Prevalence of sexually transmitted infections (STI) and factors associated with sexual behaviours and STI positivity among school-going 14-19-year-old adolescents of the Comarca Ngäbe-Buglé, Panama

Adolescents (14-19 years old) may be at increased risk for sexually transmitted infection (STI) acquisition compared to adults due to several factors, such as individual biological, social and material factors. Indigenous peoples make up 12.2% of the Panamanian population. The Comarca Ngäbe-Buglé (CNB) is the largest Comarca (administratively semi-autonomous Indigenous lands) in Panama, home to over 200,000 peoples of Ngäbe and Buglé ethnicities. Little is known about adolescent sexual behaviours in the CNB. However, HIV rapid test positivity is concentrated among adolescent and young adult males. Knowledge of factors related to STI infection is needed to inform how to develop culturally-congruent, sexual health interventions for adolescents of the CNB. The aims of this thesis are i) to describe the social and cultural factors related to sexual behaviour among adolescents of CNB, and ii) to describe STI prevalence and associated factors.

The thesis uses a combination of qualitative and quantitative research methods. Qualitative research was collected first and informed the quantitative survey instrument. The qualitative methods included ethnographic research (participant observation) over two months, as well assemi-structured interviews with young people 14-19 years old and with primary caregivers of young people. The quantitative research was a cross-sectional study of sexual behaviour and STI among male and female adolescents 14-19 years old enrolled in public high schools (7-12th grades). Participant inclusion was organised following a two-stage cluster sample design. Among eligible and consenting participants, we measured STI prevalence and analysed risk factors for infection.

This thesis reports its findings over 4 Results Chapters. Chapter 4 describes the gender norms relating to sexual activity and sexual behaviour. The results were published in Culture, Health and Sexuality. Chapter 5 reports the prevalence of STIs and their risk determinants from the epidemiological study. The findings were partially published in the journal STD. The genital Chlamydia trachomatis results formed part of a broader analysis among urban and rural Indigenous adolescents of Panama (published in STI). Chapter 6 (submitted to Sexual and Reproductive Health Matters) explored where adolescents learn about sexual health and with whom they discuss such issues. Chapter 7 (published in Sex Education) used an explanatory mixed-methods analysis of the prevalence of transactional sex (TS), and the social normative beliefs related to TS. This interdisciplinary thesis included qualitative and quantitative results that studied gender norms related to sexual decision making, sexual behaviours, social norms related to transactionalsex, and STI prevalence. The results from this thesis are valuable to future inform culturally-congruent sexual health and STI control interventions among adolescents of the CNB.