Reworking HIV/STI Prevention Priorities: Perceptions from Key Populations of Youth in Peru

Purpose

With the failure of the latest vaccine trial, HIV prevention efforts worldwide remain essential. Men who have sex with men (MSM) and sex workers appear to be overrepresented in new HIV/ STI cases in Peru.  Most of the HIV/STI prevention programs have been directed to these populations, but HIV incidence remains stable with at least 50% of new cases exposed to HIV before the age of 21. These statistics pointed to the importance of focusing on youth in HIV/STI prevention; however, youth participation in determining prevention priorities has been limited.  The purpose of this research was to determine HIV/STI prevention priorities by examining the perceived needs of key populations of youth in two geographically and culturally diverse cities in Peru.

Methods:

Focus groups in Lima and Ayacucho (n = 6) were conducted with youth (18-25 years old) that self-identified themselves as heterosexual (n = 20), gay (n = 16), and Trans (n = 30).  Additional data was collected from semi-structured interviews with key informants (activists, community workers, health officers) in both cities (n = 20). Two forums were also conducted to elicit community input on preliminary findings.  Focus groups and interviews were transcribed verbatim and coded using thematic analysis and informed by Baral et al’s (2013) multilayered Modified Social Ecological Model (MSEM) of HIV risks and prevention. The MSEM is composed of five layers of risk for HIV: individual, network, community, policy, and stage of the HIV epidemic.

Results:

Findings indicate that perception of HIV/STI risks and prevention strategies varied significantly amongst the three key populations of youth.  While heterosexual youth have the lowest risk at the level of the HIV epidemic, individual and network risks are high, as they do not practice safe sex approaches, overlooking potential heterosexual bridging of HIV infection. Gay youth, in particular MSM youth, had high risk at the level of the HIV epidemic, and despite better awareness  of safe sex measures, also had high risk at network levels because of HIV/STI prevalence in social/sexual networks that can result in transmission of HIV/STI.  Trans youth had the highest risk at the level of the HIV epidemic as well as individual, network and community levels because of commonly unprotected sex work and discrimination from employment and other social roles.  All groups disregarded transmission vehicles such as tattoos or drug injections. However, all coincide on priorities such as education for families on sexually diverse identities, and safeguarding the health rights of LGBT youth.

Implications:

Findings highlight the importance of immediate social networks surrounding HIV/STI prevention, particularly for addressing homophobia and HIV stigma, given their role in providing a safe space to discuss sexual health and sexual diversity for youth. By providing support and public education to families and communities, social workers can help youth to better utilize HIV/STI prevention strategies, in particular LGBTQ  youth . This study points out the importance of interdisciplinary collaborations to address the complexity of the global HIV epidemic, by developing unique models for specific populations to identify relevant risk contexts.