Contesting everyday violence: Resilience pathways of gay and transgender youth in Peru

ABSTRACT

Within Peru, lesbian, gay, bisexual, transgender, intersex, and queer/questioning (LGBTIQ) groups experience significant levels of violence, particularly LGBTIQ youth. This study explored youth responses to violence in two cities: Lima and Ayacucho. We sought to formulate key factors facilitating LGBTIQ youth resilience to inform local practice and policy. Focus groups were conducted with youth that self-identified as gay and transgender. We used thematic analysis to identify both inductive and deductive themes. Deductive themes were driven from resilience and structural violence theories. Structural and direct violence was reported by all youth with differences regarding the role of self, place and people in their resilience pathways. Despite experiencing everyday violence, LGBTIQ youth participants displayed remarkable resilience, though the resilience strategies and experiences of violence were distinctive for each group. Transgender youth relied more on their collective rather than individual resilience. In contrast, gay youth revealed a high level of individual resilience. Overall, the participants exhibited a fluidity of resilient and resistant behaviours toward violence. The use of place theory and a social resistance framework is suggested for interventions that effectively honour and foster the courageous resilience of LGBTIQ youth and effectively equalize their opportunities.

KEYWORDS:

• LGBTIQ youth
• resilience
• resistance
• everyday violence

Introduction

On July 2013, the Peruvian Parliament voted for a motion proposing legal sanctions against hate crimes that are associated with discrimination against any group or individual in Peruvian society. Although lesbian, gay, bisexual, trans, intersex, queer, and questioning (LGBTIQ) groups and parliament representatives were active proponents of the motion, violence targeting sexually diverse populations was excluded from the category of hate crimes (El País, July 5, 2013). Another attempt to include hate crimes towards LGBTIQ groups in the legislation took place on May of 2018 when discrimination against sexually and gender diverse populations was again not legally considered as a hate crime. At that time, opposition lawmakers in Congress revoked the penal code reform supported by President Kuczynski that specifically sanctioned discrimination and crimes committed on the basis of sexual orientation or gender identity (Human Rights Watch, 2019). Contrasting this opposition to protective legislation, on March 2018 the preliminary results of a national electronic survey revealed that over 60 percent of surveyed LGBTIQ people had suffered some type of discrimination or violence (Human Rights, 2019). Despite an existing international human rights framework that has made progress in legal protections (Logie, 2012; Neilands et al., 2008; Organization of American States, 2011), the Peruvian case demonstrates how LGBTIQ minorities continue to experience systemic marginalization, violence, and stigma.

In particular, LGBTIQ youth are experiencing enhanced vulnerability to discrimination and violence worldwide (Evens et al., 2019; Logie et al., 2016; Meyer, 2003; Scourfield et al., 2008). Yet, there is limited research on how these groups of youth often transform stigma and violence into experiences of resilience. Hindered by insufficient evidence, current empowerment practices are thus often unable to reach its objectives. LGBTIQ youth must be engaged as knowledge producers in this pursuit in order to understand their experiences and develop new strategies to facilitate them. Our study responds to these gaps and aims to understand how LGBTIQ youth in Peru perceive factors that enhance or inhibit their resilience in the face of everyday violence and discrimination. This article will offer service providers and policy makers a preliminary basis for generating programs to increase the social inclusion of LGBTIQ youth. In addition, the findings of this exploratory study will stimulate further explanatory research on the resilience of LGBTIQ youth, which is overlooked in the existing literature.

Context

Youth (15-29 years old) are a large heterogeneous segment of the population in Peru, representing approximately 28% of the population 8 million (UNPFA, 2012). Of this population 48% are migrants living in urban zones; only one-third are studying, and 81% of youth in poverty are sexually active before 19 years of age (UNPF, 2012). One of the most pressing concerns is that there are no existing policies to protect the sexual and reproductive health rights of youth in Peru, apart from teen pregnancy prevention programs.

