Violence Experiences in Childhood and Adolescence Among Gay Men and Transgender Women Living in Perú: A Qualitative Exploration

Abstract

The overall goal of this study was to qualitatively explore the different types of violence experienced by gay men (GM) and transgender women (TW) living in Peru during childhood and adolescence, as well as their potential consequences and sources of protection. Participants were selected using purposive sampling. Recruitment took place in a community-based organization in Lima, Peru. In all, 32 GM and 23 TW participated in a total of four Focus Group Discussions (FGD) and 25 in-depth interviews (IDI). Qualitative data collection was conducted between July and October 2016. Four FGD took place with GM (n = 21) and one with TW (n = 9). In addition, 11 IDI with GM and 14 with TW were conducted. Data were analyzed using descriptive inductive analysis. Three main types of violence were experienced in childhood and adolescence: (a) violence occurring in the home or otherwise perpetrated by family members, (b) school-based violence, and (c) sexual violence. Both GM and TW experience violence within and outside school and home. School systems should make teachers and parents aware of the impact of homophobic and transphobic bullying and violence. Certain modifications in schools, such as having all-gender bathrooms and promoting activities that are not grounded in gender roles, could be very effective at reducing homophobic and transphobic violence. Schools should also address sexual violence more actively, among both male and female students. Parents’ attitudes toward homosexuality and gender diversity need to be addressed by future interventions.

Introduction

The World Health Organization (WHO; 2017a) defines violence as

the intentional use of physical force or power, threatened or actual, against oneself, another person, or against a group or community, which either results in or has a high likelihood of resulting in injury, death, psychological harm, mal-development, or deprivation.

For the purposes of this article, we will use this broader definition while also exploring specific types of violence. Sexual violence involves nonconsensual sexual contact and nonconsensual noncontact acts of a sexual nature committed against someone who is unable to consent or refuse (Basile, Smith, Breiding, Black, & Mahendra, 2014). Structural violence is defined as the “physical and psychological harm that result from exploitative and unjust social, political and economic systems” (Rutherford, Zwi, Grove, & Butchart, 2007). Finally, child violence, sometimes called child abuse, is defined as

all forms of physical and/or emotional ill-treatment, sexual abuse, neglect or negligent treatment or commercial or other exploitation, resulting in actual or potential harm to the child’s health, survival, development or dignity in the context of a relationship of responsibility, trust or power. (WHO, 2017a)

Human rights advocates have spoken out against the disproportionate burden of violence and cruelty experienced by gay men (GM) and transgender women (TW) throughout the world (Human Rights Watch, 2017). Murder and other forms of extreme violence receive the most media attention and have been more consistently reported (National Coalition of Anti-Violence Programs [NCAVP], 2016). However, these are not isolated events; they are on the spectrum of violence that is experienced by this population.

Research has demonstrated that sexual and gender minority (SGM) youth are at higher risk of experiencing bullying and other types of harassment than their heterosexual peers (Bucchianeri, Gower, McMorris, & Eisenberg, 2016; Cáceres & Salazar, 2013; Ceccarelli et al., 2012; Espelage, 2016; Zou & Andersen, 2015). Bullying has been associated with poor academic performance in school, psychological distress, and suicide attempts among adolescents (Almeida, Johnson, Corliss, Molnar, & Azrael, 2009; Luk, Wang, & Simons-Morton, 2010; Roman & Murillo, 2011; Romo & Kelvin, 2016; Tucker, Ewing, Espelage, de la Haye, & Pollard, 2016). In the long term, experiencing bullying in childhood and adolescence has been associated with higher risk of HIV acquisition and suicide attempt during young adulthood (Duong & Bradshaw, 2014; Lloyd & Operario, 2012). Sexual abuse is also more frequent among SGM youth compared with their heterosexual counterparts (Bouris, Everett, Heath, Elsaesser, & Neilands, 2016; Friedman et al., 2011). The consequences of sexual violence include higher prevalence of mental disorders, elevated rates of drug use, increased prevalence of high-risk sexual behaviors, and increased likelihood of having attempted suicide (Austin, Herrick, & Proescholdbell, 2016; Castelví et al., 2017).

