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“Manejar la Situacion”: Partner Notification, Partner Management, and Conceptual Frameworks for HIV/STI Control Among MSM in Peru

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Abstract

Previous analyses of partner notification (PN) have addressed individual, interpersonal, social, and structural issues influencing PN outcomes but have paid less attention to the conceptual framework of PN itself. We conducted 18 individual interviews and 8 group discussions, in a two-stage qualitative research process, to explore the meanings and contexts of PN for sexually transmitted infections (STI) among men who have sex with men (MSM) and men who have sex with men and women (MSMW) in Lima, Peru. Participants described PN as the open disclosure of private, potentially stigmatizing information that could strengthen or disrupt a partnership, structured by the tension between concealment and revelation. In addition to informing partners of an STI diagnosis, the act of PN was believed to reveal other potentially stigmatizing information related to sexual identity and practices such as homosexuality, promiscuity, and HIV co-infection. In this context, the potential development of visible, biological STI symptoms represented a risk for disruption of the boundary between secrecy and disclosure that could result in involuntary disclosure of STI status. To address the conflict between concealment and disclosure, participants cited efforts to “manejar la situacion” (manage the situation) by controlling the biological risks of STI exposure without openly disclosing STI status. We use this concept of “managing the situation” as a practical and theoretical framework for comprehensive Partner Management for HIV/STI control systems among MSM in Latin America.

Resumen

Los estudios previos sobre Notificación de Parejas (NP) han analizado aspectos del individuo, la relación interpersonal, la sociedad y los factores estructurales asociados a la ocurrencia de la NP; pero se han enfocado poco en el tema de la NP como acto en sí. Para explorar los significados y los contextos de la NP para las Infecciones de Transmisión Sexual (ITS) entre hombres que tienen sexo con hombres (HSH) y hombres que tienen sexo con hombres y mujeres (HSH/M) en Lima, Perú, realizamos 18 entrevistas individuales y 8 grupos focales en un proceso de investigación cualitativa de dos etapas. Los participantes describieron la NP como una revelación abierta de información privada y potencialmente estigmatizante que podría fortalecer o romper una relación de parejas. Aparte del diagnóstico de la ITS, el acto de la NP fue considerado como una revelación de otra información privada y potencialmente estigmatizante como la homosexualidad, la promiscuidad, y la infección con VIH. En este contexto, el desarrollo potencial de síntomas visibles de una ITS fue considerado como un quiebre del límite entre la confidencialidad y la divulgación que podría terminar con la notificación no intencional de una ITS. Para controlar la tensión entre la confidencialidad y la divulgación, muchos participantes se refirieron a sus esfuerzos para “manejar la situación” por controlar los riesgos biológicos de una ITS para sus parejas sin avisar abiertamente sobre su estatus de ITS. Nosotros usamos este concepto de “manejar la situación” como un marco teórico y práctico para ampliar el concepto desde la Notificacion hacia el Manejo de Parejas y mejorar los sistemas para el control de ITS entre HSH en Latinoamerica.

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Acknowledgments

Thanks to the staff of Asociacion Civil Impacta Salud y Educacion, Clara Sandoval and Mijail Garvich, and to the participants for sharing their lives with us. Funding provided by NIH K23 MH084611 as well as P30 MH58107, P30 AI028697, UL1 TR000124.

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Authors and Affiliations

  1. Division of Infectious Diseases and Program in Global Health, Department of Medicine, University of California, Los Angeles, 10833 Leconte Avenue, CHS 37-121, Los Angeles, CA, 90095, USA

    Jesse L. Clark & Amaya Perez-Brumer

  2. Unidad de Salud, Sexualidad y Desarrollo Humano, Universidad Peruana Cayetano Heredia, Lima, Peru

    Ximena Salazar

Authors
  1. Jesse L. Clark
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  2. Amaya Perez-Brumer
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  3. Ximena Salazar
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Correspondence to Jesse L. Clark.

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Clark, J.L., Perez-Brumer, A. & Salazar, X. “Manejar la Situacion”: Partner Notification, Partner Management, and Conceptual Frameworks for HIV/STI Control Among MSM in Peru. AIDS Behav 19, 2245–2254 (2015). https://doi.org/10.1007/s10461-015-1049-3

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