Victor Hugo Cerna

Peruvian Víctor Cerna is engaged in a novel AIDS prevention initiative that focuses on gay and bisexual men not effectively reached by other programs. In the workshops, mutual support groups, and other activities that he organizes, Víctor places heavy emphasis on nurturing the self-esteem of program participants.

Víctor Cerna is developing an AIDS prevention initiative that is focused on gay and bisexual men and based on a strong conviction that technical information about “safe sex” is not in itself sufficient to ensure “safe sex” behavior. In Víctor’s view (which is shared by many experts in the AIDS prevention field), the self-esteem of men at risk of contracting the disease is a critically important determinant of whether they will or won’t acquire the HIV virus. Accordingly, in marked contrast with other AIDS prevention programs in Peru, Víctor’s initiative places heavy emphasis of strengthening the self-esteem of its participants and building a support network that will provide continuing companionship, counsel and motivation to refrain from unsafe practices.

Víctor’s program relies on two key instruments to accomplish its aims. The first is an ongoing series of self-financing workshops that are directed particularly at men who are most at risk. The second is an expanding network of mutual support groups, organized by men who have participated in the workshops but reaching out to others who have not had that experience.

In Peru, as elsewhere in Latin America, AIDS and HIV infection have assumed epidemic proportions. Since 1983, when the first case of AIDS was reported to public health authorities in Peru, the number of people with the disease has steadily increased. In early 1996, there were 4,190 known cases of full-blown AIDS in the country, and at least two-thirds of the people suffering from the disease were gay or bisexual men, the vast majority of them between twenty and forty years of age. (Males accounted for approximately 86 percent of the known active cases, and survey data indicate that four out of every five Peruvian males with the disease are gay or bisexual.)


But active cases of AIDS, of course, are only the tip of the iceberg. Research in a wide variety of settings indicates that, for every person with the full-blown disease, there are another 50 to 100 who are carrying the virus but have not yet developed the symptoms that are commonly associated with the disease (and constitute the basis of official tallies of the disease’s spread). There is thus strong reason to believe that at least 200,000 Peruvians (approximately one percent of the country’s total population) are infected with the HIV virus.

Unfortunately, ongoing AIDS prevention programs are by no means adequate to curb the continuing spread of the disease. In spite of the fact that gay and bisexual men constitute a very large portion of people with AIDS and HIV in Peru, there is a notable absence of prevention efforts specifically addressed to that group. The government’s AIDS education and prevention campaigns focus on fidelity and safe sex, stressing the importance of condom use, but their messages are not specifically targeted at gay and bisexual males. Of the few nongovernmental organizations engaged in AIDS prevention work in Peru, only one is working directly with Lima’s gay community, and it has not succeeded in reaching out to the large numbers of men who engage in sexual activity with other men but do not regard themselves as, or admit to being, gay.

In the view of most international experts in AIDS prevention work, moreover, successful efforts to encourage gay and bisexual men to avoid the practices that result in the disease’s spread must be sensitively attuned not only to their lifestyles but also to negative self-images of many, if not most, such individuals. For any number of reasons, including the stigma associated with being gay (which has been reinforced in recent years by the AIDS outbreak), large numbers of gay and bisexual men suffer from low self-esteem, and the “unsafe” practices in which they all too commonly engage are a consequence, at least in part, of that self-estimate. Accordingly, the success of efforts to encourage and help them make the necessary changes in their behavior will depend very heavily, in the last analysis, on their effectiveness in building self-esteem. Sadly, however, most AIDS prevention efforts in Peru (and elsewhere) do not take that factor sufficiently into account.

The strategy embodied in Víctor’s AIDS prevention initiative has four distinguishing characteristics. It seeks out men who are most at risk of contracting AIDS but particularly difficult to reach. It employs workshops that cover a wide range of topics of concern to gay and bisexual men and stimulates the formation of mutual support groups that provide longer-term opportunities for continued learning, encouragement and counsel. It stimulates workshop participants to assume active roles in AIDS prevention and care endeavors. And, in each of its activities, there is a conscious emphasis on building the self-esteem of the individuals involved.


