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Try out PMC Labs and tell us what you think. Learn More. Participants were recruited through social media. Logistic regression was used to identify associations between variables and behavioural changes. We recruited participants; The median age was 28 years IQR: 23—37 yearsand of Compared with no change in virtual sex Virtual sex sexting and cybersex use was common before COVID social distancing measures, and reported changes in this practice were associated with a decrease in casual sex.

HIV and other STIs have been on the rise in Panama for the past several years, 1 and groups including young adults 2 and Indigenous youth who live in comarcas administratively semiautonomous Indigenous regions 3 are particularly affected. As ofHIV prevalence nationwide was estimated at 0. The COVID pandemic has brought several important changes relevant to sexual health and also created challenges for inperson data collection. Many population health surveys and other sexual health research were initially paused. Given the relatively high prevalence of HIV and STIs in Panama and the potential for COVID measures to affect both behaviours and access to medical care, the objective of this study was to examine reported changes in sexual behaviours and access to key sexual health services during COVID measures using an online survey.

Participants reported behaviours from the 3-month period before lockdown measures from 17 December to 17 March and during the strictest COVID lockdown measures from 18 March to 12 September The survey was advertised on the website and social media Facebook and Twitter of the national public health research institute, Instituto Conmemorativo Gorgas de Estudios de la Salud; on the social media of non-profit organisations; and through SMS short message service and direct messages sent to individuals and groups who had ly interacted with partner organisations.

Targeted invitation was included in provincial and comarcal social media platforms to increase participation in these regions to better match census population estimates online supplemental table 1. No IP internet protocol address restrictions were included more than one result can be recorded on the same device as mobile phones are commonly shared within households and among community members. We used convenience sampling. Only items associated with skip patterns were obligatory.

We conducted univariable analyses to describe demographic characteristics. All participants with valid data were included; due to non-response to some questions, sample sizes varied.

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Only participants who gave online informed consent by ticking a box could participate. No monetary incentive was provided to participants. The survey did not collect WhatsApp phone s, telephone s, IP addresses or any other identifying information. In total, participants from 11 out of 12 Panamanian provinces responded to the survey; provincial distribution was similar to the census projection 12 online supplemental table 1. Of participants who completed the online questionnaire, The median age was 28 years IQR: 23—37 years.

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Overall, sexual experience was reported by Of those who reported casual sex, always using a condom in such encounters was reported by Of the participants with a long-term partner, sex with the long-term partner and casual sex encounter at least monthly before COVID measures were reported by Sexual intercourse at least monthly with their long-term partner was reported by This percentage did not differ between urban and rural areas Of the This percentage was higher in urban areas; however, the difference was not ificant Few 15 of1.

Of the 15 respondents living with HIV, 13 were in urban areas, and all participants living with HIV reported worrying about antiretroviral therapy shortages. Demographic, social and sexual factors associated with a reported decrease in casual sex partners during COVID measures in Panama, Individuals of Afro-descendant ethnicity reported a larger decrease in sex with casual partners There was a weak association between sexual orientation and decreased sex with casual partners Participants who reported the same or increased levels of alcohol use during COVID measures were less likely to report decreased casual sex compared with those who decreased their alcohol use during COVID measures Reported changes in virtual sex during COVID measures were also associated with decrease in casual sex in adjusted models.

Our among a diverse convenience sample of urban and rural dwellers across 11 of 12 provinces expand the literature about sexual behaviours during COVID measures in Latin America. We found that overall sexual activity may have decreased among some individuals.

Casual sex, widely practised by This may have been due to extended periods together and increased time with children or other housemates. Sex with casual partners has also shown to have decreased in the USA and Australia early in the pandemic. However, the first analyses from North America did not demonstrate this. Our findings indicate that virtual sex use in Panama may serve both as a substitute and a preamble to inperson sex. A pre-COVID meta-analysis found positive correlations between sexting, of sex partners and condomless sex. Additionally, community-wide campaigns could educate on privacy laws and recommend use of encrypted applications.

The HIV epidemic is concentrated among specific populations, particularly MSM and transwomen; STI prevalence is high among adolescents and unregistered female sex workers. Panama does not have policies supporting HIV self-testing and STI sample self-collection, as can be found elsewhere globally. Therefore, our findings suggest the need for patient self-testing approaches 26 27 that would help maintain continuity of services during national medical crises. Our study has several limitations.

First, online questionnaires are likely to suffer selection bias as they are only able to include participants who have seen the announcement and are both motivated and able to use online tools. However, given the health emergency context, there was no feasible way to organise a population-representative survey.

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This finding is common in sexual and reproductive health surveys. Fourth, comparisons between sexual orientation and gender groups should be interpreted with caution given the relatively smaller sample of non-cisgender respondents. Fifth, this paper focused on casual sexual encounters and sexual behaviours in general.

Other related sexual health topics including intimate partner violence, access to reproductive health services and mental health will be reported elsewhere.

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Sixth, this is a single behavioural cross-sectional study and the capacity for collecting biological samples was limited during this time; therefore, there should be caution when making any causal inferences from the data. Lastly, this analysis is unable to correlate behaviour with biological outcomes and therefore we do not know the impact of behavioural changes on rates of HIV or STI. Our data suggest the need and usefulness of more rigorous behavioural research during national medical crises that have the capacity to disturb normal services.

While we were able to recruit a convenience sample during the pandemic, national panels or other methods can be used to obtain less biased observations. We found a decrease in sexual activity among some individuals for casual encounters, paralleled with a rise in the use of virtual sex.

We are thankful to all the participants of this study and to all who shared the study links on social media. Handling editor: Nicola Low. Twitter: agabster, KatzJennifer. AG drafted the manuscript. All authors contributed to critical revisions and final approval. AG is responsible for the overall content as a guarantor. Funding: The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors. Competing interests: None declared.

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Provenance and peer review: Not commissioned; externally peer reviewed. Data are available upon reasonable request to the corresponding author. National Center for Biotechnology InformationU. Sex Transm Infect. Published online Aug Author information Article notes Copyright and information Disclaimer.

Corresponding author. Received Jan 23; Accepted Jul No commercial re-use. See rights and permissions.

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Published by BMJ. You may use, download and print the article for any lawful, non-commercial purpose including text and data mining provided that all copyright notices and trade marks are retained. This article has been cited by other articles in PMC. Associated Data Supplementary Materials Supplementary data. Supplementary data. Abstract translation: This web only file has been produced by the BMJ Publishing Group from an electronic file supplied by the author s and has not been edited for content.

Key messages. Introduction HIV and other STIs have been on the rise in Panama for the past several years, 1 and groups including young adults 2 and Indigenous youth who live in comarcas administratively semiautonomous Indigenous regions 3 are particularly affected.

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Open in a separate window. Figure 1. Supplementary data sextranssupp Study de and populations We used convenience sampling. Statistical analyses We conducted univariable analyses to describe demographic characteristics. Table 1 Sociodemographic characteristics of the study population in Panama, Sexual behaviours sexual experience was reported by Long-term partner relationship and sexual behaviours Overall, Table 3 Demographic, social and sexual factors associated with a reported decrease in casual sex partners during COVID measures in Panama,

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