Little research has addressed violence experienced during childhood and adolescence in low- and middle-income countries among SGM youth. Particularly in the Peruvian context, our literature review identified only three studies that included the issue of transphobic/homophobic violence in high schools (Cáceres & Salazar, 2013; Ceccarelli et al., 2012; Centro de Promoción y Defensa de los Derechos Sexuales y Reproductivos [PROMSEX], 2016). Although not all of them focused on childhood and adolescent violence among SGM youth specifically, these studies reported, among other findings, the high frequency of homophobic and transphobic bullying in schools. They also mentioned the limitations that Peruvian schools have in terms of properly addressing this issue and the important role that stereotypes and gender roles play in the perpetuation of this type of violence. To our knowledge, no studies have been conducted that include childhood and adolescent violence experiences of lesbian, gay, bisexual, and transgender (LGBT) people in Perú in settings outside of school.

The overall goal of this study was to qualitatively explore the different types of violence experienced by GM and TW from Peru during childhood and adolescence, as well as their potential consequences and sources of protection. We elected to address violence within these subpopulations within the LGBT community at the request of our community partners based on the high levels of victimization they suffer (PROMSEX, Red Peruana de Trans, Lesbianas, Gays y Bisexuales, 2016).

The experiences of GM and TW are distinct and it would therefore be inappropriate to discuss the violence experienced by these groups without disaggregating the data. However, in the context of Peru, where “machismo” is a main component in the construction of social gender norms, the childhood experiences of these two communities often overlap and share important elements. In Peru, gender identity and sexual orientation are often conflated, and as a result, violence perpetrated against GM may be rooted in transphobia and misogyny, whereas violence perpetrated against transgender and gender nonconforming youth may be grounded in homophobia. The way that victims conceptualize their experiences of violence and discuss the sociocultural context can make it difficult to disentangle transphobia from homophobia, particularly when these experiences occur in childhood and victims are still exploring their sexual orientation and gender identity. Furthermore, the perpetrator of the violence may perceive the victim in a way that does not align with their identity, but nevertheless plays a role in the violence.

Method

Participants

Participants were selected using purposive sampling; they were selected if they were Peruvian and living in Lima, identified as either TW or GM and were participating in the activities of the community-based organization or receiving medical care in the nongovernmental organization (NGO) where the study took place. The characteristics of the participant population are described in Table 1.

Table 1.

Participant Characteristics and Method of Data Collection by Study Population.

Population	Total Number of Participants	Median Age	High School Education or Less	Incomplete Higher Studies	Complete Higher Studies	Number of FGD	Number of IDI
GM	32	31	4	15	13	3	11
TW	23	32	7	11	6	1	14

Note. FGD = focus group discussion; IDI = in-depth interviews; GM = gay men; TW = transgender women.

Ethical Considerations

This study protocol was reviewed and approved by the Ethics Committee of the “Asociación Civil Impacta Salud y Educación (IMPACTA)” in Lima, Peru. Participants were engaged in an informed consent process prior to any data collection, including explanation of the protocol and details of the project, responding to their concerns and questions, and asking for oral consent to participate in the study.

No personal identifiers, such as names, were collected or recorded. Consent forms were signed by the researcher to indicate that the informed consent process had been completed. Each consent form was assigned a unique code and was stored in a locked secure cabinet. All electronic data were stored in a password-secured computer that could only be accessed by research staff.

Procedures, Theoretical Perspective, and Epistemology

This study was conceived under the symbolic interactionism theoretical perspective (Serpe & Stryker, 2011) and was informed by a constructivist epistemology, meaning that our intention was not to impose a preconceived idea of violence and how this affects the GM and TW communities, but instead to understand the types of violence affecting these communities from their point of view.

