Masculinidad, violencia sexual y género en el genocidio en Guatemala durante el conflicto armado

En Guatemala no se ha revisado el entrenamiento del ejército durante el conflicto armado ni su relación con las violaciones a los derechos humanos, específicamente con las violaciones sexuales a mujeres. Por otra parte, en ello se ha tratado del sufrimiento de las mujeres, pero no de aquél experimentado por “el victimario”. En este artículo se analiza quiénes eran los perpetradores, qué formación recibieron y cómo se construyó la masculinidad dentro del ejército. Se analiza la creación de un sistema guatemalteco de represión capaz de permitir y ordenar acciones violentas, con un ejército en sintonía con normas y valores culturales, basados en el autoritarismo, el racismo, el clasismo y las relaciones de poder entre hombres y mujeres.In the case of Guatemala’s Armed Conflict, the relation between military training, human rights violations and women’s rape has not been studied. Studies have tended to explore women’s suffering experiences, rather than to analyse the one of the perpetrator. This article deals with the figure of the offender in order to know their profile and training and to understand the building of masculinity in the army. It analyses the creation of Guatemala’s repressive structures that allowed and authorized violent actions, and their relations with an army whose values were based on authoritarianism, racism, classism, and gender power relations.Au Guatemala, l’entraînement de l’armée pendant le conflit et les atteintes aux Droits de l’Homme, en particulier les viols contre les femmes, n’ont pas été étudiés. Par ailleurs, s’il a été question de la souffrance des femmes, celle du “bourreau” est demeurée à l’écart. Cet article se penche sur ceux qui ont perpétré ces crimes, sur leur formation et sur la construction de la masculinité au sein de l’armée. Il analyse la création d’un système guatémaltèque de répression capable de permettre et d’ordonner des actions violentes au cœur d’une armée en accord avec les normes et valeurs culturelles: l’autoritarisme, le racisme, les rapports de classes et les rapports de pouvoir entre hommes et femmes

‘Clinics aren’t meant for men’: Sexual health care access and seeking behaviours among men in Gauteng province, South Africa

Men may be key players in the transmission of sexually transmitted infections (STI), and it is important that STI/HIV health services reach men. The objective of this study was to explore sexual health care access and seeking behaviours in men. This study used focus groups to examine sexual health care access and seeking behaviours in men 5 years after implementation of free antiretroviral therapy (ART) in the South African public sector. Six focus groups (N=58) were conducted with men ≥18 years in an urban area of Gauteng province. Men were recruited from various locations throughout the community. Men reported several barriers and facilitators to the use of public and private clinics for sexual health services including HIV testing, and many men reported seeking care from traditional healers. Men often viewed public clinics as a place for women and reported experiences with some female nurses who were rude or judgmental of the men. Additionally, some men reported that they sought sexual health care services at public clinics; however, they were not given physical examinations by health care providers to diagnose their STI syndrome. Most men lacked knowledge about ART and avoided HIV testing because of fear of death or being abandoned by their families or friends. Study findings suggest that men still require better access to high-quality, non-judgmental sexual health care services. Future research is needed to determine the most effective method to increase men’s access to sexual health care services.Keywords: sexual health care access, men.Les hommes peuvent être des responsables dans la transmission des infections sexuellement transmissibles (IST), et il est important que les services de santé des IST/VIH les sensibilisent (les hommes). Les objectifs de cette étude étaient d’examiner l’accès aux soins de santé et les comportements sexuels des hommes pendant 5 ans après la mise en oeuvre de la thérapie antirétrovirale (ART) gratuite dans le secteur public Sud-Africain. Six groups d’hommes âgés ≥18 ans (N=58) ont menés des discussions dans la zone urbaine de la province de Gauteng. Ces hommes sont recrutés dans divers endroits dans toute la communauté. Ils ont déclarés rencontrés des obstacles et facilitateurs à l’accès des cliniques publiques et privées des services de santé sexuelle, y compris le test du VIH, et beaucoup d’hommes déclarent être à la recherche de soins vers des guérisseurs traditionnels. Les hommes ont souvent vu les cliniques publiques comme des endroits pour les femmes et se sont souvent plaint des expériences qu’ils ont eues par rapport aux infirmières qui ont un mauvais jugement sur eux. Certains d’entre eux ont déclaré qu’ils cherchaient des soins de santé dans les cliniques publiques, mais qu’ils n’étaient pas soumis à des examens physiques pour diagnostiquer leurs syndrome d’IST. La plupart d’entre eux n’avaient pas de connaissances de l’ART et évitent le test du VIH parce qu’ils ont peur de la mort ou d’être abandonné par leurs familles ou leurs amis. Cette étude suggère que les hommes doivent exiger de meilleures qualités de soins, un non-jugement des services de santé sexuelle. Les recherches futures sont nécessaires pour déterminer la méthode la plus efficace d’accroitre l’accès des hommes aux services de santé sexuelle

