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GUATEMALA CITY, Guatemala, October 26, 2004 — PSI's experience working with commercial sex workers (CSWs) and men who have sex with men (MSM) in Central America has shown that stigma reduction is a vital component of any comprehensive HIV prevention project targeted at these populations. The Pan American Social Marketing Organization (PASMO), PSI's Central American affiliate, launched a project in 2001 with support from the British Department for International Development (DFID) to reduce discrimination against CSWs and MSM. The project, completed in early 2004, demonstrates the importance of incorporating discrimination reduction components in HIV prevention projects, both with vulnerable populations and perpetrators of abuse. CSW and MSM abuse was found to be widespread. Police officers, strangers, family members and colleagues/clients were among the most common reported perpetrators of abuse. MSM and CSWs suffer from discrimination at public health centers, often mistreated or refused services because of their sexual practices and orientation. While discrimination directly affects MSM and CSWs, it also has the potential to affect society at large. Social pressure to be heterosexual leads many gay and bisexual men to mask their sexual identities, maintaining girlfriends or wives and hiding the fact that they have sexual relations with men. Their efforts to conceal their sexual desires result in sexual encounters that occur in isolated places, often when condoms are not readily available, and most do not use condoms with their wives or girlfriends as it would arouse suspicion. Meanwhile, a large percentage of heterosexual Central American men,
both married and unmarried, frequent CSWs. Many CSWs who try to insist
on the use of condoms report threats from clients, ranging from the
potential loss of the client to physical abuse. Thus, discrimination
and abuse often lead to risky sexual activity that serves a bridge for
the virus to spread and the potential to create a generalized epidemic.
• Human rights and sexual health information was presented, with heavy emphasis placed on appropriate and effective reactions to abuse. References were given for NGOs that offer support during the process of filing a denunciation with National Human Rights Commissions. Self esteem-building games, team-building activities, panel discussions and "socio-dramas" in which participants acted out common abusive situations and the implications of different responses were held. • For the police, PASMO developed a two-hour training program to addresses misperceptions about HIV and populations that are especially vulnerable. Educators presented HIV/AIDS information, and then initiated discussion about discrimination, asking police officers to reflect on their own experiences as victims, thus cultivating empathy rather than adopting an accusatory tone. At the end of the project, national police forces in Guatemala and El Salvador issued formal, written requests for replications of the training; the Guatemalan police force requested that the trainings be conducted with all 23,000 police officers in the country. • PASMO contracted local Guatemalan NGO Asociación de Salud Integral to design a workshop for medical personnel. Comprehensive two-day workshops were held with medical staff in all project countries and were well received, although pre/post test results clearly demonstrate that more discrimination reduction trainings are necessary for health workers. • The final component of the DFID project involved the institutional strengthening of local NGOs that work with populations vulnerable to HIV. Four-day workshops on strategic planning, donor relations, proposal writing, establishing strategic alliances, effective behavior change communications activities and conflict resolution were held in early 2004, and participants issued a resounding request on the evaluation form for more training in all of the workshop modules. PASMO has found that people's vulnerability to HIV is very much affected by their access to health care and their ability to negotiate condom use, and that HIV prevention efforts which do not address discrimination have less impact. Since Central American societies tend to tolerate and even condone the marginalization of MSM and CSWs, efforts must be made to reduce discrimination at the societal level. Harnessing the power of mass media, PASMO has raised awareness and promoted discussion through creative radio and television advertising campaigns on abstinence, condom use, women's ability to negotiate condom use and partner reduction. For more information on the project, contact Tracy Rudne. — Tracy Rudne, PSI/PASMO
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