Men who have sex with men (MSM) and transgender women are disproportionately affected by HIV in Guatemala, yet little is known about their experiences with diagnosis, linkage to care, and retention. We conducted qualitative interviews with 26 MSM and transgender women living with HIV in Guatemala City. HIV diagnosis experiences changed over time with increasing asymptomatic testing at non-governmental organizations. Fear of the physical and social impacts of HIV delayed testing, acceptance of diagnosis, and linkage to HIV care. These fears were driven by layered stigma and discrimination due to non-normative gender expressions and/or sexual orientation. Retention-specific determinants included HIV clinic dynamics and limited employment opportunities. There is an urgent need to improve support systems for early testing and linkage to care and to expand employment opportunities. Stigma and discrimination must be addressed at the family, clinic and contextual levels to reduce fear of diagnosis and improve access to care.

Introduction: Men who have sex with men and transgender women across the globe experience barriers to timely linkage-to-HIV care. Health navigation is a strengths-based approach, originally developed for cancer patients, to address these barriers and provide support. We piloted a health navigation strategy to improve timely linkage-to-care among men who have sex with men and transgender women recently diagnosed with HIV in three sexual health clinics in Guatemala City. Methods: Participants included individuals who were at least 18 years old, identified as a cisgender man or transgender woman, reported having had sex with a man in the past 12 months, and had received a positive HIV diagnosis at one of the participating clinics. Three health navigators were trained in health navigation including: assets-based counselling and support; health system information; and advocacy. We used a combination of quantitative data collected during clinic visits and qualitative data collected through in-depth interviews with participants who accepted navigation to characterize the acceptability, effectiveness, and our primary outcome of time to linkage, defined as having the first clinical care visit. Results: Out of 61 men who have sex with men and transgender women diagnosed at the participating clinics during the study period, 54 were offered participation and enrolled in our pilot (n=52 men who have sex with men; n=2 transgender women). Fifty participants (92.6%) accepted navigation, all who accepted were successfully linked-to-care. The median time to linkage was 3 days (Interquartile Range 2–5 days). In qualitative interviews, participants expressed feeling extremely scared and alone following their diagnosis and appreciated the support of a navigator especially when they did not feel they could access their existing support networks. Conclusions: Navigation was a highly acceptable and effective strategy for facilitating timely linkage-to-care among newly diagnosed men who have sex with men at participating clinics in Guatemala City. Differentiated approaches should be used to improve engagement with transgender women. Based on these findings, navigation strategies are currently being integrated into HIV prevention and care models in the Central American region. Rigorous implementation science research and evaluation should continue to explore the use of health navigation with key populations recently diagnosed with HIV.

En Guatemala no se ha revisado el entrenamiento del ejército durante el conflicto armado ni su relación con las violaciones a los derechos humanos, específicamente con las violaciones sexuales a mujeres. Por otra parte, en ello se ha tratado del sufrimiento de las mujeres, pero no de aquél experimentado por "el victimario". En este artículo se analiza quiénes eran los perpetradores, qué formación recibieron y cómo se construyó la masculinidad dentro del ejército. Se analiza la creación de un sistema guatemalteco de represión capaz de permitir y ordenar acciones violentas, con un ejército en sintonía con normas y valores culturales, basados en el autoritarismo, el racismo, el clasismo y las relaciones de poder entre hombres y mujeres.

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