UK
  2. 2 Genómica y Proteómica, Instituto Conmemorativo Gorgas de Estudios de la Salud, Panama, Panama
  3. 3 School of Health and Human Sciences, University of North Carolina at Greensboro, Greensboro, North Carolina, USA
  4. 4 Department of Public Health and Primary Care, Universiteit Gent, Gent, Belgium
  5. 5 Faculty of Infectious and Tropical Diseases, Clinical Research Department, London School of Hygiene and Tropical Medicine Faculty of Infectious and Tropical Diseases, London, UK
  6. 6 Facultad de Medicina, Universidad de Panama, Panama, Panama
  7. 7 Faculty of Medicine and Health, Universiteit Gent, Gent, Belgium
  1. Correspondence to Dr Amanda Gabster, Investigación en Genómica y Proteómica, Instituto Conmemorativo Gorgas de Estudios de la Salud, Ciudad de Panamá, Panamá; agabster{at}


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.

  • COVID-19
  • sexual behaviour
  • Latin America

Data availability statement

Data are available upon reasonable request to the corresponding author.

This article is made freely available for personal use in accordance with BMJ’s website terms and conditions for the duration of the covid-19 pandemic or until otherwise determined by BMJ. You may use, download and print the article for any lawful, non-commercial purpose (including text and data mining) provided that all copyright notices and trade marks are retained.

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Data availability statement

Data are available upon reasonable request to the corresponding author.

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  • Handling editor Nicola Low

  • Twitter @agabster, @KatzJennifer

  • Contributors AG, JTE, KM, CPE, MM, JK, GCT, MdA, AM and JDT contributed to conception of the international and national versions of the I-SHARE project and survey instrument. Data collection was performed by AG, JK, GCT, MdA, AM and JMP. Data curation and analysis were performed by AG, JTE, JDT and PM. AG drafted the manuscript. All authors contributed to critical revisions and final approval. AG is responsible for the overall content as a guarantor.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.