MEMORIA DEL ORGANISMO ANDINO DE SALUD CONVENIO HIPÓLITO UNANUE 1971­2021: ORAS-CONHU 2022 / 5 0 a ñ o s t r a b a ja n d o p o r la s a lu d, e l b ie n e s t a r y la in t e g r a c ió n a n d in a / ANNUAL REPORT OF THE ANDEAN HEALTH AGENCY HIPÓLITO UNANUE AGREEMENT 1971 ­ 2021 ORAS-CONHU; 2022

La presente publicación da cuenta de los principales hitos y logros obtenidos a través de las diferentes gestiones institucionales en los últimos cincuenta años. Estos sintetizan las apuestas y retos en la búsqueda de salud para todos, con sistemas nacionales de salud más accesibles y con el fortalecimiento de la ciudadanía en este terreno, coadyuvando a superar las brechas para alcanzar mayores niveles de equidad y bienestar para cada una de las personas. Ello permitirá enfrentar la actual pandemia con mayor eficacia, en estos tiempos, marcados por la emergencia, la experiencia y el compromiso de servicio, el ORAS-CONHU seguirá contribuyendo en responder los nuevos retos de los países andinos

HPV vaccine knowledge and acceptability among Peruvian men who have sex with men and transgender women: A pilot, qualitative study.

PURPOSE: Human papillomavirus (HPV) is the most common sexually transmitted infection globally and is responsible for a variety of cancers in men and women. An effective HPV vaccine licensed for use in girls and boys has been indicated for-but is not widely implemented in-men who have sex with men (MSM). Limited data are available for transgender women (TW). We explored the social and behavioral aspects related to HPV vaccine uptake and participation in HPV vaccine studies among Peruvian MSM and TW. METHODS: Focus groups and individual in-depth interviews were conducted to obtain the knowledge, thoughts, and opinions from Peruvian MSM and TW regarding HPV vaccination. Data were analyzed using systematic comparative and descriptive content analysis. RESULTS: Three focus groups and fifteen individual in-depth interviews were conducted among 36 MSM and TW. Participant mean age was 26 years (range 18-40). Though many participants were unfamiliar with HPV vaccination, most expressed positive attitudes. Participants expressed concerns about the potential for stigma when disclosing HPV vaccination. CONCLUSION: Peruvian MSM and TW felt that HPV vaccination would be acceptable to themselves and their peers. Nonetheless, vaccine intake may be impeded by potential stigma. Findings from this study may guide HPV vaccine implementation in similar populations.

Transactional sex and prevalence of STIs: a cross-sectional study of MSM and transwomen screened for an HIV prevention trial.

Few studies have characterised the degree of engagement in transactional sex among men and transgender women who have sex with men and explored its association with sexually transmitted infections and human immunodeficiency virus in Ecuador. We screened 642 men who have sex with men and transgender women for a pre-exposure prophylaxis clinical trial (iPrEx) in Guayaquil, Ecuador, 2007-2009. We analysed the association of degree of engagement in transactional sex and prevalence of sexually transmitted infections including human immunodeficiency virus using chi-square and analysis of variance tests. Although just 6.2% of those who screened self-identified as sex workers, 52.1% reported having engaged in transactional sex. Compared to those who had never been paid for sex, those who had been paid were more likely to have a sexually transmitted infection (56.6% vs. 45.0%, p = 0.007) and trended towards a higher human immunodeficiency virus prevalence (16.6% vs. 10.4%, p = 0.082) at screening. Transgender women compared to other men who have sex with men were more likely to have sexually transmitted infections diagnosed at screening (75.6% vs. 50.0%, p = 0.001). Transactional sex is practiced widely but occasionally among the men who have sex with men and transgender women in Guayaquil who screened for the iPrEx study; however, engaging in transactional sex may not lead to a sex worker self-identification. Both transactional sex and being a transgender woman are associated with sexually transmitted infections prevalence.

Preparing for rectal microbicides: sociocultural factors affecting product uptake among potential South American users.

