Compensated Sex and Sexual Risk: Sexual, Social and Economic Interactions between Homosexually- and Heterosexually-Identified Men of Low Income in Two Cities of Peru

Abstract

This study describes the complex dynamics of the sexual, economic and social interactions between a group of feminized homosexual men and men who have sex with men and self-identify as heterosexual (‘mostaceros’), in lower-income peripheral urban areas of Lima and Trujillo, Peru. The study examined sexual risk between these two groups of men, and the significance of the economic exchanges involved in their sexual interactions. Using a Grounded Theory approach, 23 individual interviews and 7 focus groups were analyzed. The results reveal that cultural, economic and gender factors mold sexual and social relations among a group of men who have sex with men in Peru. Compensated sex is part of the behaviors of these men, reflecting a complicated construction of sexuality based on traditional conceptions of gender roles, sexual identity and masculinity. Several factors (e.g. difficulty in negotiating condom use, low self-esteem, low risk perception, alcohol and drug consumption), in the context of compensated sex, play a role in risk-taking for HIV infection.

Introduction

While many men who have sex with men (MSM) in lower-income peripheral urban areas of Peru define themselves as homosexuals, many others self-identify as heterosexual (Cáceres and Rosasco, 1997, 2000; Cáceres et al., 2002). This allows for the generation of numerous ways of experimenting with sexuality among men. As Toro-Alfonso (2002) points out, there are diverse sexual cultures that govern the lives of MSM. However, many of these cultures, not well described and marginal, are key constituents of the local sexual universe in Peru.

The most sexist lay view in Latin America has traditionally framed homosexuality within a binary gender system with fixed sexual expectations, so that male homosexuality has been seen as a deviation where men are feminized (Eribon, 2001; Hindley, 2001; Mejía et al., 2000; Núñez, 1999; Parker, 1991; Viveros, 2001). From that perspective, wide-spread in less educated social strata, between two men who are sexually involved with each other, one is masculine and the other is necessarily feminine. Moreover, only the feminized partner is considered to be ‘homosexual’ (Motta, 1999). A homosexual man is expected to define himself in relation to stereotypically normatively feminine attributes (e.g. clothes, attitudes, appearance, gestures), occupations (e.g. working in hair salons), and social and sexual roles, which mold the individual as well as his sexual behavior. If the masculine sexual role is active penetration, sexual behavior between men is based on traditional sexual roles where the ‘man’ is the one who penetrates, and the ‘woman’ the one who is penetrated (Guajardo, 2002; Toro-Alfonso, 2002). The homosexual partner is penetrated; he who penetrates is not defined as a homosexual. Thus, a man that acts and looks like a woman is homosexual.

In Peru, bisexually active men who define themselves as heterosexual and who have sexual relations with feminized homosexual men, are widely referred to as ‘mostaceros’¹ or ‘cacaneros’.² The category mostacero describes the intersection of gender identity and sexual identity associated with the hegemonic view of masculinity in Latin America, in which one of the most important attributes expected from men is their mandatory heterosexuality. The type of interactions between mostaceros and homosexual men can be thought of as a ‘non-normative heterosexual relationship’, which is simultaneously part of and at odds with the traditional and normative models of sexuality and masculinity. This view of masculinity transforms homosexuality into an illegitimate practice (Fuller, 2001; Montoya, 1998; ONUSIDA, 2000; Parker, 1996; Schifter et al., 1996; Shepard, 1997). Mostaceros, when having sex with feminized homosexual men in exchange for economic and/or material compensation, perceive themselves as heterosexual, masculine and ‘active’. As Vásquez (2002) points out, in assuming the ‘active’ role in sexual relationships with other men, mostaceros do not believe that they ‘lose’ status compared with other men. In fact, they presume they may even ‘gain’ status by obtaining benefits from homosexual men on grounds of being sufficiently masculine to seduce them and cunning enough to get what they want in exchange for insertive sex (Fuller, 2001). Moreover, compensated sex frequently becomes a commodity to help alleviate the conditions of unemployment pervasive in low-income urban areas, as well as to allow young men to feel that they can, to a certain extent, also participate in the cultural trends of consumerism which would otherwise be beyond their own economic means. In this way, in the low-income peripheral urban areas of the Peruvian coast, social, sexual and economic interactions between mostaceros and feminized homosexual men develop. Even if these economic interactions between mostaceros and homosexual men possess a certain legitimacy in these areas, they continue to be marginalized and clandestine behaviors. Given that there is ample evidence of the vulnerability for HIV infection among MSM, their marginalization makes their sexual interactions risky (Toro-Alfonso, 2002; Vera et al., 2004), as is reflected in the high prevalence of HIV (14%) among MSM nationally (MINSA, 2006).

This study describes the complex dynamics of the sexual, economic and social interactions between mostaceros and homosexual men, the instances of compensated sex where homosexual men provide mostaceros with money, drinks, food or clothes in exchange for sex, as well as the sexual risk perceptions that both groups report when they become sexually involved.

Methodology

Study context

Data for this study were collected through one-on-one interviews and focus groups as part of the ethnographic component of the NIMH HIV/STD Collaborative Prevention Trial. The ethnographic study consisted of exploring the knowledge, beliefs, attitudes and behaviors of different population segments with regards to sexually transmitted infections (STI) and HIV, with the objective of developing a community-level HIV/STI prevention intervention.

