Clark, J., Salvatierra, J., Segura, E., et al. AIDS and Behavior (May 2013), Vol. 17 No. 4, pp.1313-1328.
This study analyzed social and behavioral factors that influence sexual identities, and how they affect patterns of HIV among men who have sex with men (MSM) in Lima, Peru. Findings showed that gender-based sexual roles among MSM were both reinforced and transformed by new sexual identities, roles, and practices. Further, social networks and behaviors affect HIV transmission by influencing relationship dynamics. Of 532 MSM, 38 percent categorized themselves as homosexual, 20 percent as transgender, 4 percent as bisexual, and 25 percent as heterosexual and were evenly divided between activo, pasivo, and moderno (a role-based, gender-versatile identity). Focus groups in 2008 and 2011 revealed four themes: 1) the pasivo MSM role is culturally associated with femininity; 2) the activo role is associated with masculinity, though sexual behaviors may threaten heterosexual masculinity; 3) moderno MSM viewed themselves as representing homosexuality and masculinity, while other MSM viewed the moderno identity as disrupting traditional gender and sexual norms; and 4) defined sexual roles provide a structure for sexual practices, identities, and social and sexual networks. Seventy-two percent of moderno and over half of other MSM reported unprotected sex. HIV prevalence was highest among pasivo and moderno MSM. The authors conclude that, although further research is needed to understand how the identities are defined and influence HIV transmission, sexual and identity roles among MSM in Peru provide a framework for HIV prevention.