AIDS and Behavior

, Volume 17, Issue 4, pp 1313–1328 | Cite as

Moderno Love: Sexual Role-Based Identities and HIV/STI Prevention Among Men Who Have Sex with Men in Lima, Peru

  • Jesse Clark
  • Javier Salvatierra
  • Eddy Segura
  • Ximena Salazar
  • Kelika Konda
  • Amaya Perez-Brumer
  • Eric Hall
  • Jeffrey Klausner
  • Carlos Caceres
  • Thomas Coates
Original Paper


Role-based sexual identities structure male same-sex partnerships and influence HIV/STI epidemiology among MSM in Latin America. We explored shifting relationships between sexual roles, identities and practices among MSM in Lima, Peru, and implications for HIV/STI prevention. Patterns of HIV/STI epidemiology reflected differential risks for transmission within role-based partnerships with relatively low prevalences of HIV, syphilis, and HSV-2 but higher prevalences of urethral gonorrhea/chlamydia among activo MSM compared with moderno and pasivo participants. Qualitative analysis of how MSM in Peru integrate sexual identities, roles, and practices identified four key themes: pasivo role as a gay approximation of cultural femininity; activo role as a heterosexual consolidation of masculinity; moderno role as a masculine reconceptualization of gay identity; and role-based identities as social determinants of partnership, network, and community formation. The concept of role-based sexual identities provides a framework for HIV prevention for Latin American MSM that integrates sexual identities, practices, partnerships, and networks.


HIV STI MSM Sexual role Peru 


Las identidades basadas en roles sexuales forman la estructura de las relaciones de pareja e influyen en la epidemiología del VIH/ITS entre HSH en América Latina. Se exploró la relación cambiante entre roles, identidades, y practicas sexuales en HSH en Lima, Perú y las implicaciones para la prevención del VIH. Los patrones epidemiológicos del VIH/ITS mostraron diferencias en riesgos de transmisión en parejas definidas por roles sexuales con una prevalencia relativamente baja de VIH, sífilis, y HSV-2, pero una prevalencia alta de gonorrea/clamidia uretral en HSH activos en comparación a modernos y pasivos. El análisis cualitativo de como los HSH en el Perú integran sus identidades, roles y practicas identificó cuatro ejes temáticos: El rol pasivo como una aproximación gay de la feminidad cultural; el rol activo como una consolidación heterosexual de la masculinidad; el rol moderno como una reconceptualización masculina de la identidad gay; y las identidades basadas en roles sexuales como determinantes de la formación de parejas, redes, y comunidades. El concepto de identidades sexuales basadas en roles sexuales ofrece un marco analítico para la prevención del VIH entre HSH Latinoamericanos que puede integrar las identidades, prácticas, parejas, y redes sexuales.



We would like to thank Ms. Patricia Arana, Ms. Vicki Solari, Dr. Doris Chunga, and the staff of the CERITS Barton for their work in completing the study protocols; Dr. Silvia Montano and the staff of the Bacteriology and Virology laboratories of the U.S. Naval Medical Research Unit-6 in Lima, Peru for testing of biological specimens; and Dr. Angela Bayer for her assistance with qualitative analysis. We would like to thank all of the participants for sharing their lives with us.Funding support provided by NIH grants T32 MH 080634 (JLC and KAK) and K23 MH 084611 (JLC).


The views expressed in this article are those of the author and do not necessarily reflect the official policy or position of the Department of the Navy, Department of Defense, nor the U.S. Government.