HIV Diagnosis, Linkage to Care, and Retention among Men Who Have Sex with Men and Transgender Women in Guatemala City

Men who have sex with men (MSM) and transgender women are disproportionately affected by HIV in Guatemala, yet little is known about their experiences with diagnosis, linkage to care, and retention. We conducted qualitative interviews with 26 MSM and transgender women living with HIV in Guatemala City. HIV diagnosis experiences changed over time with increasing asymptomatic testing at non-governmental organizations. Fear of the physical and social impacts of HIV delayed testing, acceptance of diagnosis, and linkage to HIV care. These fears were driven by layered stigma and discrimination due to non-normative gender expressions and/or sexual orientation. Retention-specific determinants included HIV clinic dynamics and limited employment opportunities. There is an urgent need to improve support systems for early testing and linkage to care and to expand employment opportunities. Stigma and discrimination must be addressed at the family, clinic and contextual levels to reduce fear of diagnosis and improve access to care

Estimating the impact of HIV PrEP regimens containing long-acting injectable cabotegravir or daily oral tenofovir disoproxil fumarate/emtricitabine among men who have sex with men in the United States: a mathematical modelling study for HPTN 083

Background: The HPTN 083 trial demonstrated superiority of HIV pre-exposure prophylaxis (PrEP) containing long-acting injectable cabotegravir (CAB) to daily oral tenofovir disoproxil fumarate/emtricitabine (TDF/FTC) among men who have sex with men (MSM). We compared the potential population-level impact of TDF/FTC and CAB among MSM in Atlanta, Georgia. Methods: An MSM HIV transmission model was calibrated to Atlanta-specific data on HIV prevalence and PrEP usage (percentage of uninfected MSM on PrEP), assuming only PrEP-indicated MSM used PrEP. CAB effectiveness (efficacy × adherence) of 91% was estimated using data from HPTN 083 and previous TDF/FTC trials. We estimated HIV infections averted over 5/10 years if TDF/FTC use were maintained, or if all TDF/FTC users switched to CAB in January 2022 (vs. no PrEP or continued TDF/FTC use). CAB scenarios with 10%/20% more users were also considered. Progress towards Ending the HIV Epidemic (EHE) goals (75%/90% fewer HIV infections in 2025/2030 vs. 2017) was estimated. Findings: We predicted TDF/FTC at current usage (∼28%) would avert 36.3% of new HIV infections (95% credible interval 25.6–48.7%) among all Atlanta MSM over 2022–2026 vs. no PrEP. Switching to CAB with similar usage may prevent 44.6% (33.2–56.6%) infections vs. no PrEP and 11.9% (5.2–20.2%) infections vs. continued TDF/FTC. Increasing CAB usage 20% could increase the incremental impact over TDF/FTC to 30.0% over 2022–2026, getting ∼60% towards reaching EHE goals (47%/54% fewer infections in 2025/2030). Reaching the 2030 EHE goal would require 93% CAB usage. Interpretation: If CAB effectiveness were like HPTN 083, CAB could prevent more infections than TDF/FTC at similar usage. Increased CAB usage could contribute substantially towards reaching EHE goals, but the usage required to meet EHE goals is unrealistic

Factors associated with Condom Use Problems during Vaginal Sex with main and non-main partners

