Resum
BACKGROUND: Indigenous adolescents of the Comarca Ngäbe-Buglé (CNB) in Panama are vulnerable to HIV/sexually transmitted infection (STI) acquisition in part due to limited access to health and education services, whilst specific cultural factors have been scarcely explored. Previous research in non-indigenous contexts has shown that communication about sexuality with either caregivers or non-caregivers affect adolescent sexual decision-making. Understanding who indigenous adolescents in Panama learn from about sexuality and the impact of this communication on subsequent sexual behavior and STI outcomes would lay the path for the development of culturally sensitive interventions to prevent HIV/STI in this highly vulnerable group. METHODS: From January to November 2018, we conducted a mixed-method study in the CNB, the largest indigenous region in Panama. The quantitative component consisted of a cross-sectional study of 700 randomly selected school-going 14-19-year-old students. Self-administered questionnaires collected data on socio-demographics, sexual behaviors, and participants´ communication with caregivers and non-caregivers on sexuality topics. Participants were also tested for HIV/STI. In the qualitative component, we used in-depth interviews with 16 caregivers, in addition to ethnographic research.
RESULTS: In the quantitative study, we found that adolescents communicated with both caregivers and non-caregivers on topics such as delaying sexual initiation, pregnancy/pregnancy prevention, and STI prevention. Communication with caregivers and non-caregivers was associated with decreased reports of sexual debut and influenced STI outcomes positively. In the qualitative study, we found that caregivers generally felt embarrassed/inadequate to talk about sexuality. Traditional coming-of-age rituals, i.e. möngöndre (for girls) and grön (for boys), included teachings on sexual behavior, but are not as thoroughly practiced today as they were in the past.
CONCLUSIONS: Communication about sexuality with both caregivers and non-caregivers play an essential positive role in indigenous adolescents´ sexuality and sexual health. A revitalization (and modernization) of some components of traditional ritualscould be beneficial to increase intergenerational communication on sexuality with adolescents of the CNB.