The information in the present study was collected in two cities: Lima, the capital of Peru, is located on the central coast, and has a population of 7,842,165; and Trujillo, on the northern coast, which has a population of 620,272 (APOYO, 2003). Work was carried out in two neighborhoods in Lima and one in Trujillo. All three are located in peripheral urban areas characterized by poverty, unemployment and high crime rates. These neighborhoods share in a wider social context marked by migration from other parts of the country, ethnic diversity, violence and authoritarianism in vertical interpersonal relationships (based on power dynamics, because of economic or gender differences, and expressed socially and in the context of the home), the disintegration of original cultural elements as a product of adapting to urban life, and a subtle racism that fragments and tears social relations (Portocarrero, 1993).

Participants

All participants in this study were young adult men between 18 and 30 years of age. From them, 23 were recruited for individual interviews (10 in Lima and 13 in Trujillo) and seven focus groups, segregated by sexual identification, were carried out (five in Lima and two in Trujillo), with 7 to 10 participants per group. The total number of participants and focus groups was determined using the saturation principle (Morse, 2000), meaning that recruitment of new subjects stopped when they began reporting the same information as previous interviewees regarding the topics in question. During the previous year and a half, a team of ethnographers conducted participant observations from which informants were sampled. Informants were chosen because of their experience with and understanding of their community and because they were members of two subpopulations with high-risk sexual behavior (Salazar et al., 2005): feminized homosexual men and MSM who self-defined as heterosexuals.

The heterosexual men (mostaceros) are young, mainly single and generally unemployed, with limited access to education, work and social mobility. They are frequently involved in petty theft, are members of small gangs, use and/or sell drugs, and have transactional sex with feminized homosexual men.

In comparison to the mostaceros, feminized homosexual men, or ‘mariconas’,³ as they often refer to themselves, have higher levels of education and often work in beauty salons or in their own businesses. Others, including the majority of the transvestites, work as sex workers outside of their own neighborhoods. In addition, these homosexual men have a general understanding of HIV/AIDS.

Instrument

The individual interviews and the focus groups were conducted using semi-structured interviews that allowed for the exploration of the meanings, beliefs, attitudes and behaviors related to the sexual practices and relationships between mostaceros and homosexual men. Themes explored included: initiation of sexual activity, types and dynamics of sexual partnerships, sexual risk perceptions, forced sex, negotiation of safer sex practices and condom use.

Process

The ethnographic study was approved by the Institutional Review Boards of the Universidad Peruana Cayetano Heredia and the University of California, San Francisco. All participants provided written, informed consent. The individual interviews lasted one hour and the focus groups, 90 minutes. The individual interviews and the focus groups were audio tape-recorded and then transcribed verbatim. The recordings were assigned an identification code to maintain the interviewees’ anonymity and the transcriptions did not include any personal identifiers.

Data processing

Once the interviews were transcribed, the data were analyzed using Grounded Theory as a reference point (Glaser and Strauss, 1967). The first step in the analysis was to codify the information using the qualitative analysis software program, Atlas-Ti©. The information was then classified into families of codes to orient the analysis: sexual identity, attitudes towards homosexuality, sexual and social relationships, couple relationships, sexual risk perception and condom use.

Results

The context of the interactions

According to the individuals interviewed in Lima, the atmosphere towards homosexuality in their neighborhoods was sometimes positive and accepting and other times violently negative.

Well, I have never felt rejected by anybody, they have always given me respect, and I have never given them a motive to disrespect me. Moreover, some of the women joke around with us and such things. Some do object, I have perceived it in some … there are women that like the affection we give them, but there are others that come in and, well, they are ill-bred tyrants. (Homosexual man 2 – Lima)

Disapproving and judgmental attitudes towards homosexual men exist because of the ‘negative image’ that they project in their neighborhoods which causes them to be perceived, especially the transvestites, as having a scandalous lifestyle. Particularly significant was the harsh self-perception of some of the homosexual men interviewed.

They tried everything to get me out of the neighborhood because I was a bad example for the new boys, the young ones! ‘Maricones’ would go to my cousin’s house. He was a transvestite. It projected a bad image. One of the neighbors started a petition to get us out but the rest of the people didn’t want to give her their signatures because they have known us for years.

The people look down on the transvestites. As they arrive the people in the neighborhood start wondering, ‘What does he do?’ Suddenly his parties create a scandal, and the children start asking questions. That’s the negative image that a gay can project. (Focus Group 1, homosexual men – Lima)

The most reactionary attitudes towards homosexuals can be seen in Trujillo, a city characterized by its conservatism. Some interviewees reported cases of aggression and verbal insult. It was not uncommon that homosexual men were victims of physical violence, even from their own family members.

In my neighborhood here, they insult us verbally. They call us ‘sidosos’,⁴ ‘cabros’,⁵ words that are used here like everywhere, but it doesn’t touch us or make us fight. I mean, they don’t hit us … but I’ve heard from ‘maricones’ that they have had rocks thrown at them. (Homosexual man 1 – Trujillo)

I’ve suffered since I was a child. My family used to spray me with water and hit me really hard with a metal bar, the ones used in construction saying, ‘go to sleep, go to sleep’, and I would go to my room and sleep. They would still hit me when I was 18, and even older. It stopped when my dad threw my stuff on the floor and said ‘get out of the house!’ I left. (Homosexual man 4 – Trujillo)

In some cases their life histories reveal that physical violence leads to sexual violence. Some see these incidents as part of their destiny and many justify and passively accept the sexual demands of the mostaceros.