This study took place in an LGBT community-based organization based in Lima, Peru. The lead author worked in collaboration with the organization’s staff, who facilitated recruitment of participants. In the first phase of the study, 21 GM and nine TW participated in a total of four Focus Group Discussions (FGD). These were facilitated by the first author and assisted by a notetaker. The discussions were audio-recorded and detailed notes were taken. This information was used to build a summary of relevant themes, which informed the refinement of the interview guide used in subsequent in-depth interviews (IDI).

In the second phase, 25 IDI were conducted, until reaching saturation (Charmaz, 2006). Eleven interviews were conducted with GM and 14 with TW. All interviews lasted between 50 and 90 min and were audio-recorded. The first author collected all of the data, and all audio recordings were transcribed verbatim by a professional transcription service. To check for accuracy, the transcripts were reviewed by the first author. In addition, detailed notes were recorded during the interviews to supplement the recorded words and capture the nuances of the narratives.

Prior to any data collection activity (i.e., FGD or IDI), participants provided oral informed consent and general demographic information, including age, serological status, educational level, and occupation.

Measures

FGDs were utilized to discuss the types of violence participants experienced during childhood and adolescence, common perpetrators, sources of support, and how the various forms of violence have affected their lives. IDI were conducted to characterize interpersonal experiences of violence in greater depth, with an emphasis on violence perpetrated at school and in the home. A semi-structured discussion guide was used for both activities.

Data Analysis

Data were analyzed using descriptive inductive analysis. Topical codes were generated based on the data and were grouped into categories and themes based on the setting and types of violence. Finally, we looked for recurring codes and their frequency in the data, both within and between groups. The analysis was conducted by the first author using the qualitative research software Dedoose (2016). After the data were analyzed, we performed member checking to provide in-group perspectives on the results (Saldaña, 2009; Lincoln & Guba, 1985). Two community leaders, one gay man and one transgender woman, were consulted for their feedback on the findings. They noted that our findings aligned with their insider knowledge about the lived experiences of the community and appropriately captured and reflected the impact of this violence.

Results

Participants described experiences that fell into three main categories of violence in childhood and adolescence: (a) violence occurring in the home or otherwise perpetrated by family members, (b) school-based violence, and (c) sexual violence.

Violence in the Home or Other Family Settings

Several of the narratives suggest that gender stereotypes and gender nonconformity are key determinants of violence experienced by both GM and TW during childhood and adolescence. Most of the TW describe how being more feminine or having more female-stereotyped preferences led to discrimination and mistreatment from family members, particularly males, and others in the participant’s environment, who intended to use violence as a method for “correcting” such behaviors:

Once my dad noticed I liked to watch soap operas and then talk about it. He grabbed me and told me “I have not raised a ‘maricon’ [sissy].” That was shocking for me … my mom always wanted me to go play football, even when I told her I didn’t want to she told me “you have to go play like the other boys.” She wanted me to play with the other boys but I didn’t want to. (Transgender woman, 25)

When I was 13–14 … he [father] left me living with an uncle … but my uncle noticed I was “afeminada” [effeminate], that I behaved like a woman and he made my life impossible, he used to hit me and everything … he used to tell me “you are a ‘maricon’ [sissy], how are you going out like that? … men are going to abuse you!, … this and that …” but I wanted to live by myself, to live in peace with nobody bothering me. Deep down I knew what I was, what I felt. (Transgender woman, 33)

Many GM also emphasized how gender stereotypes affected their lives. Some of them referenced violence in childhood that was perpetrated because their behaviors were not considered “typical” of male children. For example, playing with girls and not playing games generally associated with boys were some of the reasons they mentioned. According to them, any attitude or act perceived as too feminine was judged harshly and was to be avoided. However, most GM emphasized that they began to experience other forms of violence during the onset of puberty and adolescence, when sexual experimentation began. Growing up in a setting where nonheterosexual identities were not socially accepted, having conservative parents who punished or criticized any behavior that they considered as a demonstration of homosexuality, or not being able to experiment sexually as other adolescents were able to are some of the forms of violence experienced during this time. Also, the constant comments about how they should act, what they should like, and how they should behave affected their lives negatively at the time and remained with them as adults:

