Association of Behavioral and Socioeconomic Factors With Sexually Transmitted Infection Positivity in Vulnerable Women From a Neotropical Setting.

Abstract

Background: Sexually transmitted infections (STIs) represent a global public health concern, particularly among vulnerable populations. In Brazil, women from quilombola, Roma, and rural communities face increased risks due to socioeconomic and cultural conditions that exacerbate susceptibility to these infections. Furthermore, they are frequently underrepresented in scientific studies, leading to a limited understanding of the epidemiological characteristics of STIs within these groups. This study aimed to estimate the prevalence of STIs among women in vulnerable situations in a neotropical region of Brazil and to analyze the association between the pathogen presence, symptoms, behavioral risk factors, and socioeconomic aspects.

Methods: A cross-sectional study was conducted in eastern Maranhão, in the municipality of Caxias, involving 295 quilombola, Roma, and rural women. Data were collected using a structured questionnaire addressing sociodemographic and behavioral factors, along with cervical liquid-based cytology samples. The samples were tested using real-time PCR with the Seegene Allplex STI Essential Assay kit. Statistical analysis employed both descriptive and inferential methods, including chi-square and Fisher's exact tests, as well as unconditional univariate and multivariate logistic regression models.

Results: The overall prevalence of STIs was 72.9% (95% CI: 66.8-77.3), with Ureaplasma parvum being the most common pathogen (61.7%), followed by Mycoplasma hominis (35.3%). Trichomonas vaginalis was significantly associated with vaginal pruritus (OR = 2.566, p=0.047). Behavioral and socioeconomic factors associated with the presence of STIs included the absence of previous cytology screening (AOR = 2.39, p=0.046), high frequency of daily bathing (AOR = 3.28, p=0.042), and prolonged use of tight underwear (AOR = 1.83, p=0.027).

Conclusion: This study revealed a high prevalence of STIs among quilombola, rural, and Roma women. The findings highlight the complexity of sexual and reproductive health in these communities and underscore the need for tailored, culturally sensitive approaches in public health policies.