The guys follow me and they grab me and they forcefully rape me. Once there were three and they started hitting me. The second time was when a few drunks grabbed me. They threatened me with a broken bottle and I got scared. They brought me to a house, forcefully grabbed me and penetrated me. (Homosexual man 3 – Trujillo)

They have treated me badly. One guy that got out of jail wanted to have sex and I told him no because I was sleeping. But I liked the guy so I went upstairs, like a homosexual should. In the hallway he grabbed me by the neck. He hurt me badly, hitting me and imprisoning me upstairs for eight days. (Homosexual man 4 – Trujillo)

In this last quotation, the homosexual man’s lack of self-respect and personal dignity is evident. The fact that someone is paying attention to him, even if it is just for sex, is potentially sufficient to ‘compensate’ for the feeling of low self-worth or loneliness regardless of the humiliation that comes with it. Homophobia, physical violence and sexual assault commonly occur under these circumstances, and in many instances are justified by the homosexual men themselves. The fact that these situations occur relates to the feelings of many homosexual men concerning their social value; they understand homosexuality as a defect or failure of nature.

Look, it’s not normal. With a woman it could be normal, but with a man? In the end we are men. Yes, we have the flaw, the ‘maricona’ trait, but we are men. (Focus Group 1, homosexual men – Trujillo)

It’s like the homosexual is a whore. We don’t have a stable partner so we go with whomever we want. (Homosexual man 1 – Trujillo)

Sexual interactions and compensated sex

‘Pechar’ is the term used in the language of homosexual men to refer to the ‘purchase’ of company or sexual favors, in exchange for some type of material or economic compensation (e.g. money, clothes, shoes, food or alcohol). Pechar literally refers to breast feeding. Once again drawing from the heterosexual perspective of gender roles, the homosexual population uses this term to refer to their interactions with the mostaceros.

This form of compensation between homosexual men and mostaceros occurs as part of the context of the sexual initiation of many adolescent boys, behaviors that tend to disappear when they become adults.

A long time ago it was taboo, they hid it, but the majority started out having sex with homosexuals. It’s because women don’t want to, and you don’t have money to go to a brothel and the homosexual will give ‘it’ to you.

Now it’s known that they do it for the money. The guys fall prey to it.

Those that don’t have experience fall prey, generally when they are eleven, twelve years old, very young adolescents. When they are adults, they don’t do it anymore. (Focus Group 4, mostaceros – Lima)

Having sex with a homosexual man for sexual initiation generates from the perception that the homosexual men are more ‘available’ than the women in the neighborhood.

In that moment he considers you a woman. I’m sure it’s because they want to have a woman and they can’t. What is left? To be with a homosexual. (Homosexual man 1 – Trujillo)

For example there are two young guys in my neighborhood who do it purely for satisfaction because they don’t have sexual relations with their girlfriends. It is simply to relieve themselves. (Mostacero 6 – Trujillo)

The following quotations describe how traditional gender roles that impede the open sexual activity of women become a motive for some of the mostaceros to look for homosexual men who are perceived as a medium for sexual relief. Additionally, according to the mostaceros, with women they can only practice more ‘traditional’ sex, which is largely limited to vaginal intercourse.

I told my girlfriend that I wanted to have anal sex and she told me she didn’t want to. She rejected me. She was disgusted, so we did it normally. (Mostacero 6 – Trujillo)

I had a casual partner for six months and I told him, ‘But you have a girlfriend that has a beautiful body, a doll face’, she is so beautiful. And he told me: ‘What do you want me to do? I can’t do “this” with her’. For the most part the guys look for us because of that, because there are times when they can do with us what they can’t with their girlfriends. (Homosexual man 2 – Lima)

A contradiction exists, however, in the comments of some mostaceros regarding women’s sexuality. When a woman wants to try different sexual acts, this willingness creates a disconcerting and uncomfortable situation for the mostaceros who tend to reject the free sexual expression of their female partners. For them, it is not that a woman does not want to have oral sex, but that a woman should not have it. Additionally, if she asks for it, she is showing that she is ‘easy’, impure and bad.

My friend was on the stairs of his house and he said to his girl, ‘Let’s go listen to music’. They left and his girl said to him, ‘Have you seen porn? Have you seen when the woman goes down on the man?’ And his girl told him, ‘I’m going to go down on you’. My friend was caught off guard and he told her, ‘No, no!’ and he didn’t have sex. (Mostacero 3 – Lima)

For the most part, the mostaceros look for homosexuals for initiation or simply for sexual gratification because it is more probable that the homosexual man will do things that a woman does not want to.

The ‘maricón’ is dirtier [sexually] than a woman. I mean, when you have sex with a ‘maricón’ … we cum on our body and the ‘maricón’ starts to kiss our body until he swallows the semen … that is why they are dirtier than women. (Mostacero 3 – Trujillo)

The aforementioned traditional heterosexual gender roles, then, are contradictory. They encourage young men’s sexual initiation while at the same time discourage young women from anything other than vaginal intercourse and even more so from having sex out of wedlock. The mostaceros we interviewed articulated this dynamic and explained how they and the homosexual men use it to their advantage. They reported that homosexual men are in the habit of looking for young men to have sex with because, generally, the young men have less money to pay for drinks, eat or buy themselves clothes. Essentially then, the homosexual men buy the company of the young men.

