Abstract
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.
Resumen
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.
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Notes
A note on terminology: we have chosen to use the term “MSM” throughout this paper to describe all male and male-to-female (m–f) transgender persons who have sex with male and/or m–f transgender partners. We are aware of the problems inherent in collapsing differences of gender and sexual identity into a uniform category of “MSM.” However, we use the term provisionally for the purpose of analysis in order to consolidate a diverse population into a single, unified category. During the course of our discussion, we explore how the emerging diversity of sexual roles structures identities and subgroups, defines partnership interactions, influences the epidemiology of HIV and STIs, and redefines the meanings of “MSM” in Latin America.
Criollamente refers to the contemporary Peruvian cultural sensibility produced by a blend of European and indigenous American cultures.
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Acknowledgments
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).
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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.
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Clark, J., Salvatierra, J., Segura, E. et al. Moderno Love: Sexual Role-Based Identities and HIV/STI Prevention Among Men Who Have Sex with Men in Lima, Peru. AIDS Behav 17, 1313–1328 (2013). https://doi.org/10.1007/s10461-012-0210-5
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DOI: https://doi.org/10.1007/s10461-012-0210-5