Prevalence of Syphilis and Related Risk Behaviors Among Women in 5 Distinct Indigenous Populations in Paraguay

Abstract

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.

Syphilis and HIV infection in indigenous Mbya Guarani communities of Puerto Iguazu (Argentina): diagnosis, contact tracking, and follow-up

“…In a study carried out in the Peruvian Amazon, 1.6% of pregnant indigenous women were infected 10 , while in other communities in the same region, the rates ranged from 3.2% to 7.5% 11,12 . In Brazil, the overall prevalence of syphilis was less than 2%, similar to the 1.82% observed in the indigenous population of the Brazilian State of Amazonas 13,14 , while in Paraguay, the prevalence in the indigenous population is about 6.6% 15,16 . Likewise, HIV shows variable prevalence rates among indigenous people, estimated at 0.2%-0.7% in the Peruvian Amazon 10,12 , 0.25% in Paraguay 15 , and 0.13%-0.80% in Brazil 13,17,18 .…”

“…In general, Amerindian populations maintain their cultural and social customs but remain economically, politically and socially excluded 28,29 . The factors most closely associated with syphilis and HIV infections in Amerindians are polygamy, multiple sexual partners, transactional sex (exchanging sex for money, goods, or other needs), high population mobility, and presence of and relationships with colonizers, among others 16,18,30 . In addition, economic, geographic and cultural barriers prevent regular access to basic health services, affecting the frequency of STI testing and treatment 16,18,30 .…”

“…The factors most closely associated with syphilis and HIV infections in Amerindians are polygamy, multiple sexual partners, transactional sex (exchanging sex for money, goods, or other needs), high population mobility, and presence of and relationships with colonizers, among others 16,18,30 . In addition, economic, geographic and cultural barriers prevent regular access to basic health services, affecting the frequency of STI testing and treatment 16,18,30 . These populations also tend to receive little information on STIs in their own languages 16 .…”

“…In addition, economic, geographic and cultural barriers prevent regular access to basic health services, affecting the frequency of STI testing and treatment 16,18,30 . These populations also tend to receive little information on STIs in their own languages 16 . Factors that might explain the higher prevalence of syphilis in these indigenous communities, in comparison to the general population, include the beliefs on health and sickness among the Mbya Guarani population; the use of traditional medicine as the first option to deal with a health problem; the continuous migration of community members, complicating the health system's capacity to detect, treat, and follow them; the negligible presentation of men to healthcare services (most indigenous people presenting to health centers are women giving birth, although most births are at home); the long distance (10 km) separating the communities and health centers with laboratory services to detect these diseases; sociocultural characteristics such as the non-acceptance of barrier contraception methods (condoms) during sexual intercourses ; the lack of sexual health promotion professionals working as linguistic and cultural facilitators; and the lack of general health promotion, as well as STI prevention, adapted to the Mbya Guarani population.…”

“…Another peculiarity that would favor transmission is the small proportion of Mbyas who maintain a semi-nomadic lifestyle, whereby individuals or small families moving between different Mbya Guarani settlements in Misiones, Brazil, and Paraguay. This mobility would also facilitate the transmission of STIs between communities 16 .…”