At parties there are lots of boys. The homosexuals come, they see them, and of course they like them. They start to talk to them and they give them money, treat them to beer, and after they are drunk they have sex with them. (Mostacero 7 – Trujillo)

They [the adolescents] fall prey because of the temptation of the money. (Focus Group 4, mostaceros – Lima)

In this way, some adolescents learn how and where they can take economic and/or material advantage of the homosexual men who are perceived as having more income. The following quotation illustrates how a mostacero initiated a relationship after the homosexual man interviewed returned with money from working in a mine.

I arrived with money. Working in a mine is like going to work abroad, because you make a lot of money in the mine. So the boy began to like me, to treat me like he was my husband. He started to ask for things. (Homosexual man 1 – Trujillo)

It is evident then, that among mostaceros, looking for homosexual men for sexual relations becomes a way to make money when experiencing financial difficulties. According to the mostaceros, a major part of their relationships and sexual encounters with homosexual men occurs out of economic or material interest.

They [the homosexuals] have taken me to eat, given me money, bought me drinks, they paid for me … like 10 soles, 15 soles. My friend XXX was given money. They bought another friend clothes, shirts, and pants. Well, it’s there when one is looking for it [homosexuals]. (Mostacero 3 – Trujillo)

According to the mostaceros, the sexual encounters usually occur when they are under the influence of alcohol or drugs, which are in many cases paid for by the homosexual men.

It has been a long time since I had sex with homosexuals. It’s been two or three years … I mean, it’s not the same as with a woman, even though you are drunk. I mean, I’ve never done it sober. I was with a homosexual twice, but drunk. (Mostacero 4 – Trujillo)

The homosexuals know how to provoke. They see someone who doesn’t have anything and wants to have a drink. They want to take advantage of them. I do it because I want a drink. (Focus Group 4, mostaceros – Lima)

The older mostaceros, the ones with more experience, learn how to take advantage of the homosexual men, including manipulating their feelings to obtain some type of benefit.

Those are the older more experienced guys. The majority has already had experience with a homosexual at 25 years old; they know how to work your emotions. They tell you they love you. (Homosexual man 3 – Lima)

Many mostaceros realize they can obtain ‘better benefits’ from the homosexual men by maintaining more stable relationships. For these homosexual men, to have a stable partner is desirable, to have a ‘real man’ (e.g. someone who is masculine) who apparently loves them, constitutes a success.

The mostaceros who were interviewed expressed that establishing a more long-term relationship with a homosexual does not imply genuine feelings, but rather only interest in financial gain.

I know that it is wrong, because you don’t do it for love; you only do it for the money. Maintaining a relationship with a ‘maricón’ looks very bad. (Mostacero 3 – Trujillo)

At the root of this, the homosexual men we interviewed showed resignation at not being able to be in a stable relationship with mostaceros, understanding that the mostaceros are just with them for economic interest.

I accept that the ‘maricones’ can live this way but it’s an illusion. Yes, they can live with a partner, but the guys [the mostaceros] here are very greedy [for money]. They [the homosexuals] give you more money, they treat you … so I can’t be with one guy for a long time … the majority of the guys are greedy, it is a rare guy who truly loves you, that respects you. (Homosexual man 3 – Trujillo)

Meeting places

Generally, the homosexual men and the mostaceros socialize with one another at discotheques, parties, polladas (community chicken dinners) and/or volleyball tournaments. Similarly, a particular space where mostaceros look for homosexuals and where they know they can have sex is at hair salons.

When there is a party with some of them, I mean a ‘pollada’ and they have volleyball games, well, all the cream of the crop of the gay world comes together, even guys from Lima come. (Homosexual man 2 – Trujillo)

At the parties I do it [sex] every 15 days. Some of my friends are crazy because they do it every day. They [the homosexuals] do it with several men, when they [the mostaceros] go to the hair salon. ‘Hey, give me a trim’ and later right there they do it. (Homosexual man 4 – Trujillo)

As illustrated in the following quotations, it is also common to look for abandoned houses or houses under construction where sex can be had with lovers or casual sexual partners. As homosexuality is interpreted through the traditional heterosexual gender scheme, the homosexual men in the following excerpts refer to one another as ‘she’ and to the mostaceros as ‘guys’.

Well, one time we went to the park with a few guys, and a neighbor there gave us the name ‘ecologists’ that like to have sex in the parks, that’s why she gave us the name ‘ecologists’.

I had a friend that whomever she met she went to the houses under construction, she went to the ones that at least had walls up, but she climbed them. (Focus Group 1, homosexual men – Lima)

Some don’t have money and sometimes they take them to a friend’s house or if not I’ve heard them say, ‘To Progreso, to Progreso’, they’re broke. It’s a little uninhabited market where they are doing construction work. I’ve heard that that is where they go. I think it’s very unhygienic … they do it standing up, or lying on their jackets or on cardboard on the ground, it’s very dirty. (Mostacero 6 – Trujillo)

Others usually have sex outside, for example in the street or in parks at night, where and when nobody can see them. Sometimes having sex in these places becomes the main alternative when they are refused entry at the motels.