Violence toward LGBTIQ youth in Peru is underreported and underestimated, as it is in other countries (Rothman et al., 2011). However, information from an observatory of violence in Peru shows that reported violence toward LGBTIQ groups is largely directed at youth (Silva & Otsuka, 2012). A more recent report found that more than 50% of reported cases of related violence have been directed to gay men (29%), transwomen (27%), and persons living with HIV/AIDS (PLHA, 21%), most violence is directed toward LGBTIQ youth between 16–25 years old (LGBTIQ Rights Observatory, 2014). Both reports examined all type of violence perpetrated against LGBTIQ communities in Peru, including hate crimes and harassment, but emphasize that there is more accurate information on violent acts attempting to the safety and physical integrity of individuals. This emphasis is important, as this type of violence (killings, assaults, etc.) are commonly the most reported and cited in official reports of the police, legal system, and health care. In addition to physical and sexual violence, this study also examined the experiences of violence that surrounds the lives of LGBTIQ youth such as unemployment, discrimination, and health inequalities.

The project was located in Lima and Ayacucho, two geographically and culturally distinct cities in Peru. Research in two cities was important, as Peruvian researchers have reported on the vast ways that intercultural diversity impacts how social indicators such as sexual violence, homophobia (Cáceres et al., 2002), religion, sexuality, sexual health and politics (Católicas por el Derecho a Decidir, 2013) are expressed and embraced in different provinces of Peru. The most significant differences were found between the coastal regions (Lima) as compared with the Andean region (Ayacucho). The findings of a national survey on discrimination in Peru (Dumont, 2004) support the importance of this research, as Indigenous people, LGBTIQ groups, people living in poverty, and people with disabilities were assessed as strongly limited in their ability to exercise their rights. Thus, there is a strong need to develop social and academic networks that better support responses of resiliency by LGBTIQ youth in the face of violence, and that inform practice and policy in Peru and internationally.

Theoretical and methodological frameworks

Our study was primarily informed by two theoretical frameworks: resilience and structural violence.

Resilience theories

Resilience theories have a long history within psychology and psychiatry (Luthar & Zigler, 1991; Obradovic et al., 2010; Rutter, 1987), but more recently, other disciplines have also developed their own valuable approaches. Our study incorporates resilience concepts from a variety of disciplines including social work, public health and political science. While there is no consensus, most theorists agree that resilience results from an interaction between individual abilities and a social environment which allows for the use of those abilities in response to adversity (Logie et al., 2018; Suarez, 2013; Ungar, 2012). Therefore, this perspective of resilience transcends the classical debate on resilience as a trait or as an exception and understands resilience as a process that unfolds through pathways of adverse experiences (Panter-Brick & Leckman, 2013). This is consistent with socio-ecological theories of resilience that have enhanced the understanding of the negotiating transactions between the individual and their social and physical ecologies (Logie et al., 2018; Ungar, 2012). These theories highlight the individual’s oppressive social and physical context, rather than an individual’s capacity to cope and consider individual as well as collective experiences of resilience (Suarez, 2013; Ungar et al., 2013).

In the absence of a definitive resilience research paradigm, Yehuda and Flory (2007) argue that investigators must clearly outline their definition of resilience. Similar to Fazio and Fazio (2005), we argue that ‘it is not [only] the definition of resilience that is important; it is the philosophy that resilience can be enhanced’ (p. 245). Therefore, it is important to understand sources to elucidate the pathways of risk and resilience. We endorse Hall and Lamont’s (2013) definition of collective and /or social resilience as ‘the capacity of groups of people bound together in an organization, class, racial group, community, or nation to sustain and advance their well-being in the face of challenges to it’ (Kindle Locations pp. 315-317). In addition, an Ayacucho interdisciplinary group, Consortium for the Integral Development of the Andean Families and Children (CODINFA, acronym from Spanish name), works through a lens that is congruent with the social ecologies framework. They define resilience as ‘the emotional, cognitive and socio-cultural capacities of individuals and groups that allow them to recognise, confront and transform constructively situations causing suffering or harm and threatening their development’ (CODINFA, 2002, p. 38). Overall, local understandings of resilience were paramount in this study.

