Structural Factors That Increase HIV/STI Vulnerability Among Indigenous Men-Who-Have-Sex-with-Men in Latin America
Methods: Throughout 2009-10, we purposively recruited indigenous MSM. The study took place throughout the Peruvian Amazon region, and in the Guatemalan highlands. Semi-structured in-depth interviews were conducted with indigenous men, who consented to voluntarily participate in the study. Indigenous MSM in Peru (n=34) represented 8 ethnic groups. In Guatemala, indigenous MSM (n=8) represented 3 ethnic groups.
Results: The qualitative data revealed a complex set of structural factors that give rise to environments of risk, where the health of indigenous MSM is constantly challenged. Extreme poverty, lack of educational and employment opportunities, lack of health services in indigenous villages, and increasing discrimination impel people to migrate to larger cities. In both countries, participants saw migration to the city as an escape from oppressive forces in the community. In the city, however, participants were often exposed to risky settings where heavy drinking and unprotected sex, including transactional sex, are common.
Conclusions and Implications: This study found that the combination of poverty, lack of educational and employment opportunities, discrimination, cultural beliefs related to health and sexual behaviors, and people mobility and mixing along Amazonian rivers in Peru, and highland towns in Guatemala give rise to environments of risk where HIV/STI prevention knowledge is minimal and the opportunities for disease transmission are abundant. The findings provide important insights, not only into the pernicious contextual circumstances in which marginalized populations struggle for health and wellness, but also into factors that may be amenable to HIV/STI prevention strategies that are culturally and contextually grounded in the local situation. For indigenous MSM, current HIV prevention efforts are unlikely to be effective if the structural factors that increase their vulnerability for diseases are not addressed. Multi-level, combination prevention strategies that integrate empirically based interventions with traditional indigenous knowledge have the potential to not only reduce vulnerability to HIV/STI transmission, but also alter the nature of the structural determinants of indigenous people's health.