You know, when you really want to have sex, you’re almost anxious. If you don’t have money for a motel, you can do it around the corner. (Mostacero 4 – Lima)

Well, I went last Wednesday with a friend looking for a motel with a garage where we could leave the car. We went all over looking for a place. He said, ‘I’m with my nephew, I just need a few minutes to shower, I’ll be in and out’ and they said ‘No’. We were refused at more than five motels. (Focus Group 1, homosexual men – Lima)

Although these sexual encounters sometimes happen in public spaces, they occur in a secret manner, clandestinely, because homosexuality is considered abnormal and is not accepted. This includes an internalized homophobia among homosexuals themselves.

[I think] that it is abnormal for two men to have sex, according to society, right? Not everyone thinks it is normal. Sometimes one has to, without wanting to, go by what society says … I mean society throws up obstacles and sometimes, so that people aren’t talking about you and saying things, one has to do things secretly. You’re not going to be on your front steps with a guy. You’ll have sex, but not right there where everyone can see. (Homosexual man 3 – Lima)

Sexual risk

Due to their clandestine character, sexual encounters between mostaceros and homosexual men are related to behaviors, perceptions and evaluations of sexual risk. In spite of the fact that, among many homosexual men, there exists an understanding of prevention and the fear of infection is constant, condom use is inconsistent, among other things, because of a fear of losing a potential sexual partner.

Oh, they say, ‘We’ll use it’ [a condom] but in the end they don’t. Sometimes the opportunity comes up that you are only with one guy, he likes you and you’re with him, you ‘pick him up’ and then he fucks you. If the guy is good looking, the ‘maricona’ will do it without thinking whether or not the guy has a condom.

I’m not going to lie – sometimes we forget to use it. Sometimes I’m in a hurry, or sometimes I don’t remember, or sometimes I don’t have one, but well it doesn’t matter. (Focus Group 1, homosexual men – Trujillo)

With respect to negotiation of condom use, difficulties exist when the exchange is between a homosexual man and a casual sexual partner. Generally, condoms are not used if the mostacero looks healthy, is very young or is known to them.

I do it without protection, naturally. If the guy likes it, I do it without protection, but if the guy demands that I use protection, I put it on him. If the guy is okay doing it without protection I do it without protection, but if he doesn’t want it that way, what can I do? I can’t force him. The guy [decides]. (Homosexual man 3 – Trujillo)

If you ask ten [adolescents], eight have had their first sexual encounter with a ‘gay’ and that is when [the ‘gays’] don’t protect themselves because [the adolescents] supposedly are inexperienced. (Focus Group 1, homosexual man – Lima)

For the mostaceros, it may have to do with the excitement of the moment, which, they say, is stronger than the desire for disease prevention.

Look there are many instances when you tell them that you have protection. They say yes, but they don’t use it. Like it has been said, in the heat of the moment they sometimes forget about the condom, in spite of having one. (Mostacero 4 – Trujillo)

The mostaceros use a condom with their female partners to avoid pregnancy or for hygiene purposes when the woman is menstruating. Their female partners also do not accept protection and for the most part do not request condom use. As evidenced in the following, the norms and values of traditional gender roles permeate and influence the woman’s evaluation of her sexual experience, and therefore her health protective behaviors.

My wife, the mother of my child, used injectable birth control, and I told her, ‘You’re getting fat, why don’t we use a condom?’ She told me, ‘No, I know you have another woman, or you’re going to infect me with something’. That is why she didn’t want to. She was too jealous. (Mostacero 4 – Trujillo)

Here the mostacero implies that for his female partner using a condom signified his own infidelity. In choosing not to use a condom she attempts to control his behavior, in essence trying to shame him into being faithful.

In having unprotected sex with homosexual men as much as with their female partners, these men who self-identify as heterosexuals can contribute to the expansion of STI/HIV in other population groups.

Sometimes you see someone who looks healthy and has only had one partner and that partner liked homosexuals. What if he has infected his female partner and she says, ‘I only have one boyfriend’ but she got the virus from him? There is no reason to trust her. (Focus Group 1, mostaceros – Trujillo)

And then there are some who have sex with the same sex, with a ‘cabro’ [a faggot] … a ‘cabro’ you know, every so often they have sex. And it could be… with the guy, and the guy with a woman, and then she gets infected. (Mostacero 6 – Lima)

Discussion

The study has shown how cultural, economic and gender forces mold sexual and social relations among a group of MSM in two cities in coastal Peru. In addition, important data were revealed with regards to sexual subcultures, language and types of relationships, as well as the social and economic environment in which those sexual and social relationships take place.

While our findings apply to men who participated in this study, we believe that economic transactions play a significant role in the sexual experiences of many homosexual men and mostaceros of the main coastal cities in Peru. The dynamics of compensated sex create a vicious cycle where the homosexual man pays or gives gifts in exchange for company or sexual favors and a heterosexually identified man seeks to obtain something such as money, clothes, food, unconventional sex or alcohol.

We have seen how sexual interactions between homosexuals and mostaceros form part of the sexual subculture where these types of relationships are permitted in exchange for material and/or economic compensation. With that said, compensated sex should be distinguished from sex work. The first is understood to be the exchange of sexual favors for some type of economic or material compensation. Sex workers, on the other hand, are paid money in exchange for sexual favors, and for them this type of work is their principal and major source of income (Browne and Minichiello, 1995; Théodore et al., 2004). Compensated sex, instead, tends to benefit (the mostacero) in a sporadic manner.