  1. 1.
    Almaguer T. Chicano men: a cartography of homosexual identity and behavior. Differences. 1991;3(2):75–100.Google Scholar
  2. 2.
    Carrier JM. Participants in urban Mexican male homosexual encounters. Arch Sex Behav. 1971;1(4):279–91.CrossRefGoogle Scholar
  3. 3.
    Carrier JM. Cultural factors affecting urban Mexican male homosexual behavior. Arch Sex Behav. 1976;5(2):103–24.PubMedCrossRefGoogle Scholar
  4. 4.
    Lancaster RN. Subject honor and object shame: the construction of male homosexuality and stigma in Nicaragua. Ethnology. 1988;27(2):111–21.CrossRefGoogle Scholar
  5. 5.
    Kutsche P, Page JB. Male sexual identity in Costa Rica. Lat Am Anthropol Rev. 1991;3(1):7–14.CrossRefGoogle Scholar
  6. 6.
    Carballo-Dieguez A, Remien RH, Dolezal C, Wagner G. Unsafe sex in the primary relationships of Puerto Rican men who have sex with men. AIDS Behav. 1997;1(1):9–17.CrossRefGoogle Scholar
  7. 7.
    Izazola-Licea JA, Gortmaker SL, de Gruttola V, Tolbert K, Mann J. Sexual behavior patterns and HIV risks in bisexual men compared to exclusively heterosexual and homosexual men. Salud Publica Mex. 2003;45(Supp 5):S662–71.PubMedCrossRefGoogle Scholar
  8. 8.
    Kendall T, Herrera C, Caballero M, Campero L. HIV prevention and men who have sex with women and men in Mexico: findings from a qualitative study with HIV-positive men. Cult Health Sex. 2007;9(5):459–72.PubMedCrossRefGoogle Scholar
  9. 9.
    Klein C. The ghetto is over, darling: emerging gay communities and gender and sexual politics in contemporary Brazil. Cult Health Sex. 1999;1:239–60.PubMedCrossRefGoogle Scholar
  10. 10.
    Parker RG. Bodies, pleasures, and passions: sexual culture in contemporary Brazil. Boston: Beacon Press; 1991.Google Scholar
  11. 11.
    Carrillo H. The night is young: sexuality in Mexico in the time of AIDS. Chicago: University of Chicago Press; 2002.Google Scholar
  12. 12.
    Munoz-Laboy M. Beyond ‘MSM’: sexual desire among bisexually-active men in New York City. Sexualities. 2004;7(1):55–80.CrossRefGoogle Scholar
  13. 13.
    Padilla M, Castellanos D, Guilamo-Ramos V, Reyes AM, Sanchez Marte LE, Soriano MA. Stigma, social inequality, and HIV risk disclosure among Dominican male sex workers. Soc Sci Med. 2008;67(3):380–8.PubMedCrossRefGoogle Scholar
  14. 14.
    Prieur A. Bodily and symbolic constructions among homosexual men in Mexico. Sexualities. 1998;3:287–98.CrossRefGoogle Scholar
  15. 15.
    Reisen CA, Zea MC, Bianchi FT, Poppen PJ, Shedlin MG, Penha MM. Latino gay and bisexual men’s relationships with non-gay-identified men who have sex with men. J Homosex. 2010;57(8):1004–21.PubMedCrossRefGoogle Scholar
  16. 16.
    Parker R. Sexuality, culture, and power in HIV/AIDS research. Ann Rev Anthropol. 2001;30:163–79.CrossRefGoogle Scholar
  17. 17.
    Parker R, Khan S, Aggleton P. Conspicuous by their absence? Men who have sex with men (MSM) in developing countries: implications for HIV prevention. Crit Public Health. 1998;8(4):329–46.CrossRefGoogle Scholar
  18. 18.
    Parker RG. Behaviour in Latin American men: implications for HIV/AIDS interventions. Int J STD AIDS. 1996;7(Suppl 2):62–5.PubMedCrossRefGoogle Scholar
  19. 19.
    Liguori AL. Las investigaciones sobre bisexualidad en Mexico. Debate Fem. 2005;11(6):132–56.Google Scholar
  20. 20.
    Caceres CF, Rosasco AM. The margin has many sides: diversity among gay and homosexually active men in Lima. Cult Health Sex. 1999;1(3):261–75.PubMedCrossRefGoogle Scholar
  21. 21.
    Caceres CF. HIV among gay and other men who have sex with men in Latin America and the Caribbean: a hidden epidemic? AIDS. 2002;16(Suppl 3):S23–33.PubMedCrossRefGoogle Scholar
