Structural Factors that Increase HIV/STI Vulnerability among Indigenous People in the Peruvian Amazon

We examined structural factors—social, political, economic, and environmental—that increase vulnerability to HIV among indigenous people in the Peruvian Amazon. Indigenous adults belonging to 12 different ethnic groups were purposively recruited in four Amazonian river ports and 16 indigenous villages. Qualitative data revealed a complex set of structural factors that give rise to environments of risk where health is constantly challenged. Ferryboats that cross Amazonian rivers are settings where unprotected sex—including transactional sex between passengers and boat crew and commercial sex work—often take place. Population mobility and mixing also occurs in settings like the river docks, mining sites, and other resource extraction camps, where heavy drinking and unprotected sex work are common. Multilevel, combination prevention strategies that integrate empirically based interventions with indigenous knowledge are urgently needed, not only to reduce vulnerability to HIV transmission, but also to eliminate the structural determinants of indigenous people’s health...

People think the captain is in charge here, but is not like that; those with access to the food are in charge, we are in charge. If we see an attractive man we give them bigger portions or an extra drumstick; that’s how we convince them to have sex with us...

Groups of three or four gays come from time to time to cut hair and stay in the villages for a few days. At night, they buy beer for everyone and sometimes after they get drunk they have sex with young men...

The findings about the role that the Amazon River and its tributaries play in increasing the vulnerability for HIV/STIs among indigenous people is extremely important for the HIV-prevention community. As a physical or environmental force, the rivers provide the means for the transport of people and goods from rural to urban settings, and vice versa, which allows for the iterative formation of risky settings and situations. Our study demonstrated that sex work was readily available in most settings related to the rivers, such as the port cities, where land-based and floating brothels operate day and night. Most indigenous men who worked at the ports were by themselves (having left their families in the village) and lacked meaningful social support. They often engaged in the normative activities of the setting, such as heavy alcohol consumption and unprotected sex with sex workers. Additionally, the finding that unprotected sex among boat passengers and crew occurred regularly, and that no prevention programs were in place, is alarming and requires urgent action from the prevention community.

The direct and ever-increasing contact between indigenous people and outsiders in the Peruvian Amazon, as a result of the resource-extraction industries and in- and out-migration to and from port cities, presents a complex risk environment that might help fuel the spread of HIV/STIs in this impoverished region. HIV-related research in other aquatic environments throughout the globe has found similar results (Allison & Seeley, 2004). In Goa, on the coastline of India, fishermen migrate out of their villages for work at the docks, often leaving their wives and family behind. At the port cities, they engage in unprotected sex with sex workers and nonspousal partners (Bailey, 2011). In Kenya, a study among fishermen on the shores of Lake Victoria showed that the majority of the fishermen reported extramarital sex and low levels of condom use (Kwena et al., 2010)...

Full article at: http://goo.gl/nEK7Q0

By: E. Roberto Orellana,1 Isaac E. Alva,2 Cesar P. Cárcamo,2 and Patricia J. García2

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1Portland State University, Portland, Oregon, USA

2Universidad Peruana Cayetano Heredia, Lima, Peru

1Portland State University, Portland, Oregon, USA

  

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