These exchanges occur in the economically disadvantaged neighborhoods of Lima and Trujillo where the sexual culture is often uncontrolled and violent. Here the streets, parks, polladas, and other social spaces are where the homosexual men and the mostaceros interact, work, socialize and have sex. It is evident then, that a certain social class niche allows for the construction of identities, sexual roles and behaviors. In these neighborhoods, a man’s sexual identity results from cultural values and mores different from, for example, a homosexual man who is a member of the Peruvian middle class. This is related to the fact that these populations experience socio-economic exclusion and many do not have stable work, income, or a level of education that allows for personal development and the establishment of social networks outside of their immediate environment.

In the social contexts of our study, identity is not very important in the definition of what an individual does sexually. Sexual practices do not define identities and one’s identity can include diverse sexual practices (Pecheny, 2000). The sexual identity of the mostacero is a product of his masculine behavior, and his heterosexuality is assumed and measured by that masculine demeanor. The closeness with his ‘patas’ (buddies) and with men in general is considered the norm that validates his masculinity and heterosexuality. While none of the ‘heterosexual’ men interviewed self-identified as ‘mostacero’, their sexual behavior might not seem inappropriate to their peers, who might even encourage that behavior as long as it fits within their patterns of heterosexuality. This sexual behavior is a pattern characteristic of young men who, when reaching adulthood and beginning to have duties and responsibilities (e.g. getting married, having children, and working to support their families), end up assuming an absolute heterosexuality.

While this study mainly describes a type of relationship between homosexual men and mostaceros framed by the traditional binary interactions of ‘pasivo/activo’, and associated with compensated sex, we believe that there can be diverse reasons and motivations as to why men, even some of our straight-identified informants, involve themselves sexually with other men, including relationships based on physical attraction and/or affection. The latter allows us to point out that compensated sex is produced by the behaviors of these two groups of men reflecting a complicated construction of sexuality based on traditional gender roles. Here, heteronormativity governs social and sexual interactions between mostaceros and homosexuals. Basilio (2004) states that homosexual men like the ones described here tend to reproduce, in their self-perceptions, the characteristics of the male/female binary. It is this difference in gender roles that makes these homosexual relationships possible, as they mirror heterosexual relationships. It is not only the sexual difference in gender roles that is important, but also the hierarchy where the masculine dominates the feminine (Eribon, 2001). The social construction of the relationship between mostaceros and ‘mariconas’ generally is unequal, revolving around the masculine/feminine dichotomy, categories more related to identity and status than to sexual practices.

The mostacero does not accept or does not see in himself the defining characteristics of a homosexual. The word ‘mostacero’ is a term used by the men of these social sectors to describe their sexual behavior, but not a category they ascribe to in order to define their personal and/or social identity, since that term can also have a pejorative connotation. Moreover, the justifications for such behaviors revolve around the exchange of sex for something. As a result the mostacero develops the ability to interact in the public heterosexual sphere as well as in the private bisexual sphere. As Basilio (2004) describes, this is ‘the heterocentric cultural form that regulates homosexuality’. In some cases, the sexual activity of the mostacero can be much more related to the reaffirmation of their gender role and homosocial status than to pleasure, sexual relief or compensated sex in itself. For example, an adolescent’s sexual initiation with homosexual men is determined by the combination of social pressure that obligates him to affirm his masculinity as well as by the fact that it is still a bit difficult for ‘good’, young women to have sex before a formal union.

In the mostaceros we see a masculinity directed towards the demonstration and practice of an active sexuality, with all the implied risks. In ‘penetrating’ a homosexual man the mostaceros feel as though they preserve their masculine identity and power, resulting in a diminished risk perception. Sexual practices with ‘mariconas’ are not associated with homosexuality. On the contrary, bisexuality is frequently practiced without acknowledging the homosexual component. Not acknowledging these homosexual practices may constitute an important obstacle for the mostaceros to perceive their own vulnerability and risk for HIV/AIDS (Bianco et al., 2003; Herrera and Campero, 2002). In diminishing their risk perception they do not recognize their own vulnerability, and therefore, their capacity to incorporate the necessary information to avoid contracting HIV (Bianco et al., 2003; Herrera and Campero, 2002).As Manzelli and Pecheny (2002) state, this contributes to the creation of ‘imaginary protections’ against HIV, referring to their own unrecognized possible risk, in the case of the mostaceros, and that of their partners, in the case of the homosexual men. Compared to the homosexual men, whose higher educational and economic level allows them better access to information on HIV/AIDS, mostaceros are more unprotected and vulnerable, especially because they are poorer and further excluded from the social system (many do not have personal identification papers and/or have criminal records).

Another characteristic of the interactions between mostaceros and homosexual men is that they take place where there exists, at least superficially, a ‘peaceful’ coexistence between the homosexual men and the general population (Figueroa, 2001; Motta, 1999). This coexistence is maintained under certain limits, something similar to the popular Peruvian saying, ‘Dios perdona el pecado pero no el escandalo’ (‘God forgives the sin but not the scandal’), meaning that tolerance exists as long as the behavior does not imply a threat to the life and tranquility of the neighborhood. Among these segments, the tolerance for homosexuality is perhaps higher than in other social strata. Homosexuality is accepted to a degree, as long as it is defined within the margins imposed by the traditional discourse (coinciding with the stereotype of the feminine homosexual). In these social sectors, effeminate men, as referred to by Carrillo (2002), may reject social expectations, renounce their masculinity, and have nothing to lose by showing their effeminacy. Because of that, homosexual men are often more visible than in other social strata. Nevertheless this same environment is evidence of the presence of a ‘double discourse’ that manifests itself through negative attitudes towards homosexuals, while at the same time they – the homosexuals – are needed to have sex. Homophobia is the indirect result of this type of relationship, sometimes expressing itself through violence. Internalized homophobia is related to the self-perception of homosexuality as something negative and unnatural, explaining why we heard, from some of the homosexual men interviewed, justifications for the violence committed against them. In this context, the homosexual men who assume the role of women and dress as women on a part or full time basis and might identify themselves as transvestites provoke the most negative reactions among the general population and suffer discrimination, homophobia and ridicule.