My dad used to tell me, the boys sit like this, only girls sit like that; and that is violence. But my dad didn’t do that because he was mean, he did it because that it’s what he was taught, because that is what is normalized. I think that to change those things we have to educate people. (Gay man, 24)

When I was an adolescent, once my mom told me something, I didn’t understand then what she meant, she told me “she brought male children to this world and that is how they were going to be.” I didn’t understand then yet … I remember as if it was yesterday … she might have already forgotten about this. (Gay man, 32)

These experiences of violence in the family had consequences. Many of the GM became (as they described) intentionally “hypermasculine” and even discriminative of other men who might not fulfill the masculine stereotypes. The levels of violence suffered also caused self-repression and forced them to hide their sexual orientation until much later in their lives, either out of fear of rejection from their families or of being judged for doing something considered as incorrect. Although the repression of their sexuality was not identified by most of the participants as an explicit form of violence, they did recognize how much it affected their lives:

When I was a young boy I attended a religious school, and I thought that it [being gay] was a sin. I also thought that if I told my parents they would get mad at me. I think that is why I have not told them about me up to now. (Gay man, 22)

I have been raised with the perception that men are men and women are women. So, when I see a guy who is too feminine I don’t like that. I kind of think that I am wrong because I know they are free and can do whatever they want to, but I feel like sometimes that is not the right place to be like that … obviously I do not feel attracted to those kind of boys at all. However, I do know they exist, that they are part of the diversity. (Gay man, 38)

In the case of TW, a few tried to change their gender expression, hiding their femininity, at least for a certain period, trying to assume a more “masculine attitude”; many of them explained that these experiences did not undermine their desire to live as women. Contrarily, in some cases, this increased their desire to fight to achieve their gender transition goals:

I: What was your reaction towards this [being mistreated by her mother as a child]?

P: I tried to dissimulate, I was more afraid, more scared, more tormented, in that age, when I was 15. However, I still tried to do it [dress like a girl]. I did it to feel good with myself, with my identity. (Transgender woman, 43)

Violence in the School Setting (Bullying)

Homophobic and transphobic bullying experiences during childhood and adolescence were reported by most of the participants. Some participants reported bullying based on their weight, color, or some other characteristic. However, most of the participants reported homophobic and transphobic bullying when they were in school. This was experienced both directly, that is, they were the target of the comments, and indirectly, that is, they witnessed the bullying of peers who were perceived as more feminine, gay, or who did not fit masculine stereotypes. Some differences in the forms of violence experienced in school between TW and GM were also highlighted. In the case of TW, the narratives include more physical demonstrations of violence, such as hitting and pushing. Also, manoseos (inappropriate touching) perpetrated by their classmates was discussed by some TW. Sexual violence in the school setting was identified only by TW. For GM, physical demonstrations of violence are also described; however, the narratives include mainly verbal and psychological violence:

I: Would you say you suffered violence when you were in school?

P: Yes, I think I did. In addition to verbal violence, I also suffered physical violence. Sometimes they attacked me. Not to the extreme of knocking me out or leaving marks on my body but they pushed me or hit me in the head. They even touched me, sometimes they pinched my butt cheeks or things like that. (Transgender woman, 27)

In the beginning they bothered me because I was darker than the others, they called me negro and many ugly things. Then they also bothered me because of the gay issue, they called me “maricon” [sissy] … My school life was hell. Sometimes I didn’t even want to go. I used to say why am I going if they are going to bother me?. I remember that when I was in high school, at some point I didn’t want to go to school anymore. (Transgender woman, 25)

I lived in a small town and I could see it [referring to homophobia] … I remember this boy in my class, who was very “afeminado” (effeminate). He walked like a girl. So, the other boys bullied him really hard. So, because I saw that I was always careful. (Gay man, 32)

