A new scientific study reveals that nearly three quarters of people diagnosed with HIV in Panama begin treatment only after the disease has already reached an advanced stage. This critical delay drastically increases their risk of severe complications, opportunistic infections, and death. The research, released in November 2025, exposes deep-seated social and structural inequalities that are hampering the national response to the epidemic, particularly in rural, indigenous, and marginalized urban communities.
The study analyzed data from seven public health centers across the country to understand the factors leading to late diagnosis and fatal outcomes. Titled “Sociodemographic and clinical-epidemiological characteristics related to advanced disease at the time of diagnosis and mortality from HIV in Panama,” the report was a collaborative effort between the Social Energy Generation Plant (PGES), the Ministry of Health (MINSa), the United Nations Population Fund, and the organization IntraHealth International. Lead researcher Amanda Gabster coordinated the scientific work, integrating clinical data and community knowledge to address a problem that continues to claim lives despite medical advancements.
“This 72 percent figure represents a silent epidemic within the epidemic,” a Ministry of Health official stated. [Translated from Spanish] “People are arriving at our hospitals when they are already very sick. This underscores an urgent need to strengthen our testing and early detection programs, especially for the most vulnerable populations.”
The immediate impact of these findings places significant pressure on Panama’s healthcare system. Late initiations of treatment lead to poorer health outcomes for individuals and increase the long-term cost of care for the public. Health authorities are now tasked with developing targeted strategies to reach communities that are currently falling through the cracks of the public health network.
Study Scope and Geographic Disparities in HIV Care
Researchers conducted the investigation at clinics and hospitals in David, Colon, San Miguelito, two facilities in the Ngäbe Buglé region (San Félix and Pueblo Nuevo), and the Nicolás Solano and Santo Tomás hospitals in Panama City. This selection of sites provided a comprehensive view of the challenges faced in urban, rural, and indigenous comarca areas. The analysis focused specifically on patients who entered the healthcare system with advanced HIV disease or who died while living with the virus.
A total of 199 clinical records from patients entering care between January 2021 and March 2022 were reviewed. The data showed a pronounced gender disparity, with men comprising 79 percent of the cases and women 21 percent. This translates to a ratio of four men for every one woman in the study group. The geographic distribution of these advanced cases was also highly concentrated.
Provinces including Panama, Panama Oeste, and Colon accounted for 68 percent of all cases. The Santo Tomás Hospital alone handled 113 of the files analyzed, representing 57 percent of the national total. This concentration suggests that complex care pathways still rely heavily on major urban hospitals. Meanwhile, the provinces of Chiriquí and the Ngäbe Buglé comarca registered the remaining 32 percent of cases, with even starker gender ratios of five and six men per woman, respectively.
“The map of advanced HIV is also a map of inequality,” a researcher involved with the project explained. [Translated from Spanish] “We see that the highest rates of late treatment initiation coincide with areas that have the greatest concentration of cases. In the comarcas, structural barriers like limited diagnostic capacity and a lack of specialized staff create a perfect storm for delayed care.”
These findings highlight a healthcare system where patients, particularly men, are seeking hospital care only after their illness has severely progressed. The data confirms that both urban centers and remote regions are struggling, though for different reasons, to connect people with timely testing and treatment.
Sociodemographic Profile of Affected Populations
The research delved into the educational, economic, and territorial conditions of the individuals diagnosed with advanced HIV. A majority of patients had either a secondary school education (24 percent) or a university-level education (21 percent). Another 18 percent had only completed primary school, and 19 percent had finished middle school. These educational disparities were more pronounced when comparing men and women.
Employment status presented a clearer picture of vulnerability. Unemployed individuals made up 33 percent of the study group, while another 35 percent worked in the informal economy. This type of precarious employment often lacks health benefits and stable income, making it difficult for people to prioritize and afford regular medical check-ups and tests.
For women, the role of homemaker was significantly more frequent, at 39 percent. This status can also influence a person’s ability to seek medical services regularly due to caregiving responsibilities and financial dependence. These combined factors paint a portrait of a crisis fueled by social and economic inequality. Educational gaps, job insecurity, and geographic isolation all contribute directly to late diagnosis and a lack of continuity in care.
The most affected demographic group consisted of patients between 20 and 34 years old. The majority were men who have sex with men. Many faced overlapping vulnerabilities that complicate their access to healthcare, including internal migration and pervasive social stigma. These conditions create multiple, often invisible, barriers that prevent people from getting an HIV test or starting treatment quickly after diagnosis.
“Stigma remains a powerful deterrent. It is not just a social issue, it is a public health barrier,” a community health worker from the Ngäbe Buglé region noted. [Translated from Spanish] “When people fear discrimination from their community or even from health workers, they will delay testing until they have no other choice.”
This fear, combined with practical obstacles like transportation costs and lost wages, means that an HIV diagnosis often comes only during a medical emergency. By that time, the immune system has typically sustained severe damage, making treatment more complex and less effective.
Implications and the Path Forward for Panama
The consequences of a late HIV diagnosis are severe both for individuals and for the broader public health system. When patients start antiretroviral therapy late, their viral load is often very high. This increases their risk of developing AIDS-defining illnesses and makes them more infectious, potentially contributing to further transmission of the virus within the community.
For the healthcare system, treating advanced HIV is far more resource-intensive than managing the disease in its early stages. It requires more frequent hospitalizations, management of complex opportunistic infections, and a greater allocation of specialized medical personnel. The study makes a compelling economic and ethical case for investing heavily in prevention and early detection programs.
Health officials now face the challenge of designing interventions that directly address the identified barriers. This could involve deploying more mobile testing units to remote and urban marginalized areas, training general practitioners to offer routine testing without stigma, and creating stronger referral systems that ensure a positive test leads immediately to care. Public awareness campaigns that normalize testing and combat discrimination are also critical components of a renewed strategy.
The 72 percent figure is not just a statistic. It represents hundreds of individuals whose lives are at greater risk because of systemic failures. The study provides Panama with a clear and urgent roadmap. Closing the gap in testing and treatment initiation will require a concerted effort that goes beyond the health sector, tackling the underlying social and economic determinants that continue to fuel this silent advance of HIV.