When poverty, social exclusion, alcohol and violence increase HIV/STI risk: men who only have sex with men (MSOM) in four Peruvian coastal cities
Background: MSOM (gays or transvestite) in Peru have a high HIV prevalence (22-5%). Low-income MSOM report unprotected sex with steady partners -who are usually bisexual men- within relationships that usually involve alcohol abuse and physical/ psychological violence. This study examines the conditions in which the violence occurs and its relation with HIV/STI risk.
Methods: 32 MSOM interviewees and 2 focus groups with 23 men self-identified as gay or transvestite, and 3 focus groups with stakeholders and activists in 4 cities were analysed for salient themes.
Results: Alcohol/drug abuse and physical/psychological violence among MSOM-bisexual couples were frequently reported. There is an asymmetrical power relation between the bisexual partner -who considers himself the “owner” of the MSOM– and the MSOM partner -who exhibits low self-esteem and emotional dependence on the abusive bisexual- that leads to forced sex, lack of capacity to negotiate safer sex and low condom use. Transvestites often reported that domestic violence is acceptable because it reinforces their feminine identity. MSOM have limited access to health services and they are reluctant to use police or human rights protection agencies because prior experiences of stigmatization and discrimination. However, in Lima younger MSOM seem to be better informed and with stronger feelings of empowerment.
Conclusions: Among low-income Peruvian MSOM, the power dynamics in their relationships with bisexual men are based on traditional gender roles that makes them vulnerable to HIV/STI risk from the interrelationships of violence, forced sex, and unprotected sex. Their limited access to information, health services, and defence of their human rights increase this vulnerability. Effective HIV/STI prevention programs for MSOM should focus on building self-esteem and self-acceptance, promoting individual and community empowerment in order to reduce their vulnerability, and fighting stigmatization and discriminatory attitudes and behaviours from health, police and justice authorities and providers.
-Abstract available at link below-