HIV Among MSM in Per: A Hidden Population, A Confounding Epidemic

Published: March 1, 2009

"Gay means transvestite, which means promiscuous, which means prostitute, which means HIV-positive." This statement, spoken by the director of Perú’s one and only chartered LGBT organization, is the stereotypical view of openly homosexual men that pervades modern Peruvian society. In a nation where homosexuality, bisexuality, and transsexuality are poorly understood and openly stigmatized, the lines between what it means to be gay or a transsexual or a drag queen are blurry, if seen at all. Unfortunately, the same lack of understanding extends to what it means to have HIV. Homosexuality and transsexuality are equated with being HIV-seropositive, which both legitimizes and intensifies stigmatization of individuals who identify as members of the broad spectrum of the gay, lesbian, bisexual, and transsexual (LGBT) community that are more open and expressive in nations like the United States, Canada, and those of Western European. Furthermore, this social outcasting of LGBT individuals has led to the significant problems of “underground” homosexual intercourse and a resultant HIV epidemic that challenges and frustrates public health officials. In the spring of 2008 I traveled to Lima, Perú on a research grant offered through Northwestern University to study HIV-related nongovernmental organizations in Perú and their efforts to reach out to the men who have sex with men (MSM) community. What I found was a set of NGOs experiencing an overwhelming lack of community in the populations they are meant to serve and a resultant difficulty reaching these individuals.

The HIV epidemic in Perú is similar to that found in many other Latin American nations, and so are the techniques that nongovernmental organizations have employed in efforts to stem the HIV epidemic. Recent research into HIV and MSM in Perú has focused on epidemiological considerations, with little assessment of how best to approach at-risk groups and establish a working rapport with at-risk individuals. This research confirms that men who have sex with men constitute the primary risk group. According to the United Nations HIV/AIDS Programme (UNAIDS), an estimated 0.6% of the total adult population and 18.5% of MSM in Lima were infected with HIV by the end of 20051. An epidemic is not considered a “generalized epidemic” (meaning that it affects the general population) until prevalence levels become greater than 1%, so Perú’s epidemic is “entrenched” within the MSM community2. Most Latin American nongovernmental organizations’ efforts at stemming HIV infection in these vulnerable populations have involved the use of educational campaigns, voluntary counseling and testing services, and stigma reduction campaigns3.

I became interested in the Peruvian HIV epidemic after reading a journal article which suggested that research NGOs in the nation were experiencing auspicious circumstances for developing programs and behavior-modification campaigns among MSM there4. The article’s author attributes this success to the organizations’ “good relationship” with the MSM community. After researching the topic further I remained at a loss as to what this “good relationship” entailed. I wanted to know exactly what these organizations are doing to reach the MSM community in Lima, Perú, a place where stigmatization, homophobia, and machismo are consistent social norms. I surmised that NGOs in Perú are helping to construct a cohesive gay community in Lima despite significant social barriers. My research goal was two-fold. I endeavored to both define the success that Peruvian HIV NGOs are having at reaching the MSM community and also discover if a cohesive gay culture in Lima is contributing to MSM’s utilization of these NGOs’ services.

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