The self-identified homosexual interviewees also revealed very low self-esteem connected to stories of mistreatment, rejection and discrimination – stories tied to self-deprecation and self-criticism of their own behavior. This intrapersonal characteristic is important because low self-esteem affects their capacity to adopt preventive behaviors. Toro-Alfonso et al. (2002) state that those who exhibit lower self-esteem and less ability to establish limits in their interpersonal relationships have more of a propensity to involve themselves in risky sexual behaviors.

Another consequence of homophobia is the way homosexual men consider or value their feelings of love and affection. Their sex with multiple casual partners would serve, for many of them, to fill an emotional vacuum and compensate for the feelings of loneliness and rejection generated by an environment hostile to their way of life. Additionally, their role models for stable relationships are almost non-existent, a fact that reinforces their search for casual sex and unsatisfying relationships. They acknowledge that because of existing homophobia, no ‘man’ will be sincerely and genuinely interested in them without material interest, since mostaceros ‘fuck’ homosexuals without any emotional interaction or commitment toward them. This aspect of their lives may make many homosexual men have a fatalist vision regarding their future. For example, they may assume that becoming infected with HIV is part of their destiny and something that cannot be prevented.

Regarding their perceptions and behaviors associated with sexual risk, we have observed that among homosexual men there is a disconnect between their level of knowledge about HIV and their low perception of risk, risk behaviors, inappropriate use of condoms, and difficulties negotiating safer sex with their partners. This paradox between discourse and practice must make us reflect (or question) whether the current prevention efforts are really effective, or whether other prevention efforts that incorporate substantial elements related to the experience of the individual and the environmental context are needed.

The low risk perception and the risk behaviors assumed by homosexuals as well as by mostaceros relates to the concept of vulnerability (ONUSIDA, 1999). As Szsaz (2004) and Cáceres (2004) state, the varied cultural traditions that sustain the economic relationships with sexual practices are a key dimension in the comprehension of socio-sexual vulnerabilities. Where sex is exchanged for goods, services or money, occasionally or continually, these relationships reflect gender inequalities and power differentials between two men having sex.

The occurrence of sexual practices in public spaces consistently predicts the presence of high-risk behaviors (Cáceres and Rosasco, 1997). The need to have sex in a rush, without being seen or heard, does not facilitate or encourage condom use (Vera et al., 2004). This is relevant to the men in our study because, besides the potential for violence and muggings, the hidden nature of their sex encounters in dark or abandoned places may increase their vulnerability for HIV infection.

Some interviewees reported that episodes of unprotected sex occurred during situations where the mostaceros had control over the encounter and the homosexual men were unable to counteract that control because they wanted to surrender, literally and symbolically (‘giving their anus’) to their man. In those situations, the homosexual men depended on the mostacero’s acceptance and desire to decide what will happen during the sexual encounter. This coincides with the trade-off scenarios described by Adam et al. (2005) as the ‘exchange of advantages and disadvantages’ through which social hierarchies create a risk economy where a sense of personal shortcomings, the self-perception of one’s own physical attraction, and the eagerness not to ruin a sexual opportunity might increase someone’s vulnerability. We have also observed that homosexual men trust the decision of using a condom to their casual partners, perhaps because of the ‘displacement’ of their own responsibility of self-care when adopting the feminine role, passive in the whole sense of the word. Homosexual men also become more vulnerable to HIV infection when they stop using condoms because they know (from the same neighborhood) the mostaceros’ female sexual partners which in turn makes them feel confident in trusting the health status of the mostacero.

By not using condoms for sex with men or women, mostaceros may play a key role as a bridge population for the transmission of HIV and STIs. This role would explain the growing number of monogamous women in Peru infected by their bisexual partners (Cueto, 2002). Similarly to their attitudes toward using condoms with other men, mostaceros may not use condoms when they have sex with women because using a condom would decrease their manhood, considered as something to be maintained and defended, as well as adding an element of mistrust since their female partners would wonder why they want to use condoms.

The high consumption of alcohol and drugs also represents another vulnerability factor for HIV. Several authors (Díaz, 1999; Koblin et al., 2006; McKirnan et al., 1996; Wolitski, 2005) have pointed out that the high consumption of alcohol and drugs might decrease good judgment, induce having sex with unknown individuals, and increase the occurrences of unprotected sex and the risk for HIV infection. Some mostaceros reported that the use of alcohol and drugs serves as a means to uninhibit or facilitate sexual encounters with homosexual men. This use (‘I only do it when I am drunk’) however, it can also be interpreted as a justification for their behaviors, even to themselves, while in fact they may consciously seek homosexual men and even enjoy having sex with them.