In recruiting program participants, Víctor makes special efforts to identify men who are actively, and often promiscuously, engaged in sexual activity with other men but do not regard themselves as homosexuals and/or openly admit to being gay. With the assistance of volunteer organizers, he searches out these “closeted” individuals and other gay and bisexual men by distributing leaflets and putting up posters in places they often frequent, including saunas, cinemas, discos and volleyball grounds, and he also uses notices in magazines and newspapers to make his program known. In all of the leaflets, posters and notices, he provides a contact telephone number. When people call, they are invited for an interview, at which the program is described in greater detail and prospective participants are asked to pay a fee (the equivalent of approximately twenty dollars per month) to cover workshop costs. When twelve people sign up, a new workshop is launched.

The workshops cover a wide range of topics of concern to gay men, including homophobia, family relationships, couple relationships, spirituality, fatherhood and AIDS. At the introductory meeting of each group, Víctor brings in participants from previous workshops to help dispel any doubts about the confidentiality or seriousness of the endeavor and to develop, from the program’s outset, an atmosphere of mutual respect and trust. Drawing on a wide range of reading materials, most of which Víctor has translated and adapted from U.S. and European sources, subsequent workshop sessions emphasize frank and open explorations and exchanges and nurture positive attitudes and outlooks on the various topics covered.

At the conclusion of the workshops, participants are encouraged to form continuing mutual support groups. Most such groups draw in other individuals who have not participated in the workshops, and each group develops its own approach and agenda. Many of the groups “adopt” a person with AIDS and provide that person with needed material and moral support. Some target particular behavioral problems, such as alcoholism or drug addiction, which are intimately linked with deeper issues of self-esteem, while others tackle the special needs of gay and bisexual men who are married and have children.

In addition to participating in continuing mutual support groups, many former workshop participants volunteer for additional training in AIDS prevention and then organize “safe sex” workshops and similar activities for people not directly reached by the workshop program. Those undertakings multiply the impact of Víctor’s initiative and play an important role in improving their organizers’ sense of self-worth.


In his continuing efforts to reach groups that are particularly at risk of contracting AIDS, Víctor is planning to organize workshops and support activities for university and high school students. Sadly, there is mounting evidence, in Peru and elsewhere, that younger generations of gay and bisexual men are not exercising appropriate caution in their sexual practices, and Víctor hopes to play an important and timely role in helping those younger people avoid the ravages of AIDS.

Growing up in Lima, Víctor sensed at an early age that he was “different” from most of the boys around him, and as he grew older, he struggled with feelings that he had learned, from comments of family members and neighbors, to associate with weakness and shame. As a teenager, he turned both to therapy and to religion in an attempt to rid himself of those feelings. And when it became clear that both of those approaches had failed, he began to fear that he was condemned to lifelong unhappiness.

Fortunately, however, he found a therapist who helped him to accept and value himself for who and what he was. Armed with this new self-confidence, he revealed his sexual orientation to his family, talking openly with them about the implications of being gay, and ultimately gaining their acceptance and support. As Víctor looks back at that experience now, he realizes that it played a decisive role in encouraging him to undertake his current work and shaping its approach.

In the mid-1980s, as AIDS began to enter the public consciousness in Peru and press coverage of the “pink plague” cited a few local cases, Víctor did not immediately sense its implications. In 1990, however, when a person with whom he was sexually involved was tested and found to be HIV positive, Víctor was suddenly confronted with the reality of the disease. As others of his friends discovered that they, too, were infected, Víctor was moved by a mounting sense of the “injustice” of that added burden for people who were already the victims of social stigma and discrimination, and he felt increasingly impelled to channel his own energies into a meaningful response.

As a university student in the field of psychology, he decided to draw on his knowledge of that field and form a “self-help” group that allowed gay men to share their experiences, worries and fears and to learn, in an atmosphere of acceptance and confidentiality, to feel more at ease with their sexuality. During the same period, he also pursued a personal study program (in the absence of formally organized instruction) on homosexuality, group therapy and related themes.

Building on his experience in the self-help group and the ideas that he encountered in his study program, Víctor established a series of “Positively Gay” workshops, both to strengthen the group dynamics of the gay community and to combat the spread of AIDS. He also developed workshops on “safe sex” and spurred the creation of new “self-help,” or mutual support, groups. Those several activities are melded together in the innovative undertaking that is described above.