Knowledge and perceptions of HIV & STIs among Amazonian indigenous health practitioners in Peru

Elevated rates of HIV and STIs have been reported in the Peruvian Amazon; indigenous populations have not been exempt. This study aimed to increase understanding of indigenous health practitioners' experiences and insights about HIV and STIs in their communities. In June and July of 2009, we conducted 29 in-depth, semi-structured interviews with a purposive sample of health students, shamans and midwives from seven Amazonian ethnic groups (Achuar, Awajun, Quechua-Lamista, Murui, Shawi, Shipibo-Konibo, and Wampis) in four cities in Peru: Lima, Bagua, Pucallpa, and Iquitos. Participants from diverse geographic and cultural backgrounds were asked about their knowledge and perceptions of HIV and STIs in their communities. Interviews were transcribed and ATLAS.ti was used to conduct a conventional content analysis. We found: 1) indigenous populations lack education, outreach and care for HIV and STIs, and are uninformed or misinformed about HIV and STI etiology, modes of transmission, preventive measures and available treatments; 2) in various indigenous communities men who have sex with men (MSM) are stigmatized and often associated with HIV; 3) many indigenous people seek traditional medicine for treatment of HIV and STIs. Participants recommended strengthening health systems in the Amazon; developing culturally competent and multi-lingual health outreach programs; supporting shamans and traditional medicine; and enhancing the capacity of indigenous people to study and work in health fields. This study gives voice to indigenous health practitioners of the Peruvian Amazon and illustrates the need to address their recommendations, as well as, MSM and HIV/STI stigma and discrimination in Amazonian indigenous communities.