Survival analysis of syphilis infection in pregnant women of Papuan and non-Papuan ethnicities in Jayapura City and Regency, Papua, Indonesia

Problem considered In Papua, Indonesia, syphilis in pregnancy persists as a public health concern, yet the role of ethnicity and culture in infection risk is poorly understood. Methods We conducted a prospective cohort study with an embedded mixed-methods design among 977 pregnant women attending their first Antenatal Care (ANC) visits across 15 health centers in Jayapura City and Regency (July 2025–August 2025). Results the overall cumulative incidence of syphilis during pregnancy was 11.7%, differing significantly by ethnicity—13.8% among Papuan women and 8.7% among non-Papuan women (log-rank p=0.03). Papuan women exhibited a higher syphilis risk compared to non-Papuans (AHR = 1.43; 95% CI: 0.98–2.08), associated with cultural taboos against premarital pregnancy. Additional risk factors included unmarried status (AHR = 1.78; 95% CI: 1.34–2.36), hepatitis B coinfection (AHR = 2.33; 95% CI: 1.31–4.16), inconsistent condom use, and uncircumcised partners. Kaplan–Meier curves showed a steep decline in syphilis-free probability during the second and third trimesters. Qualitative insights underscored the influence of stigma, gendered sexual decision-making, and reliance on ANC for diagnosis and treatment. Conclusion Maternal syphilis in Jayapura is influenced by intertwined biological, behavioral, and socio-cultural factors. Targeted, culturally sensitive interventions, enhanced ANC utilization, integrated STI/Hepatitis services, and promotion of safe sexual practices are essential to reduce incidence and support elimination efforts.