OBJECTIVES: We examined views on rectal microbicides (RMs), a potential HIV prevention option, among men who have sex with men and transgender women in 3 South American cities. METHODS: During September 2009 to September 2010, we conducted 10 focus groups and 36 in-depth interviews (n = 140) in Lima and Iquitos, Peru, and Guayaquil, Ecuador, to examine 5 RM domains: knowledge, thoughts and opinions about RM as an HIV prevention tool, use, condoms, and social concerns. We coded emergent themes in recorded and transcribed data sets and extracted representative quotes. We collected sociodemographic information with a self-administered questionnaire. RESULTS: RM issues identified included limited knowledge; concerns regarding plausibility, side effects, and efficacy; impact on condom use; target users (insertive vs receptive partners); and access concerns. CONCLUSIONS: Understanding the sociocultural issues affecting RMs is critical to their uptake and should be addressed prior to product launch.

Rectal douching and implications for rectal microbicides among populations vulnerable to HIV in South America: a qualitative study.

OBJECTIVE: While gel-formulated rectal microbicides (RM) are the first to enter clinical trials, rectal douching in preparation for anal intercourse is a common practice; thus RMs formulated as douches may be a convenient alternative to gels. Nonetheless, little is known about potential users' thoughts regarding douche-formulated RMs or rectal douching practices, data that is needed to inform the advancement of douche-based RMs. This qualitative study examined thoughts regarding douches, their use as an RM and current douching practices among men who have sex with men and transgender women. METHODS: 12 focus groups and 36 in-depth interviews were conducted (N=140) to examine the overall acceptability of RM, of which one component focused on rectal douching. Focus groups and interviews were recorded, transcribed verbatim and coded; text relating to rectal douching was extracted and analysed. Sociodemographic information was collected using a self-administered questionnaire. RESULTS: Support for a douche-formulated RM centred on the possibility of combined precoital hygiene and HIV protection, and it was believed that a deeply penetrating liquid douche would confer greater HIV protection than a gel. Drawbacks included rectal dryness, impracticality and portability issues, and potential side effects. Non-commercial douching apparatus use was common and liquids used included detergents, vinegar, bleach, lemon juice and alcohol. CONCLUSIONS: A douche-formulated RM, while desirable and perceived as more effective than a gel-formulated RM, also generated questions regarding practicality and side effects. Of immediate concern were the non-commercial liquids already being used that likely damage rectal epithelia, potentially increasing HIV infection risk. Precoital rectal douching is common and an RM formulated as such is desirable, but education on rectal douching practices is needed now.

HPV and genital warts among Peruvian men who have sex with men and transgender people: knowledge, attitudes and treatment experiences.

BACKGROUND: Several studies have assessed the epidemiology of HPV infection among MSM, but no qualitative studies have specifically assessed how HPV and genital warts (GW) affect South American men who have sex with men (MSM) and male-to-female transgendered women (TG). This study explored the knowledge, attitudes and experiences of Peruvian MSM and TG regarding HPV and GW. METHODS: We performed a qualitative study consisting of fifteen in-depth interviews and three focus groups carried out in Lima, Peru with diverse MSM and TG groups, including sex workers. Resulting data were analyzed by applying a systematic comparative and descriptive content analysis. RESULTS: While knowledge of HPV was limited, awareness of GW was common, particularly among TG persons and sex workers. Still, few participants recognized that GW are sexually transmitted, and many had problems differentiating between GW and other STI/anogenital conditions. Stigmatizing experiences were common during sexual encounters with people who had visible GW. Shame, emotional and physical troubles, and embarrassing sexual experiences were reported by individuals with GW. Search for treatment was mediated by peers, but stigma and apparent health services' inability to deal with GW limited the access to effective medical care. CONCLUSIONS: In Peru, public health interventions should strengthen services for HPV/GW management and increase accurate knowledge of the transmission, treatment, and sequelae of HPV/GW in MSM and TG populations.

Using conjoint analysis to measure the acceptability of rectal microbicides among men who have sex with men in four South American cities.