Witnessing bullying of their schoolmates, because of their feminine behaviors, led some participants to repress or hide their own sexual orientation or gender identity. In some cases, it also generated changes in their own behaviors. For example, two of the male participants mentioned that they assumed hypermasculine behavior and even became aggressive toward others, to prevent becoming the target of bullying themselves:

I saw that horrible life that they [people who appeared to be gay in school] had and that terrified me. That is why I preferred not to talk to anyone about it [questioning of sexual orientation]. (Gay man, 53)

According to several of the testimonies, the main factor associated with bullying was abstaining from playing soccer, a sport still primarily considered masculine in Peru. Playing this sport appears to be necessary for social acceptance among school-aged boys. Moreover, one of the testimonies of one TW explains that although she was very feminine as a child, she also played soccer with the boys and enjoyed doing so, which solidified her acceptance by male peers:

I feel like the problem was always the soccer, because I didn’t like it, and to be honest I was the worst playing it and couldn’t care less about playing it … so they started calling me things like the little girl. (Gay man, 24)

E: Was there ever any kind of comment or aggression from your classmates that you experienced?

P: No, because I was a little delicate, but I did play soccer in primary school, I used to play with the boys and with the girls. With the boys, we used to play soccer, I behaved as a normal boy, playing the normal games. (Transgender woman, 32)

Different methods of protection from bullying are identified between the two populations. As described earlier, enacting violence was one way some participants found to protect themselves from bullying. Others sought protection from a male schoolmate, who was considered stronger, or by forming part of a group. Finally, a few participants mentioned that female schoolmates played a very important role in their lives. According to them, female peers, in addition to being considered as friendlier and trustworthy, were also a source of safety and protection:

My advantage was that I was tall, I knew very well how to fight. So, if they didn’t bully me, they couldn’t make fun of me like they did with my classmates. I was the defender, the fighter, the “pleitista”‘ [short-fused]. (Gay man, 53)

A friend of mine used to defend me when the others bullied me, he used to advise me, make me think of other things. We never talked about LGBT topics. Furthermore, this boy was not gay, but instead was straight. But still, he gave me a lot of confidence, he gave me a lot of comfort. (Gay man, 27)

When I was with the girls I used to talk to them, just like I am talking to you, I was friends with them, I hugged them… They were my friends and I felt just like them, we had the same way of behaving, sitting down and same dressing styles. I could ask them to paint my nails and they liked it, they liked it. (Transgender woman, 50)

Teachers rarely played a protective role regarding bullying experiences. Instead, they also perpetrated some forms of bullying through homophobic and transphobic comments. In other cases, even when they witnessed the violence experienced by some of their students, they failed to intervene when these events occurred:

Even the teachers had these comments like just in case, here only boys and girls are accepted, there are not intermediates here or here, there can’t be any “maricon” [sissy] … (Gay man, 27)

E: Did you ever talk about this [suffering bullying] with anyone?

P: No, because the teacher could also see what was happening but he would just ignore it. Or he would say something like ok, don’t tease him and that was it. He did no more than that.

E: Would you say the teacher ignored this kind of thing?

P: Yes, they did. (Transgender woman, 39)

Sexual Violence

About one third of participants self-reported childhood sexual violence. The context in which these events occurred differed among groups. Also, the narratives have certain differences that are important to mention.

Most of TW who described childhood sexual violence reported that the events occurred at school. In the case of a person who lived in a shelter (thus school and home were co-located), events occurred there. One TW also reported having experienced sexual abuse at home by a relative, in addition to sexual abuse in school. In all cases of school-based sexual violence, the perpetrator was another male student a few years older than the victim. According to their narratives, some of these events marked the initiation of their sexual lives. For example, one of the victims shared that she had sexual intercourse with her attacker on several occasions. According to her, in some cases she was forced and in some it was consensual. Another participant mentioned that although a classmate forced her the first time, the next year she had consented to intercourse with a friend of his who had known about the attack.