Structural violence theory

We used Galtung’s (1990) theory of structural violence to explore consequences of LGBTIQ youth oppression. The structural violence theory explains the role of social arrangements that expose certain individuals or groups to harmful conditions, including extreme health disadvantages (Farmer et al., 2006; Shannon et al., 2008; Shannon et al., 2017). These arrangements are considered structural because they are embedded in the social, political and economic organization of society. Further, these constructs are classified as violent because they cause harm to people even when not primarily physical. Structural violence is particularly relevant to this research, as it reminds us of the importance of studying the legitimization of violence and the use of violence – in this case, the targeted violence toward LGBTIQ populations’ worldwide. The structural violence theory centers on the forces that cause harm through inequitable access to material resources, social care and power, leading to everyday transgressions of the basic human rights of marginalized groups (Farmer et al., 2006). These transgressions are the focus of the Yogyakarta Principles which, through recognition that human rights violations of LGBTIQ people occur, seek to clarify the states’ obligation to promote the human rights of all persons, regardless of sexual orientation or gender identity (Yogyakarta Principles, 2007; Yogyakarta Principles plus 10, 2017). This project used these principles to maintain a human rights focus.

Structural violence theory was also used to categorize different forms of violence: direct violence (e.g. killings), structural violence (e.g. poverty), and cultural violence, which legitimize violence by regulating their normativity in a social context. The unrelenting exposure to violence affecting LGBTIQ youth reflects Galtung’s three interrelated concepts of violence: the events of direct violence, which trigger the continuous process of structural violence up or down, legitimated by permanent invariant cultural violence. However, as Munck (2008) reminder us, these layers of violence intersect in multilayered and multidirectional ways rather than as a predictable continuum. Structural violence is also congruent with an intersectionality analysis as allow us to consider intersecting factors including gender, class, and ethnicity in how violence is produced and engaged (Confortini, 2006; Shannon et al., 2017). Despite Peru’s 2011 official endorsement to the mandate of the Rapporteurship on the Rights of LGBTIQ Persons Human Rights System of the Inter-American Court of Human Rights (Organization of American States, 2011), a persistent elevated number of incidents of violence perpetrated to LGBTIQ persons continued to be reported (Human Rights, 2019; LGBTIQ Rights Observatory, 2014). In this case, the direct violence towards LGBTIQ groups (killings, beatings, etc.) is legitimated by experiences of structural violence (poverty, unemployment, lack of legal protection), and reinforced by the ‘invariant’ and continuous discrimination of Peruvian LGBTIQ groups. While LGBTIQ youth’s experiences of violence have been documented worldwide, there is scant research (Coe et al., 2012), on how youth themselves can effectively challenge everyday violence and attempt to reduce their exposure and vulnerability. Our research addresses these literature gaps by identifying Peruvian LGBTIQ youth participants’ mitigation strategies.

Methods

This article reports on findings from focus groups with key populations of Peruvian LGBTIQ youth to examine perceptions, experiences, and strategies in surviving violence. The study was part of a larger research project, which also included risks to HIV and sexually transmitted infections (STIs) among key populations of youth in Peru. Ethical approval for the study was obtained from the Review Ethics Board at Wilfrid Laurier University, Canada. In addition to our interdisciplinary research team (ES, CL, JFA, TS), the study was conducted in collaboration with community-based agencies (HS), public health officers in Lima and Ayacucho, and social science and public health scholars in both cities. Our research partnership is a strategic alliance between Canadian and Peruvian human-rights researchers and practitioners. The partnership was founded on a shared commitment towards collaborative research, which would result in knowledge mobilization and capacity building for all of those involved in the project. By training local youth as co-researchers and utilizing community forums to disseminate research findings, the study aimed to promote empowerment among LGBTIQ groups in Peru, in order to continue challenging violence at both local and global levels.

Research methodology

Our research was informed by principles of an action research approach (Brydon-Miller et al., 2003). Though not strictly following the predetermined action research methodology, we demonstrated components of empowerment, social change, and partnership with local communities. This orientation also allowed for multiple data collection methods; focus groups and community forums. The inclusion of local youth, researchers, and agencies as knowledge producers in this study also reflects an attempt to transcend the typical ‘top-down’ direction of global health knowledge and instead endorse a truly reciprocal, bi-directional flow. Our team itself, comprised of diaspora interdisciplinary researchers from the global South (Peru, Venezuela, Tajikistan) living and working in the global North (ES, JFA, TS) and Canadian (CL) and Peruvian researchers (HS) reflects the transnational collaboration inspiring this project. We are aware of the tensions surrounding the object and purpose of global health knowledge (Suarez et al., 2014), and held the perspective that global health research must be connected with a human rights framework as well as with priorities defined by Southern populations.

