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Sex and the River: HIV and other sexually transmitted infections in the Peruvian Amazon
E.R. Orellana1,2, I.E. Alva3,4,5, C. Carcamo3, F. Canchihuaman3,5, A. Bernabe3,5, A. Cotrina3,5, M. Chiappe3, M. Valderrama3, E. Hall6, R. Castillo6, T. Kochel6, A. Romero6, P.J. Garcia3
1Portland State University, Portland, OR, United States, 2Columbia University, New York City, NY, United States, 3Universidad Peruana Cayetano Heredia, Lima, Peru, 4Via Libre, Lima, Peru, 5University of Washington, Seattle, United States, 6Naval Medical Research Center Detachment, Lima, Peru
Background: The role of highways in abetting the AIDS epidemic is well documented. The Peruvian Amazon may face a similar threat in its waterways. Rivers are the “highways” in the jungle and may replicate the problems seen on land in other parts of the world. We examined river transportation systems and their connection with risky sexual behaviors. Prevalence of HIV/STIs among indigenous groups was also estimated.
Methods: A mixed-methods study was conducted in 2007-08. Qualitative methods were employed to ascertain information on the role of river transportation on the region´s sexual health. A quantitative survey assessing HIV risks was administered to indigenous adults. Participants voluntarily provided samples for HIV/STIs testing.
Results: Qualitative: Findings from ethnographic interviews and focus groups point at facilitators of HIV/STIs infection: 1) boat crew members have transactional sex with female passengers; 2) men who have sex with men who work as cooks have unprotected sex with male passengers; 3) sex work is common. Quantitative: 644 indigenous individuals completed the survey. Men (n=285) reported ever having sex with a sex worker (24%), having sex with other men (17%), and low rates of protected sex at last intercourse (18%). Two men tested positive for HIV, however, syphilis (5.3%), chlamydia (12%), gonorrhea (1.1%) and herpes (37.9%) were more prevalent. Among women (n=359), 8% reported condom use at last intercourse; and 4% exchanged money for sex. No women tested positive for HIV, however, syphilis (2.5%), chlamydia (13.4%), gonorrhea (2.2%), herpes (50.3%), thricomoniasis (5%) and bacterial vaginosis (71.8%) were prevalent.
Conclusions: The high risk behaviors on boats and river port areas in conjunction with the constant contact of this industry with indigenous individuals may be one of the mechanisms by which STIs are moving into indigenous communities. These findings demonstrate that culturally congruent interventions are urgently needed in the Peruvian Amazon.
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