  22. 22.
    Carballo-Dieguez A, Dolezal C, Nieves L, Diaz F, Decena C, Balan I. Looking for a tall, dark, macho man: sexual-role behaviour variations in Latino gay and bisexual men. Cult Health Sex. 2004;6(2):159–71.CrossRefGoogle Scholar
  23. 23.
    Carrillo H. Cultural change, hybridity and male homosexuality in Mexico. Cult Health Sex. 1999;1(3):223–38.PubMedCrossRefGoogle Scholar
  24. 24.
    Diaz RM. Latino gay men and HIV. New York: Routledge; 1998.Google Scholar
  25. 25.
    Parker RG. Beneath the equator: cultures of desire, male homosexuality, and emerging gay communities in Brazil. New York: Routledge; 1999.Google Scholar
  26. 26.
    Diaz RM, Ayala G, Bein E, Henne J, Marin BV. The impact of homophobia, poverty, and racism on the mental health of gay and bisexual Latino men: findings from 3 US cities. Am J Public Health. 2001;91(6):927–32.PubMedCrossRefGoogle Scholar
  27. 27.
    O’Donnell L, Agronick G, San Doval A, Duran R, Myint UA, Stueve A. Ethnic and gay community attachments and sexual risk behaviors among urban Latino young men who have sex with men. AIDS Educ Prev. 2002;14(6):457–71.PubMedCrossRefGoogle Scholar
  28. 28.
    Agronick G, O’Donnell L, Stueve A, Doval AS, Duran R, Vargo S. Sexual behaviors and risks among bisexually- and gay-identified young Latino men. AIDS Behav. 2004;8(2):185–97.PubMedCrossRefGoogle Scholar
  29. 29.
    Finlinson HA, Colon HM, Robles RR, Soto M. Sexual identity formation and AIDS prevention: an exploratory study of non-gay-identified Puerto Rican MSM from working class neighborhoods. AIDS Behav. 2006;10(5):531–9.PubMedCrossRefGoogle Scholar
  30. 30.
    Bianchi FT, Reisen CA, Zea MC, Poppen PJ, Shedlin MG, Penha MM. The sexual experiences of Latino men who have sex with men who migrated to a gay epicentre in the USA. Cult Health Sex. 2007;9(5):505–18.PubMedCrossRefGoogle Scholar
  31. 31.
    Padilla MB, Guilamo-Ramos V, Bouris A, Reyes AM. HIV/AIDS and tourism in the Caribbean: an ecological systems perspective. Am J Public Health. 2010;100(1):70–7.PubMedCrossRefGoogle Scholar
  32. 32.
    Caceres CF, Hearst N. HIV/AIDS in Latin America and the Caribbean: an update. AIDS. 1996;10(Suppl A):S43–9.PubMedCrossRefGoogle Scholar
  33. 33.
    Clark JL, Caceres CF, Lescano AG, et al. Prevalence of same-sex sexual behavior and associated characteristics among low-income urban males in Peru. PLoS ONE. 2007;2(1):e778.PubMedCrossRefGoogle Scholar
  34. 34.
    Fernandez-Davila P, Salazar X, Caceres CF, et al. Compensated sex and sexual risk: sexual, social and economic interactions between homosexually and heterosexually-identified men of low income in Peru. Sexualities. 2008;11(3):352–74.PubMedCrossRefGoogle Scholar
  35. 35.
    Konda KA, Lescano AG, Leontsini E, et al. High rates of sex with men among high-risk, heterosexually-identified men in low-income, coastal Peru. AIDS Behav. 2008;12(3):483–91.PubMedCrossRefGoogle Scholar
  36. 36.
    Salazar X, Caceres C, Maiorana A, Rosasco AM, Kegeles S, Coates T. Influence of socio-cultural context on risk perception and negotiation of protection among poor homosexual males on the Peruvian coast. Cad Saude Publica. 2006;22(10):2097–104.PubMedCrossRefGoogle Scholar
  37. 37.
    Silva-Santisteban A, Raymond HF, Salazar X, et al. Understanding the HIV/AIDS epidemic in transgender women of Lima, Peru: results from a sero-epidemiologic study using respondent driven sampling. AIDS Behav. 2012;16(4):872–81.PubMedCrossRefGoogle Scholar
  38. 38.
    Ramirez-Valles J, Garcia D, Campbell RT, Diaz RM, Heckathorn DD. HIV infection, sexual risk behavior, and substance use among Latino gay and bisexual men and transgender persons. Am J Public Health. 2008;98(6):1036–42.PubMedCrossRefGoogle Scholar