It is important to mention that most of the victims of sexual violence also reported experiences of homophobic bullying or mentioned homophobic insults occurring previously or in the moment of the attack:

P: I used to dance and I remember that boys used to say “this is a cabro (faggot), no?.” They used to murmur about me. So, I remember that I had an experience with another boy in the bathroom. I was little, I was only 11 year old and that was the first time that happened to me.

E: Was this forced?

P: What do you mean? I knew what I was doing, I wanted to do it. He did not force or hit me [to force her to have sex] or anything

E: How old was he?

P: He was 15, I was 11 and about to turn 12.

E: Were you ever forced to have sex by this boy?

P: Sometimes I didn’t want to … I was sometimes forced, in the bathroom … Sometimes when the mom (caregiver) was not around, he used to take me upstairs, he would take off my pants and well, we used to do it. He used to tell me quiet, quiet, do not say anything. (Transgender woman, 24)

I was 13 … it happened in the bathroom, when the school day was over … he was my classmate Richard. He found me when I was washing up, before going home; and he grabbed me from behind and got me into the bathroom… He told me lets have [sex] … You are crazy, why? I said. He forced my pants down and I … we had intercourse, but I didn’t want to. (Transgender woman, 25)

In the case of GM, two reported sexual abuse that occurred at home. In such cases, the perpetrator was a family member who was only a few years older. Another two GM reported suffering sexual assault in the street. In these cases, although the perpetrators were not related to the victims, the participants had previously seen the attackers around the places they used to frequent. Also, most of them did not make any association between homophobic violence and the attacks:

It happened in 2007, until 2010 [he was between 10 and 12 years old], I think. What happens is that he [his brother who is 2 years older] kind of forced me to do things. We didn’t have sex but he forced me to do stuff … He used to tell me kiss it or suck it, things like that. He tried to penetrate me but no, I was too scared. (Gay man, 19)

[He was 12 years old] I was coming back to my uncles’ house at about 10 pm… I was walking and I felt someone pull me into an alley and cover my mouth… he told me to be quiet, that I would enjoy it and those kind of things … the only thing that I remember is that I was shaking, crying and when I got to see his face, I realized it was the same guy that always bothered me … I only remember hitting him and crawling to escape. (Gay man, 28)

In almost all of the cases, the participant did not tell anyone about what had happened, either out of fear of being blamed for what happened or to avoid the perceived trouble that telling someone about the incident might have caused, particularly because most perpetrators were part of their close circles. However, some of them reported talking about these experiences, later in their lives, with a trusted person.

One participant reported having told a family member about the incident, but he did not receive support from the trusted adult. Instead, the victim felt that he was being blamed for what had happened.

… When I decided to talk about it [sexual violence suffered in the street when he was a young boy] with my family, the first answer that I got, instead of being, “are you alright? Did something happen to you? Did someone do something to you?,” was “What have you done to provoke that?” … I felt like

… One, I felt so ashamed; two, I felt like I had no support from those who were supposed to take care of me. Ever since then, I don’t trust my family anymore. (Gay man, 28)

Discussion

Our study explores violence experienced during childhood and adolescence, among TW and GM beyond the school environment in Peru. Data on violent experiences in the home among this population are critical for understanding the full impact that violence during childhood and adolescence has on TW and GM over the life course. The data presented here provide evidence of the importance of including parents and family members in childhood violence interventions. In addition, the role of gender stereotypes in perpetuating and justifying violence and discrimination must be highlighted and intervened upon.

Many interviewees, both GM and TW, described having suffered mistreatment from their parents, particularly fathers, or other caregivers since the very early stages of childhood. These are mostly associated with being gender nonconforming or feeling “different” as children (Austin et al., 2016). Thus, mistreatment was mostly related to having feminine expression or not fulfilling the masculine stereotypes, such as playing soccer. This evidence is consistent with previous findings that gender nonconformity in childhood was associated with paternal, maternal, and peer rejection (Landolt, Bartholomew, Saffrey, Oram, & Perlman, 2004) and that LGBT adolescents have poorer relations with their parents in comparison with their heterosexual peers (Bos, Sandfort, Bruyn, & Hakvoort, 2008; Pearson & Wilkinson, 2013).

