Rates of Violence Among Vulnerable Populations

Discover the reality for many MSM and people living with HIV.

MSM experience high rates of psychological and verbal abuse.

The experience of violence is widespread among MSM in Central America but varies by type of violence and by location. Psychological abuse (feeling threatened or put in danger) and verbal abuse (being yelled at or insulted) were most commonly reported in all cities studied, but rates in Guatemala City, San Salvador, and Managua were particularly high. Respondents from both cities in Panama reported the lowest levels of violence.

Percentage of MSM Who Experienced Violence in the Last 12 Months

Costa Rica El Salvador Guatemala Nicaragua Panama
19% 41% 40% 38% 25% Psychological violence
11% 23% 18% 20% 12% Verbal violence
10% 23% 28% 19% 10% Physical violence
2% 26% 17% 6% 4% Sexual violence
(Wheeler et al., table 2)

Among people living with HIV, gender and sexual orientation are further associated with violence.

Across the region, reported violence among people living with HIV was similar to that among MSM, although it was far more common in Costa Rica and Belize than in other countries.

Levels of violence were higher among women living with HIV and bisexual or homosexual men than among heterosexual men. This added vulnerability related to gender and sexual orientation likely stems from “machismo” and homophobic attitudes prevalent in the region, suggesting that reducing violence may require addressing not only HIV-related stigma, but also ingrained social norms.

People Living with HIV Who Experienced Violence in the Last 12 Months

of People Living with HIV Have Been Abused (Sexually, Physically, Verbally) in the Last 12 Months
33% Women
34% Bisexual/homosexual Men
21% Heterosexual Males
(Vu et al., table 2)

How Violence Affects Sexual Behavior

Explore the correlation between experiencing violence and engaging in risky behaviors.

Stigma and violence challenge outreach efforts.

Besides violence perpetrated by family or partners, most-at-risk populations sometimes face discrimination by doctors, employers, and other professionals. 5.5% of people living with HIV reported being discriminated against by a healthcare provider.

To reduce their exposure to potential abuse or embarrassment, vulnerable individuals may shy away from public outreach channels. Some turn to the internet for anonymous sources of information and support, but many more remain hidden, making it difficult for programs to promote healthy behaviors and connect people to services.

Violence is associated with risky sex and STI symptoms.

Violence impedes HIV prevention efforts because of potentially harmful links to risky sexual behavior. Among MSM, physical or sexual violence was significantly associated with having multiple partnerships, transactional sex, and sex under the influence of alcohol or drugs. Violence was also associated with lower odds of consistently using condoms and lubricant. Psychological or verbal violence had a less strong, but still clear, association with all types of sexual risk behavior.

Among MSM, survivors of any form of violence were almost twice as likely to have had symptoms or a diagnosed sexually transmitted infection in the past year. A similar trend in use of alcohol or drugs during sex suggests that survivors may be in greater need of biomedical services, such as HIV or STI testing and treatment, and complementary services, such as substance use counseling.

Likelihood that MSM Who Experienced Violence Engage in Sexual Risk Behaviors

(Wheeler et al., table 4)

Violence discourages status disclosure and condom use.

People living with HIV who have experienced physical or sexual violence were also less likely to use condoms or disclose their status. It is likely that the fear of a partner’s angry reaction deters them, but because those behaviors help avert transmission from HIV-positive individuals to their partners, eliminating violence as a barrier could play a critical role in limiting the spread of HIV.

Decreased Odds of Safe Behavior among People Living with HIV who Experienced Physical or Sexual Violence

(Vu et al., tables 3 and 4)

Responding with Community-Based Interventions

Find out how PASMO and its partners are creating structural interventions to raise public awareness and change attitudes toward violence.

Communication campaign focuses on reporting violence.

In the past year, the Program has renewed its commitment to reducing violence as part of HIV prevention. A series of print and outreach materials help individuals assess whether they are in a violent relationship or situation and learn how to report it. In response to regional variations in violence reported by MSM, PASMO reinforced campaigns in Guatemala and El Salvador with structural changes.

In El Salvador, the program promotes a culture of safe reporting by addressing victim-blaming attitudes among police and social workers and encouraging people to come forward with reports of violence. In Guatemala, materials explain the justice system and violence laws in lay terms and advise where and how victims can report violence and seek care.