Conjoint Analysis (CJA), a statistical market-based technique that assesses the value consumers place on product characteristics, may be used to predict acceptability of hypothetical products. Rectal Microbicides (RM)-substances that would prevent HIV infection during receptive anal intercourse-will require acceptability data from potential users in multiple settings to inform the development process by providing valuable information on desirable product characteristics and issues surrounding potential barriers to product use. This study applied CJA to explore the acceptability of eight different hypothetical RM among 128 MSM in Lima and Iquitos, Peru; Guayaquil, Ecuador; and Rio de Janeiro, Brazil. Overall RM acceptability was highest in Guayaquil and lowest in Rio. Product effectiveness had the greatest impact on acceptability in all four cities, but the impact of other product characteristics varied by city. This study demonstrates that MSM from the same region but from different cities place different values on RM characteristics that could impact uptake of an actual RM. Understanding specific consumer preferences is crucial during RM product development, clinical trials and eventual product dissemination.

Diversity of commercial sex among men and male-born trans people in three Peruvian cities.

In Peru, commercial sex involving men and male-born travestis, transgenders and transsexuals (CSMT) is usually represented as a dangerous practice carried out on the streets by people experiencing economic hardship and social exclusion. However, in reality little is known about the complexities of this practice in Peru. This paper presents findings from an ethnographic study of the characteristics, patterns and sociocultural aspects of CSMT in three Peruvian cities. The study included participant observation in sex work venues and interviews with 42 sex workers and 25 key informants. We found that CSMT in Peru takes many forms (some not previously described in the country) and is practised in different places by people from various socioeconomic levels. In many cases, the practice appears linked to ideals of social mobility, migratory experiences and other economic activities. In addition, the increasing use of the Internet and mobile phones has changed patterns of sex work in Peru. We review the implications of these findings for future research and public health interventions.

Incorporación del enfoque intercultural en el sistema de salud peruano: la atención del parto vertical / Incorporation of an intercultural approach in the Peruvian health care system: the vertical birth method

Peru has a large indigenous population (40 percent of the total), made of 72 distinct groups. These peoples are at a great disadvantage compared to the mestizos and other groups that are more closely connected with the dominant culture. The political and economic inequality and inequities are particularly stark with regard to health conditions. National policy and plans have not considered the indigenous peoples' values and identity, nor their right to self-determination and control of their land and resources, and even less so, their health knowledge and practices, inasmuch western "modern medicine" has been imposed upon them by the dominant culture. Since 1992, as a result of international forums and academia, as well as a growing movement in Peru to acknowledge the value of cultural diversity and the rights of indigenous peoples, Government proposals, initiatives, and programs were undertaken to incorporate and empower cultural contributions and traditional practices in a way that would not only benefit the indigenous, but also enrich, through various intercultural venues, the stock of cultural traditions and ethnic roots of the greater Peruvian society. This article explores specifically how these intercultural strategies have been rolled out in health care to institutionalize the vertical birth method in rural, predominantly indigenous, communities, and endeavors to assess the decrease in maternal mortality, as well as the difficulties encountered, and mostly overcome, by expressing multiculturalism in the health field.

[Incorporation of an intercultural approach in the Peruvian health care system: the vertical birth method]. / Incorporación del enfoque intercultural en el sistema de salud peruano: la atención del parto vertical.

Peru has a large indigenous population (40% of the total), made of 72 distinct groups. These peoples are at a great disadvantage compared to the mestizos and other groups that are more closely connected with the dominant culture. The political and economic inequality and inequities are particularly stark with regard to health conditions. National policy and plans have not considered the indigenous peoples' values and identity, nor their right to self-determination and control of their land and resources, and even less so, their health knowledge and practices, inasmuch western 'modern medicine' has been imposed upon them by the dominant culture. Since 1992, as a result of international forums and academia, as well as a growing movement in Peru to acknowledge the value of cultural diversity and the rights of indigenous peoples, Government proposals, initiatives, and programs were undertaken to incorporate and empower cultural contributions and traditional practices in a way that would not only benefit the indigenous, but also enrich, through various intercultural venues, the stock of cultural traditions and ethnic roots of the greater Peruvian society. This article explores specifically how these intercultural strategies have been rolled out in health care to institutionalize the vertical birth method in rural, predominantly indigenous, communities, and endeavors to assess the decrease in maternal mortality, as well as the difficulties encountered, and mostly overcome, by expressing multiculturalism in the health field.