The correlates of safer behavior among homosexually active men in Lima.

OBJECTIVE: To describe sexual behavior patterns and identify psychosocial and situational correlates of safer practices among men who have sex with other men in Lima. DESIGN: A cross-sectional survey. SUBJECTS AND METHODS: In 1992, 223 mostly young, working- and middle-class homosexually active men in Lima, who reported either being seronegative or not knowing their HIV status, were recruited from public places, gay organizations and through snowballing techniques. Measurements included patterns of sexual behavior and socialization with other homosexually active men, and psychosocial and situational factors. Three risk behavior indicators were used: the practice of unprotected receptive anal intercourse, the practice of unprotected anal intercourse (insertive or receptive) and an index of behavioral risk based on numbers of sexual partners for different risk practices. RESULTS: The subjects (mean age 24.9 years, SD 6.3) were mostly exclusively homosexual (74%) and self-identified as gay/homosexual (73%); 41% had had unprotected anal intercourse during the last 4 months (75% of them in the receptive role). Reporting sex in public places consistently predicted riskier behavior by any of the three indices, whereas a lower perception of benefits of condoms/safer sex, poor AIDS knowledge, participation in a steady relationship and higher self-efficacy were associated with one or two of the indices. CONCLUSIONS: Besides considering basic AIDS information and the promotion of condoms and safer sex, intervention programs for homosexually active men in Lima should emphasize the need for open discussions on safety in steady relationships, promote accurate perceptions of personal risk and sensitively address the special difficulties posed by sexual activity in public places.

Young people and the structure of sexual risks in Lima.

OBJECTIVES: (1) To describe psychosocial variables related to sexual activity and the prevalence of contextual factors (e.g. coercion, paid sex and drug/alcohol use) and various sexual experiences among young men and women in Lima; and (2) to assess the relationship between psychosocial, contextual and behavioral factors on one hand and negative sexual health events such as unplanned pregnancies and sexually transmitted diseases (STDs) on the other hand. DESIGN: A cross-sectional serosurvey complemented with focus groups and in-depth interviews. SUBJECTS AND METHODS: A total of 611 adolescents (16-17 years old) and 607 young adults (19-30 years old) were recruited randomly from among those registering for military service (adolescents) or seeking work/study permits (young adults). These subjects were asked to fill out a self-administered questionnaire with detailed information on sexual experiences and psychosocial variables. The response rates were 98% (adolescents) and 82% (young adults). A subsample of 858 subjects provided blood specimens, which were analyzed for antibodies to HIV-1, the hepatitis B virus and syphilis. The relationship between the main study variables and sociodemographic indicators was also assessed, and multivariate analysis was used to identify those variables associated with sexual health problems. A preliminary qualitative phase helped in the questionnaire design and in interpreting survey findings. RESULTS: Thirty-four percent of adolescents and 75% of young adults were sexually experienced. The prevalence of bisexual behavior was high, particularly among males (12%). The males often reported paid sex (47%) and the females often reported sexual coercion (47%). Among the heterosexually active, only 11% reported consistent use of condoms. While 22% of the heterosexually active reported an unplanned pregnancy in self (females) or partner (males), 18% of the sexually active reported a history of STD symptoms or diagnoses. Among the sexually active who gave a blood sample, 0.2% were positive for HIV, 6.7% for hepatitis B and 1.5% for syphilis. Those who experienced an unplanned pregnancy or STD symptoms or, for the subsample, were seropositive for HIV or other STDs, were more likely to perceive social norms as restricting condom use to casual sex, to be older, to combine sex with alcohol or drugs and to report a history of sexual coercion or of having paid or been paid for sex. For females only, engaging in sex at a younger age was a risk marker, while engaging in any homosexual activity was protective. CONCLUSIONS: Cultural norms that restrict condoms to casual sex may place many young people in Lima at risk of an unplanned pregnancy or STDs. Sexual behavior may be especially risky in a context of sexual coercion and paid sex, when sex is combined with drugs and alcohol, and when engaged in by younger females. Sexual health education should work to change such cultural norms and these risky contexts.

Evaluating a school-based intervention for STD/AIDS prevention in Peru.

PURPOSE: In a context of increasing HIV/STD risks among adolescents in Latin America, new conceptions of sequential "sex education" are needed. However, older adolescents must be reached through shorter programs. A quasi-experimental study was conducted to evaluate the impact of a short school-based STD/AIDS prevention program on knowledge, attitudes, and intended behavior among secondary students in Lima. METHODS: Aimed at empowering adolescents regarding their sexuality, improving knowledge and attitudes, and developing skills and prevention-oriented behavioral intentions, the program consisted of seven weekly two-hour sessions. Cost exclusive of research expenses was $3 per student reached. RESULTS: 1213 students from 14 schools participated in either the intervention or control groups. Significant changes in knowledge on sexuality and AIDS, erotophilia, acceptance of contraception, machismo, and discrimination against persons with HIV/AIDS were found in the intervention group, as compared to the control group. Self-efficacy and prevention-oriented behavioral intentions were significantly better in the intervention group. CONCLUSIONS: Owing to its effectiveness, acceptability, and low cost, this program may become useful in reaching adolescents unable to participate in longer-term sex education programs in Peru and elsewhere.

