Facultad de Salud Publica y Admnistración

Gastroenterology, Volume 136, Issue 5, Pages A-864, May 2009, Authors:Cesar P. Carcamo; Carlos Appiani; Patricia J. Garcia; Raul Gutierrez; Nancy Cure-Bolt; Marina Chiappe; Antonio Bernabe; Armando Cotrina; Roberto Orellana; Isaac Alva; Marco A. Gonzales; Geoff P ...

We examined structural factors-social, political, economic, and environmental-that increase vulnerability to HIV among indigenous people in the Peruvian Amazon. Indigenous adults belonging to 12 different ethnic groups were purposively recruited in four Amazonian river ports and 16 indigenous villages. Qualitative data revealed a complex set of structural factors that give rise to environments of risk where health is constantly challenged. Ferryboats that cross Amazonian rivers are settings where unprotected sex-including transactional sex between passengers and boat crew and commercial sex work-often take place. Population mobility and mixing also occurs in settings like the river docks, mining sites, and other resource extraction camps, where heavy drinking and unprotected sex work are common. Multilevel, combination prevention strategies that integrate empirically based interventions with indigenous knowledge are urgently needed, not only to reduce vulnerability to HIV transmission, but also to eliminate the structural determinants of indigenous people's health.

In Peru, current interventions in high-risk men who have sex with men (MSM) reach a limited number of this population because they rely solely on peer education. The objective of this study was to assess the use of the internet as an alternative tool to access this population. Two nearly identical banner ads-both advertising an online survey but only one offering free HIV/syphilis tests and condoms-were displayed randomly on a Peruvian gay website. The inclusion of the health incentive increased the frequency of completed surveys (5.8% vs 3.4% of delivered impressions; p<0.001), attracting high-risk MSM not previously tested for HIV but interested in a wide variety of preventive Web-based interventions. Eleven per cent (80/713) of participants who said they had completed the survey offering free testing visited our clinic: of those who attended, 6% had already been diagnosed as having HIV, while 5% tested positive for HIV. In addition, 8% tested positive for syphilis. The interne...

Elevated rates of HIV and STIs have been reported in the Peruvian Amazon; indigenous populations have not been exempt. This study aimed to increase understanding of indigenous health practitioners' experiences and insights about HIV and STIs in their communities. In June and July of 2009, we conducted 29 in-depth, semi-structured interviews with a purposive sample of health students, shamans and midwives from seven Amazonian ethnic groups (Achuar, Awajun, Quechua-Lamista, Murui, Shawi, Shipibo-Konibo, and Wampis) in four cities in Peru: Lima, Bagua, Pucallpa, and Iquitos. Participants from diverse geographic and cultural backgrounds were asked about their knowledge and perceptions of HIV and STIs in their communities. Interviews were transcribed and ATLAS.ti was used to conduct a conventional content analysis. We found: 1) indigenous populations lack education, outreach and care for HIV and STIs, and are uninformed or misinformed about HIV and STI etiology, modes of transmission...

Background: MSM are at substantially increased risk for HIV infection in virtually every study conducted in Latin America. HIV prevalence among MSM ranges from 12% to 22% in Peru, and 11.5% to 18.3% in Guatemala. In these countries, research on the impact of HIV among indigenous MSM is scarce, even though indigenous people constitute large proportions of the total populations of each of these countries. Common to populations heavily affected by HIV, and other sexually transmitted infections (STIs), is exposure to structural factors that increase their vulnerability to drug use and disease acquisition. Structural factors include social, political, economic, and environmental factors that operate at different ecosocial levels and shape the risks for drug use and HIV infection. Authors present data examining structural factors associated with increased HIV/STI vulnerability among indigenous MSM in Guatemala and Peru. Methods: Throughout 2009-13, we purposively recruited indigenous MSM....

ReSUMeN Objetivo: Evaluar el uso de Internet para buscar parejas sexuales e información sobre VIH/SIDA o infecciones de transmisión sexual (ITS) entre personas viviendo con VIH/SIDA (PVVS). Materiales y métodos: Entrevistamos a las PVVS que acudieron consecutivamente a Vía Libre en Lima Perú entre mayo y junio de 2004. Resultados: De las 100 PVVS (46 hombres que tienen sexo con hombres (HSH), 18 hombres heterosexuales y 36 mujeres), 59% reportó el uso de Internet en los últimos 12 meses. De ellos, la mayoría (73%) accedió a Internet en un lugar público; 16 (27,1%) reportaron haber buscado parejas sexuales en línea y cinco (8,5%) reportaron haber tenido sexo con una pareja que conocieron por Internet. Todas las PVVS que buscaron sexo en Internet fueron hombres, siendo el porcentaje de HSH significativamente mayor que la de heterosexuales (94% frente a 6%; p=0,032). Los cinco que reportaron haber tenido sexo con una pareja que conocieron en línea fueron HSH. De los que accedieron a In...

It is well recognised that unsafe abortions have significant implications for women's physical health; however, women's perceptions and experiences with abortion-related stigma and disclosure about abortion are not well understood. This paper examines the presence and intensity of abortion stigma in five countries, and seeks to understand how stigma is perceived and experienced by women who terminate an unintended pregnancy and influences her subsequent disclosure behaviours. The paper is based upon focus groups and semi-structured in-depth interviews conducted with women and men in Mexico, Nigeria, Pakistan, Peru and the United States (USA) in 2006. The stigma of abortion was perceived similarly in both legally liberal and restrictive settings although it was more evident in countries where abortion is highly restricted. Personal accounts of experienced stigma were limited, although participants cited numerous social consequences of having an abortion. Abortion-related stigma played an important role in disclosure of individual abortion behaviour.

Why is induced abortion common in environments in which modern contraception is readily available? This study analyses qualitative data collected from focus group discussions and in-depth interviews with women and men from low-income areas in five countries – the United States, Nigeria, Pakistan, Peru and Mexico – to better understand how couples manage their pregnancy risk. Across all settings, women and men rarely weigh the advantages and disadvantages of contraception and abortion before beginning a sexual relationship or engaging in sexual intercourse. Contraception is viewed independently of abortion, and the two are linked only when the former is invoked as a preferred means to avoiding repeat abortion. For women, contraceptive methods are viewed as suspect because of perceived side effects, while abortion experience, often at significant personal risk to them, raises the spectre of social stigma and motivates better practice of contraception. In all settings, male partners figure importantly in pregnancy decisions and management. Although there are inherent study limitations of small sample sizes, the narratives reveal psychosocial barriers to effective contraceptive use and identify nodal points in pregnancy decision-making that can structure future investigations.