Evidence has also demonstrated that GM and TW suffer higher levels of different types of harassment in school, compared with their heterosexual peers. This harassment and bullying is not exclusively on the basis of sexual orientation, but also weight, race, and disability (Andersen & Blosnich, 2013; Bucchianeri, Gower, McMorris, & Eisenberg, 2016; Earnshaw, Bogart, Poteat, Reisner, & Schuster, 2016; Hughes, McCabe, Wilsnack, West, & Boyd, 2010). Our study was consistent with this evidence and identifies the impact of specific gender norms, such as playing soccer, as a trigger for bullying. Challenging gender norms and transgressing stereotypical notions of masculinity have the potential to increase the risk of violence in childhood and adolescence. Very simple changes in children’s environment, such as having more inclusive games, not reinforcing stereotypes by assigning colors and activities on the basis of sex, and having spaces that are inclusive of all gender identities, could greatly improve development and well-being for all children, but especially gender nonconforming children.

Being bullied has also been associated with violence perpetration among the participants of our study. As a consequence of mistreatment, many GM attributed their rejection to nongender normative behavior and internalized this intolerance of behavior deemed effeminate. They identified other GM as too feminine, gossipy, traitorous, and noisy; consequently, they preferred to avoid other GM. These findings appear to be consistent with previous evidence that among those who are either cyber or school bullied, there are higher odds of engaging in violent events and attempting suicide (Duong & Bradshaw, 2014; Nansel, Overpeck, Haynie, Ruan, & Scheidt, 2003). Thus, extreme types of violence are often rooted in the inculcation of discrimination and hatred toward gender-diverse people, including themselves. It is key to properly address this core issue if we intend to reduce the levels of discrimination and violence and to increase the well-being of these populations.

The role that cisgender women and girls play in school-based bullying warrants further exploration. Our data indicate that cisgender girls in schools may potentially serve as protective allies in situations of homophobic or transphobic bullying. They also affirm existing evidence that suggests female friends can be an important source of protection and support for TW and GM in the school environment (Poteat & Vecho, 2016). However, it is important that protective interventions empower not only women but also men to act as effective allies when transphobic and homophobic violence and discrimination occur. Teachers, who are obligated to protect children and adolescents in school, were consistently identified as untrustworthy and ambivalent regarding transphobic and homophobic violence. This gap between the teacher’s vocational duty to provide a safe and affirming environment for all students and the lived experiences of GM and TW in Peru should be addressed. The passive role that teachers take in homophobic bullying has been documented in the literature (Anagnostopoulos, Buchanan, Pereira, & Lic, 2009; Kosciw, Palmer, Kull, & Greytak, 2012; Mishna, Newman, Daley, & Solomon, 2009; Mooij, 2016; Richard, Miller, & Car, 2010). However, our testimonies provide evidence that teachers might also be perpetrators of homophobic violence. This may be reflective of a lack of training or capacity when it comes to working with LGBT youth, but it also is influenced by the very socially conservative environment and “machismo” culture in Peru. In low-income settings of the country, the socially conservative culture tends to be even more prevalent, in part as a consequence of the work of fundamentalist groups who have lobbied for the elimination of a gender perspective in education.

Evidence in different settings suggests that appropriate training can potentially improve the capacity to take action among schools personnel (Page, 2017; Hall, 2017); however, considering that sexual education and gender diversity are still issues poorly included in the Peruvian educational curricula, it might take a higher level of interventions, including protective laws addressing homophobic and transphobic violence. Additional research that measures the impact of preventive measures informed by the cultural context of Peru is necessary to articulate the most impactful interventions for this setting.

Sexual violence was also present in both groups. All the participants who reported experiencing sexual violence were under 13 years old when the events occurred. Previous research has identified sexual abuse as more frequent among adolescents between 14 and 17 years of age; however, this evidence suggests that such events might have their origins earlier in life (though rarely reported at that time; Mujica, 2011). Our findings are consistent with this evidence.

