Abstract
HIV and other sexually transmitted infections (STIs) continue to affect men who have sex with men (MSM) and transgender women (TW) in Peru at disproportionately high rates. The ineffectiveness of traditional prevention strategies may be due to the disconnect between health promotion messages and community-level understandings of sexual cultures. We conducted 15 workshops with MSM and TW to develop a community-based sexual health intervention. Intervention development consisted of focus groups and scenic improvisation to identify sexual scripts for an HIV prevention telenovela, or Spanish soap opera. Workshops were stratified by self-reported socioeconomic status, sexual orientation, and gender identity: (1) low-income MSM (n = 9); (2) middle/high-income MSM (n = 6); and (3) TW (n = 8). Employing a conceptual model based on sexual scripts and critical consciousness theories, this paper reports on three themes identified during the telenovela-development process as participants sought to “rescript” social and sexual stereotypes associated with HIV-related vulnerability: (1) management of MSM and TW social identities at the intersection of socioeconomic status, sexuality, and gender performance; (2) social constructions of gender and/or sexual role and perceived and actual HIV/STI risk(s) within sexual partnership interactions; and (3) idealized and actual sexual scripts in the negotiation of safer sex practices between MSM/TW and their partners. These findings are key to reframing existing prevention strategies that fail to effectively engage poorly defined “high-risk populations.” Leveraging community-based expertise, the results provide an alternative to the static transfer of information through expert–patient interactions in didactic sessions commonly used in HIV prevention interventions among MSM and TW.
Highlights
Controlling the endemic rates of HIV transmission among men who have sex with men (MSM) and transgender women (TW) has been a central but elusive goal for public health systems in Latin America
Leveraging communitybased expertise, the results provide an alternative to the static transfer of information through expert–patient interactions in didactic sessions commonly used in HIV prevention interventions among MSM and TW
Existing prevention strategies in Peru are often based on a static transfer of information through expert–patient interactions in structured, didactic sessions, directed toward poorly defined “high-risk populations.”. This approach does not account for experiential knowledge from communities most impacted by HIV and, as such, is limited in its ability to effectively engage socially marginalized groups. Addressing this limitation, this paper reports on themes identified during the telenovela-development process as participants sought to reconfigure, or “rescript,” social and sexual stereotypes associated with HIV-related vulnerability among MSM and TW
Summary
Controlling the endemic rates of HIV transmission among men who have sex with men (MSM) and transgender women (TW) has been a central but elusive goal for public health systems in Latin America. Other research has suggested that there is a population-level discordance between what MSM and TW “know” about HIV risk and prevention and what they “do” in their sexual practices (Beyrer et al, 2013; Garcia et al, 2016a, b). This discrepancy between knowledge and behavior is often complicated by stigmatizing attitudes toward homosexuality and transphobic gender stereotypes that generate barriers to health-seeking and risk reduction (Cáceres, Aggleton, & Galea, 2008).
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