  39. 39.
    Munoz-Laboy M, Dodge B. Bisexual Latino men and HIV and sexually transmitted infections risk: an exploratory analysis. Am J Public Health. 2007;97(6):1102–6.PubMedCrossRefGoogle Scholar
  40. 40.
    Zellner JA, Martinez-Donate AP, Sanudo F, et al. The interaction of sexual identity with sexual behavior and its influence on HIV risk among latino men: results of a community survey in northern San Diego County, California. Am J Public Health. 2009;99(1):125–32.PubMedCrossRefGoogle Scholar
  41. 41.
    Tabet SR, de Moya EA, Holmes KK, et al. Sexual behaviors and risk factors for HIV infection among men who have sex with men in the Dominican Republic. AIDS. 1996;10(2):201–6.PubMedCrossRefGoogle Scholar
  42. 42.
    Kim EJ, Creswell J, Guardado ME, et al. Correlates of bisexual behaviors among men who have sex with men in El Salvador. AIDS Behav. 2012. [Epub ahead of print].Google Scholar
  43. 43.
    Tabet S, Sanchez J, Lama J, et al. HIV, syphilis and heterosexual bridging among Peruvian men who have sex with men. AIDS. 2002;16(9):1271–7.PubMedCrossRefGoogle Scholar
  44. 44.
    Sanchez J, Lama JR, Kusunoki L, et al. HIV-1, sexually transmitted infections, and sexual behavior trends among men who have sex with men in Lima, Peru. J Acquir Immune Defic Syndr. 2007;44(5):578–85.PubMedCrossRefGoogle Scholar
  45. 45.
    Tun W, de Mello M, Pinho A, Chinaglia M, Diaz J. Sexual risk behaviours and HIV seroprevalence among male sex workers who have sex with men and non-sex workers in Campinas, Brazil. Sex Transm Infect. 2008;84(6):455–7.PubMedCrossRefGoogle Scholar
  46. 46.
    Goodreau SM, Goicochea LP, Sanchez J. Sexual role and transmission of HIV Type 1 among men who have sex with men, in Peru. J Infect Dis. 2005;191(Suppl 1):S147–58.PubMedCrossRefGoogle Scholar
  47. 47.
    Goodreau SM, Peinado J, Goicochea P. Role versatility among men who have sex with men in urban Peru. J Sex Res. 2007;44(3):233–9.PubMedCrossRefGoogle Scholar
  48. 48.
    Instituto Nacional de Estadistica e Informatica. Mapa de Necesidades Basicas Insatisfechas de los Hogares a Nivel Distrital. Accessed 24 Feb 2012.
  49. 49.
    Barros AJ, Hirakata VN. Alternatives for logistic regression in cross-sectional studies: an empirical comparison of models that directly estimate the prevalence ratio. BMC Med Res Methodol. 2003;20(3):21.CrossRefGoogle Scholar
  50. 50.
    Strauss A, Corbin J. Basics of qualitative research: grounded theory procedures and techniques. 2nd ed. Thousand Oaks: Sage; 1998.Google Scholar
  51. 51.
    Baggaley RF, White RG, Boily MC. HIV transmission risk through anal intercourse: systematic review, meta-analysis and implications for HIV prevention. Int J Epidemiol. 2010;39(4):1048–63.PubMedCrossRefGoogle Scholar
  52. 52.
    Trichopoulos D, Sparos L, Petridou E. Homosexual role separation and spread of AIDS. Lancet. 1988;2(8617):965–6.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Jesse Clark
    • 1
  • Javier Salvatierra
    • 2
  • Eddy Segura
    • 1
  • Ximena Salazar
    • 2
  • Kelika Konda
    • 1
  • Amaya Perez-Brumer
    • 1
  • Eric Hall
    • 3
  • Jeffrey Klausner
    • 1
  • Carlos Caceres
    • 2
  • Thomas Coates
    • 1
  1. 1.Program in Global Health, Division of Infectious Diseases, Department of Medicine, David Geffen School of MedicineUniversity of California, Los AngelesLos AngelesUSA
  2. 2.Instituto de Estudios en Salud, Sexualidad y Desarollo HumanoUniversidad Peruana Cayetano HerediaLimaPeru
  3. 3.U.S. Naval Medical Research CenterBethesdaUSA

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