Incorrect condom use is a common problem that can undermine their prevention impact. We assessed the prevalence of 2 condom use problems, breakage/slippage and partial use, compared problems by partnership type, and examined associations with respondent, partner, and partnership characteristics

Social Network Characteristics and HIV Vulnerability Among Transgender Persons in San Salvador: Identifying Opportunities for HIV Prevention Strategies

The purpose of this study is to improve understanding of HIV vulnerability and opportunities for HIV prevention within the social networks of male-to-female transgender persons in San Salvador, El Salvador. We compare HIV prevalence and behavioral data from a sample of gay-identified men who have sex with men (MSM) (n = 279), heterosexual or bisexual identified MSM (n = 229) and transgender persons (n = 67) recruited using Respondent Driven Sampling. Transgender persons consistently reported higher rates of HIV risk behavior than the rest of the study population and were significantly more likely to be involved in sex work. While transgender persons reported the highest rates of exposure to HIV educational activities they had the lowest levels of HIV-related knowledge. Transgender respondents’ social networks were homophilous and efficient at recruiting other transgender persons. Findings suggest that transgender social networks could provide an effective and culturally relevant opportunity for HIV prevention efforts in this vulnerable population

Understanding Social and Sexual Networks of Sexual Minority Men and Transgender Women in Guatemala City to Improve HIV Prevention Efforts

Sexual minority men and transgender women are disproportionately affected by HIV in Guatemala. Innovative prevention strategies are urgently needed to address these disparities. While social network approaches are frequently used to reach sexual minorities, little is known about the unique network characteristics among sub-groups. We conducted in-depth qualitative interviews with 13 gay-identifying men, eight non-gay-identifying men who have sex with men (MSM) and eight transgender women in Guatemala City. Using narrative and thematic coding procedures, we identified distinct patterns in the size, composition, and overlap between social and sexual networks across groups. Gay-identifying men had the largest, most supportive social networks, predominantly comprising family. For both non-gay-identifying MSM and transgender women, friends and sex clients provided more support. Transgender women reported the smallest social networks, least social support, and the most discrimination. HIV prevention efforts should be tailored to the specific sexual minority population and engage with strong ties

The Where and How for Reaching Transgender Women and Men Who Have Sex with Men with HIV Prevention Services in Guatemala

This study aims to describe the transgender women and men who have sex with men (MSM) missed through venue-based sampling and illustrate how data on venues can be used to prioritize service delivery. Respondent-driven sampling (RDS) and time-location sampling (TLS) were used concurrently in 2010 for behavioral surveillance among MSM and transgender women in Guatemala City. RDS recruits who did not frequent venues (n = 106) were compared to TLS recruits (n = 609). TLS participants recruited at different types of venues were compared. RDS recruits who did not frequent venues were less educated, less likely to identify as gay, more likely to have concurrent partners and female sexual partners. Participants recruited at NGOs, saunas, hotels, streets and parks had more partners, were more likely to receive money for sex or have concurrent partners. Prevention programs for MSM and transgender women should characterize social venues and people that frequent them and improve service coverage through venues and social networks

Sex work, discrimination, drug use and violence: a pattern for HIV risk among transgender sex workers compared to MSM sex workers and other MSM in Guatemala

The risk of HIV infection is higher among transgender women and cisgender men who have sex with men (MSM) compared to the general population due in part to social and contextual factors. This study aimed to determine the prevalence and association of alcohol and drug abuse, discrimination and violence among transgender sex workers compared to cisgender male sex workers and cisgender men who had not received money for sex in Guatemala City. In 2010, transgender women and cisgender men who had had sex with men or transgender women were recruited into a cross-sectional behavioural survey. Among transgender women, 86% received money for sex in the past year. Transgender sex workers were more likely to use drugs and binge drink, three times as likely to be discriminated against and eight times as likely to be forced to have sex compared to non-sex worker men. Male sex workers were twice as likely to use illicit drugs or experience physical violence and six times as likely to experience forced sex compared to non-sex worker men. Transgender and male sex workers would benefit from harm reduction for substance use, violence prevention, response and strategies to mitigate discrimination