Instituto Conmemorativo Gorgas de Estudios de la Salud, Panamá City, Panamá, Panamá.
London School of Hygiene and Tropical Medicine, London, United Kingdom.
PLoS One. 2024 May 31;19(5):e0304805. doi: 10.1371/journal.pone.0304805. eCollection 2024.
The Comarca Ngäbe-Buglé (CNB), home to >200,000 Indigenous people, is one of the poorest regions in Panama. We describe transactional sex (TS) behaviours, normative beliefs and factors associated with TS among Indigenous adolescents(14-19years) in the CNB. We conducted a mixed-methods study in the CNB between January and November 2018, which included a qualitative study with participant observation and semi-structured interviews that focused on descriptive norms related to TS; and a cross-sectional study among public-school-going adolescents using self-administered questionnaire to report sexual behaviour and injunctive norms related to TS. Participants in the epidemiological study were also asked to submit samples for HIV, syphilis, chlamydia, and gonorrhoea testing. Qualitative thematic analysis was used to organise and analyse field notes and semi-structured interviews. Quantitative analysis included four models: TS experience and acceptance of a TS offer and the associations of these outcome variables with demographic and behavioural variables and HIV/STI infections. In the qualitative study among 20 adolescents, we found that people offering TS were reported to be from within and outside of the community, and included older men and women, and disturbingly, teachers. Participants reported feeling individual and collective agency in the decision to engage in TS and described little social sanctions for participation. In the quantitative study among 700 adolescents(309 girls[45.1%],379 boys[54.9%]), we found that girls(18.8%;58/309) and boys(15.5%;58/379) reported similar levels of having been offered TS, and of acceptance among those offered(girls 81.4% [35/43]; boys 77.8% [35/45]). TS was found to be associated with the reported forced sex and HIV/syphilis seropositivity. Due to widespread acceptance and feelings of agency, interventions would not be effective if they focused on eliminating the transactional component of sexual encounters. Instead, interventions should focus on individual and household economic stability, increasing violence reporting, bringing perpetrators to justice, and adopting condom use during all sexual encounters.
恩贝拉-布格勒地区（CNB）是巴拿马最贫穷的地区之一，拥有超过 20 万的土著居民。我们描述了该地区 14-19 岁土著青少年的性交易行为、规范信念以及与性交易相关的因素。我们于 2018 年 1 月至 11 月期间在 CNB 进行了一项混合方法研究，其中包括一项定性研究，采用参与者观察和半结构化访谈，重点关注与性交易相关的描述性规范；以及一项在公立学校就读的青少年中进行的横断面研究，使用自我管理的问卷报告性行为和与性交易相关的禁令规范。流行病学研究的参与者还被要求提交 HIV、梅毒、衣原体和淋病检测样本。定性主题分析用于组织和分析实地记录和半结构化访谈。定量分析包括四个模型：性交易经历和接受性交易提议，以及这些结果变量与人口统计学和行为变量以及 HIV/性传播感染的关联。在 20 名青少年的定性研究中，我们发现提供性交易的人据报道来自社区内外，包括年长的男女，令人不安的是，还有教师。参与者报告说，他们在决定从事性交易时具有个人和集体能动性，并描述了对参与性交易的社会制裁很少。在 700 名青少年（309 名女孩[45.1%]，379 名男孩[54.9%]）的定量研究中，我们发现女孩（18.8%[58/309]）和男孩（15.5%[58/379]）报告的被提供性交易的比例相似，以及接受被提供性交易的比例（女孩 81.4%[35/43]；男孩 77.8%[35/45]）。性交易与报告的强迫性性行为和 HIV/梅毒血清阳性率有关。由于广泛的接受和能动性的感觉，如果干预措施侧重于消除性接触的交易性成分，那么这些干预措施将不会有效。相反，干预措施应侧重于个人和家庭经济稳定、增加暴力报告、将犯罪者绳之以法，以及在所有性接触中使用避孕套。