We have been able to identify several factors (difficulty negotiating condom use, low risk perception, alcohol and drug consumption and so on) in the context of compensated sex that imply risk for HIV infection. In general, the diversity that exists between men who have sex with men, in our study homosexual men and mostaceros, is a challenge for HIV prevention and education programs. Taking into account sexual diversity in prevention programs is crucial because not all men who are in sexual relations with other men share the same sexual identity, and while they may be able to understand prevention messages they do not necessarily have the ability to apply them. Generalizing concepts, like the term MSM, though somewhat useful from an epidemiological perspective, only serve to confuse and create an illusion of uniformity where diversity exists, thus making better prevention difficult (Pecheny, 2000). Likewise, we believe that HIV prevention and education campaigns for this diverse population must take into account their circumstances of high vulnerability, poverty, prejudice and violence (Barreda and Isnardi, 2004). HIV prevention programs and strategies should further incorporate a gender perspective, since gender constructs seem to frame the sexual arrangements and identities of most men (Montijo and Gottbacher, 2004). By more closely considering the role gender plays in HIV transmission (from a social perspective), a major gap between current prevention approaches and the reality of people’s lives can be closed.⁶

Finally, while the relations between mostaceros and homosexual men are not recognized or identified by them as compensated sex, it is important to examine the concept from a public health perspective. While compensated sex in itself may not equal risk, it becomes a risk for HIV and STIs because of the conditions that surround it and the population that practices it.

Biographies

Percy Fernández-Dávila is a psychologist. He has participated in research and prevention activities for the Cayetano Heredia University and the NGO Redess Jóvenes on issues such as sexuality, gender, sexual health and AIDS. He has written some articles on masculinity and homosexuality in Peru. Currently he is studying a PhD at Ramón Llull University in Barcelona, Spain, focusing his studies on applied qualitative research. Address: Cayetano Heredia University, Av. Armendariz 445, Lima 18, Lima, Perú. [email: rpfernan@pucp.edu.pe]

Andre Maiorana is an anthropologist who has worked on the design, implementation and evaluation of primary and secondary HIV prevention programs for different communities. Andre has participated in several US and international research and evaluation projects as project director and/or co-investigator, focusing on applied qualitative research, ethnography, behavioral interventions, technical assistance, community collaboration and ethical issues in public health and research. His research interests include HIV prevention, evaluation, gay men, research ethics, and Latin America. Address: AIDS Policy Research Center/Center for AIDS Prevention Studies, UCSF, 50 Beale Street, suite 1300, San Francisco, CA 94105, USA. [email: andres.maiorana@ucsf.edu]

Ximena Salazar is an anthropologist. She has participated in several researches on sexuality, gender, domestic violence and reproductive health. Currently she is the coordinator for the Intervention Component, Peru Site, NIMH Collaborative HIV/STD Intervention. Address: School of Public Health. Cayetano Heredia University, Av. Armendáriz 445, Lima 18, Lima, Perú. [email: 16570@upch.edu.pe]

Carlos F. Cáceres is a physician and a social epidemiologist. Currently he is Professor and Vice Dean at Cayetano Heredia University School of Public Health in Lima, Peru, where he also coordinates the masters program on gender, sexuality and reproductive health. Dr Cáceres has done extensive research on HIV/AIDS epidemiology and prevention, sexuality and sexual health, and has worked and published on all these topics. He is the editor of ‘AIDS and Sex between Men in Latin America: Vulnerabilities, Strengths and Proposed Measures’ (Lima, UPCH, UNAIDS and PAHO, 2003). Address: Facultad de Salud Pública y Administración ‘Carlos Vidal Layseca’, Cayetano Heredia University, Av. Armendáriz 445, Lima 18, Perú. [email: ccaceres@upch.edu.pe]

Josefa Martinez is a Research Associate with the Yale University Psychology Department’s Health, Emotion and Behavior Laboratory. She has a graduate degree in International Health from Johns Hopkins University. Ms. Martinez has devoted more than five years to international efforts in community-rooted HIV prevention interventions for under-served populations in the United States and Peru. As a researcher she has coordinated the design and evaluation of a number of federally-funded programs. She has also worked extensively with community groups providing technical assistance and capacity building in the design and evaluation of evidence-based prevention interventions in HIV/AIDS. Address: Johns Hopkins Bloomberg School of Public Health, International Health Department, Social and Behavioral Interventions Program, 95 Ironworks Rd, Clinton, CT 06413, USA. [e-mail: jmartine@jhsph.edu]

Susan Kegeles is a research psychologist who has worked in the field of HIV/AIDS for over 20 years. Her research primarily focuses on HIV prevention issues with gay/bisexual men and other men who have sex with men. Address: Professor and Co-Director, Center for AIDS Prevention Studies, University of California, San Francisco, 50 Beale Street, Suite 1300, San Francisco, CA, USA. 94105. [email: Susan.Kegeles@ucsf.edu]

Thomas J. Coates is Professor, Division of Infectious Diseases, and Director, UCLA Program in Global Health at the David Geffen School of Medicine at the University of California, Los Angeles. His interests and experience focus on the study of disease-related behavior, with an emphasis on interventions to modify behaviors. He is the author of many publications on the effects of antibody testing on high-risk behavior, the efficacy of strategies to modify high-risk behavior, the relationship between psychosocial variables and AIDS-related immune dysfunction, and clinical illness and interventions to reduce high-risk behavior among seropositive men. Address: David Geffen School of Medicine, University of California, Los Angeles, 10940 Wilshire Blvd. Suite 1220, Los Angeles CA 90024–7320, USA. [email: tcoates@mednet.ucla.edu]