title: Prevalence of HIV and other sexually transmitted infections and factors associated with syphilis among female sex workers in Panama.
abstract: OBJECTIVE
  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.
authors.affiliation: Department of Epidemiology and Threat Assessment, United States Military HIV Research Program, Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland 20817, USA. shakre@hivresearch.org
authors.forename: Shilpa
authors.initials: S
authors.lastname: Hakre
authors.forename: Griselda
authors.initials: G
authors.lastname: Arteaga
authors.forename: Aurelio E
authors.initials: AE
authors.lastname: Núñez
authors.forename: Christian T
authors.initials: CT
authors.lastname: Bautista
authors.forename: Aimee
authors.initials: A
authors.lastname: Bolen
authors.forename: Maria
authors.initials: M
authors.lastname: Villarroel
authors.forename: Sheila A
authors.initials: SA
authors.lastname: Peel
authors.forename: Gabriela
authors.initials: G
authors.lastname: Paz-Bailey
authors.forename: Paul T
authors.initials: PT
authors.lastname: Scott
authors.forename: Juan M
authors.initials: JM
authors.lastname: Pascale
mesh_terms: D000293:Adolescent; D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008875:Middle Aged; D010176:Panama / Q000453:epidemiology; D012307:Risk Factors; D016036:Seroepidemiologic Studies; D060386:Sex Workers; D012749:Sexually Transmitted Diseases / Q000453:epidemiology*; D055815:Young Adult