[Educational needs relative to human sexuality and AIDS among secondary school students and teachers in Lima]. / Necesidades educativas en relacion con la sexualidad humana y el SIDA entre estudiantes y profesores de escuela secundaria en Lima.

PIP: Between November 1989 and January 1990, a pilot study was conducted among state secondary school students and teachers in Lima Peru by questionnaires with the objective of determining their knowledge about human sexuality, sexual behavior, pregnancy, sexually transmitted diseases (STDs), AIDS, drug abuse, and sexual activity. 110 students (64 boys and 46 women) aged 13-18 of low and medium-low socioeconomic background from metropolitan Lima participated. 40 teachers (70% females) aged 40.1 + or - 9.3 years also took part. THe adolescent focus groups were anxious to talk openly about sexuality to dispel their doubts. The levels of knowledge reached 46% for human sexuality, 50% for physiology and pregnancy, 35% for STDs and preventive sexual behavior, 50-60% for AIDS (transmission and risk groups), and only 35% for prevention. 21 had heterosexual experiences: 19 males and 2 females. 6 youngsters had homosexual experiences: 4 males and 2 females, 3 of these also had heterosexual sex. 20 of students without sexual experience expressed on interest, in engaging in sexual behavior if they fell in love. 33 adolescents reported using alcohol, 1/4 of these had consumed more than 6 bottles the previous week. The report on drug use was low, because 32% failed to answer this question. 60-70% of the teachers knew about human sexuality, while 72% knew about AIDS. 76.5% of them considered sex education in schools inadequate. 88.2% thought that adolescents need an explicit preventive program which should start in primary school and continue through all grades. This would require additional school resources. The teachers deemed daily life more educational about sexuality than information from schools and universities. 52% said that AIDS education messages had to be clear about preventive sexual behavior. 32% believed that correct use of the condom had to be demonstrated in class. 78% identified the mass media for dissemination of AIDS information, and only 15% judged their knowledge about AIDS sufficient for imparting it to students.^ieng

Implementation effects of GFATM-supported HIV/AIDS projects on the health sector, civil society and affected communities in Peru 2004-2007.

The emergence of opportunities for support from the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) for HIV-related projects has so far generated funding of over US$75 million for three proposals in Peru. The size of this investment creates the need for close monitoring to ensure a reasonable impact. This paper describes the effects of collaboration with the GFATM on key actors involved in HIV-related activities and on decision-making processes; on health sector divisions; on policies and sources of financing; on equity of access; and on stigma and discrimination of vulnerable and affected populations. Data analysed included primary data collected through interviews with key informants, in-depth interviews and group discussions with vulnerable and affected populations, as well as several public documents. Multisectorality, encouraged by the GFATM, is incipient; centralist proposals with limited consultation, a lack of consensus and short preparation times prevail. No accountability mechanisms operate at the Country Coordinating Mechanism (CCM) level regarding CCM members or society as a whole. GFATM-funded activities have required significant input from the public sector, sometimes beyond the capacity of its human resources. A significant increase in HIV funding, in absolute amounts and in fractions of the total budget, has been observed from several sources including the National Treasury, and it is unclear whether this has implied reductions in the budget for other priorities. Patterns of social exclusion of people living with HIV/AIDS are diverse: children and women are more valued; while transgender persons and sex workers are often excluded.

The margin has many sides: diversity among gay and homosexually active men in Lima.

PIP: This study provides a perspective on the sexual culture, self-representations and behaviors of men who have sex with men. Focus groups and semi-structured interviews were conducted with gay-identified men from both working class and middle-class backgrounds, non-gay-identified men who had sex with men, "fletes" (young men who sell homosexual sex), and transvestites. Ages among the study group ranged from 18 to 35. Issues explored included homosexuality and bisexuality, sexual experiences, socialization and support networks, "fleteo" and prostitution, AIDS-related concerns, emotional attachment, sexual identity and self-image. Findings suggest that a unitary homosexual culture does not exist in Lima. Ideologies structuring relationships within homoerotic culture range from more the more traditional, in which relationships are organized according to gender-transformed relationships, whereby ordinary males performed as "activos" with feminized "pasivo" males, to contemporary Western patterns involving equals who are able to exchange sexual roles. Awareness of this diversity should facilitate the identification of different sexual health needs and the protection of sexual rights, leading to the development of programs more sensitive to the cultural heterogeneity of male homosexualities in Lima.^ieng