Background The objective of this study was to measure the prevalence of syphilis among women of reproductive age from 5 distinct indigenous populations in Paraguay. We also sought to identify the demographic profile and behaviors of women with elevated prevalence of syphilis. Methods We conducted a population-based, cross-sectional survey among women aged 15 to 49 years from 5 distinct language families in Paraguay in 2016. The 5 language families were Guaraní, Maskoy, Mataco, Guaicurú, and Zamuco, sampled through a probability-based, multistage cluster design. Participants completed a questionnaire on demographic characteristics and risk-related behavior. Blood samples were drawn for rapid testing for syphilis with confirmation and titers. Participants provided written informed consent; minors had written parental consent and provided their own assent. Results A total of 1732 indigenous women were enrolled. Overall syphilis prevalence was 6.8% (95% confidence interval [CI], 5.6–8.0). Syphilis prevalence varied by language family/ethnic group (P = 0.010), with Mataco having the highest prevalence (8.2%; 95% CI, 5.3–11.9) and Maskoy having the lowest (2.5%; 95% CI, 1.1–4.7). Women reporting multiple partners (11.3%; 95% CI, 6.9–17.1; P = 0.031) and transactional sex in the last year (18.7%; 95% CI, 7.2–36.4; P = 0.010) had higher prevalence of syphilis. Conclusions Our survey found high prevalence of syphilis in indigenous women in Paraguay, in association with transactional sex and multiple partners. Interventions to reduce sexual behaviors associated with an increased risk of sexually transmitted infections (STI) in indigenous women must be carried out with programs aimed at addressing transactional sex, appropriately framed to respect interculturality and an indigenous worldview.

Transgender women have been understudied and underserved in Paraguay; data are urgently needed to understand their HIV prevention and care needs. To estimate HIV prevalence and related risk and preventive behaviors among trans women in Paraguay, we conducted a cross-sectional survey in 2017. We employed starfish sampling – a hybrid venue-based and peer-referral method combining recruitment at randomly sampled venues and randomly selected clients from program lists, followed by short-chain referrals of eligible peers. Among 304 trans women enrolled, HIV prevalence was 24.8% (95% confidence interval [CI] 18.5–31.2%), with risk increasing with age (adjusted odds ratio [AOR] 1.06 per year, 95% CI 1.03–1.10), residence in Asunción department (AOR 4.75, 95% CI 1.57–14.36), and cocaine use (AOR 2.09, 95% CI 1.11–3.95). Trans women in Paraguay need to be prioritized for interventions with high HIV prevention efficacy. Substance use interventions to address cocaine use may also yield prevention benefits for trans women in our context.

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Prevalencia del VIH/Sífilis y comportamientos de riesgo en mujeres trabajadoras sexuales en Paraguay RESUMEN Introducción: En Paraguay, la epidemia del VIH se encuentra concentrada en población clave. La ruta principal de transmisión de las infecciones de transmisión del VIH y la Sífilis es la sexual. Las mujeres trabajadoras sexuales (MTS) presentan riesgo incrementado debido a su trabajo sexual y sus comportamientos de riesgo.

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