Among TW, sexual abuse appears to follow a different narrative. According to most participants, the perpetrators were peers, who were only a few years older than the victims. Also, all the attacks occurred in school bathrooms, an environment that has been previously identified by this population as an extremely unsafe space (Bucchianeri et al., 2016). It is also noteworthy that experiences of sexual violence among TW were often discussed in the context of sexual debut. The absence of comprehensive sexual education in Peru and the abstinence-based education may work to perpetuate sexual violence by ignoring the role of consent in sexual relationships. This is important to take into account not only to empower SGM to identify different forms of sexual violence but also to acknowledge their right to have a safe sexual life and to make their own decisions over their bodies and sexual experiences. Also, according to our data, sexual violence among this population was often preceded by homophobic bullying. Thus, this form of psychological violence could indicate increased risk of sexual violence among these youth, and interventions should address all types of violence against SGM youth.

As has been reported in other studies (Ministerio de la Mujer y Poblaciones Vulnerables, 2012), among both groups, sexual victimization in childhood and adolescence goes unreported in a majority of cases. Empowering children to report these events and generating systems that can properly respond to such abuse are essential for addressing and ending childhood sexual abuse.

Strengths and Limitations

Our study was limited by recruiting solely from one community center. Thus, the participants might have higher levels of information and might be more empowered than the general GM and TW population. Another limitation of our study is that it retrospectively recounts experiences from earlier in the participants’ lives. Thus, it is prone to recall bias and reinterpretation of the events experienced. Finally, the lack of generalizability could be considered an inherent limitation of qualitative research. However, it is not a goal of this method to obtain generalizable results. Instead, it is used to understand certain phenomena in a specific population and to explain how these experiences operate among other individuals in similar situations. A strength of this study was the use of qualitative methods that allowed for a deeper exploration of events that might otherwise be available in a quantitative survey that requires participants to select from preidentified options.

Conclusions and Recommendations

Both GM and TW experience violence within and outside school settings. This violence has long-lasting effects on their well-being. School systems should make teachers aware of the impact of homophobic and transphobic bullying and violence and should train them to recognize and address these issues. In schools, the importance of having all-gender bathrooms is highlighted by our results. Also, promoting activities that are not grounded in gender roles could be very beneficial in diminishing homophobic and transphobic violence among children and adolescents. Schools should also more actively address the prevention of sexual violence, among both male and female students. Parents’ attitudes toward homosexuality and gender diversity need to be addressed by future interventions to diminish violence among children and to enhance parents’ roles as protectors.

Biographies

Author Biographies

Elisa Juarez-Chavez is a Peruvian medical doctor and current Fogarty UCGHI GloCal Fellow, 2017–2018. Her research focuses on the use of qualitative methods for the study of different public health topics, including maternal and child health, maternal mortality, child development, and health and well-being of sexual and gender minority populations.

Erin E. Cooney is a research data analyst in the Department of Epidemiology at Johns Hopkins Bloomberg School of Public Health. Her research focuses on the health and well-being of transgender women, HIV prevention in transgender populations, the impact of stigma on care seeking, and structural determinants of health.

Alberto Hidalgo has a bachelor in political science and administration from the Complutense University of Madrid (UCM), a masters in democracy and electoral affairs from the University of Valencia (UV), and postgraduate training in contemporary studies in Latin America (UCM). He has developed most of his professional career in the field of international cooperation for development, in institutions such as Fundación Triángulo (Spain) and PROMSEX (Peru), where he has specialized in advocacy for the promotion of human rights. He currently works as a parliamentary advisor in the Spanish Senate

Jorge Sánchez, specialist in infectious diseases, is an affiliate professor of the School of Global Health at the University of Washington. Since 2000, he is principal investigator of the Clinical Trial Unit in Peru funded by the Division of AIDS (US-NIH).

Tonia Poteat is an assistant professor of epidemiology at Johns Hopkins Bloomberg School of Public Health. Her research focuses on the social determinants of health with particular attention to the health of sexual and gender minority populations.