Principles of action research were employed to: (1) Examine the Lima and Ayacucho gay/bisexual and trans youth’s experiences of violence and discrimination, including the factors that influence their responses to violence and (2) Mobilize the findings to community members aiming to translate the study outcomes into direct benefits for this population. Action research attempts to make change by concurrently acting on the social systems while conducting research (Brydon-Miller et al., 2003).

Focus groups and community dialogues were combined, following the multi-method tradition of action research. We used the focus group data collection method to elicit information about individuals’ experiences within a socially influenced context (Baines, 2014; Kitzinger, 1995; Pollack, 2003; Sossou, 2011; Wilkinson, 1998). The ability of focus groups to simulate social processes was congruent with the theoretical frameworks of this study. Moreover, focus groups provide the potential to foster empowerment and solidarity among participants and minimize the power differential between researchers and participants (Logie et al., 2016; Slack et al., 2016). Key informants in both cities suggested separate focus groups to allow for collective narratives of individual experiences. Therefore, we conducted focus groups in each city to reflect potentially different experiences of violence and enhancers or barriers to resilience. The participatory component of this project was further reinforced by the participation of peer researchers representing the key populations of LGBTIQ youth, by co-creating knowledge with youth participants, and fostering social inclusion of LGBTIQ youth through community forums in each city.

Research locations

Lima, the capital city of Peru, is located in the coastal region overlooking the Pacific Ocean. It is the largest city in Peru with a population of 9,866,647 persons, representing more than 30% of the overall country’s population (INEI, 2017). Lima is a cosmopolitan, modern city where living standards and income per capita are above the national average. In contrast, Ayacucho is a mid-size city in the impoverished Andean region, with a population of approximately 180,766 residents (INEI, 2017). Ayacucho was also the region where the Peruvian armed conflict first erupted in 1980 and lasted until 2000, eventually expanding to other parts of the country. As consequence of the conflict, approximately 69,280 people were either murdered or disappeared. Of these victims, 75% were, young, Indigenous – mostly of Andean background, with 40% from the province of Ayacucho (CVR, 2003).

Participants

Purposive sampling was used to recruit participants for the focus groups. The study information was posted on the websites of collaborative agencies and disseminated through ‘word of mouth’ and informal presentations in both cities. Two focus groups were conducted in each city; one for gay and bisexual youth and the other for transgender youth, most of who were trans women. Participants read, agreed to, and signed a consent form. Participants were paid 20 Peruvian soles ($6 CDN) to compensate for transportation costs to research locations. Two self-identified gay male youth peer researchers were hired and trained for the study in Lima. Three members of the research team (ES, HS, and JFA) co-facilitated the focus groups in Ayacucho. The two peer researchers did the same in Lima. Focus groups were facilitated in Spanish. The interview guide for all focus groups included questions about the participants’ experiences of violence, understanding of resilience, and factors enhancing or hindering resilience. Focus group discussions were audio-recorded, transcribed verbatim, and further translated from Spanish to English for data analysis. Translations and back translations were done by bilingual (Spanish-English) research assistants and verified by bilingual members of the research team (ES, JFA).

Data analysis

Transcribed data from the focus groups was analyzed using thematic analysis, a theoretically flexible approach to analyze qualitative data and for coding of main themes (Braun & Clarke, 2006). We began the data analysis procedure by having two members of the research team (ES and TS) read the six focus group transcripts several times. Using a reflexive approach, preliminary codes were discussed and consensus was achieved through comparison of the resulting themes. Two additional investigators (HS and JFA), who also participated in the focus groups, reviewed the emerging themes to confirm the authenticity of the findings. CL also offered feedback on the thematic findings at different times. Preliminary results were discussed and presented to youth participants, key informants, and lay community members.

Results

Fifty-three youth between 18 and 30 years old (M = 26 years old) who self-identified as gay men (n = 24) and/or transgender/transwoman (n = 29) participated in the focus groups (n = 4) for each identified key population of youth, two in each city. Most gay youth (n = 20) had some post-secondary education. In comparison, most trans youth reported having completed elementary education, only few have finished secondary education (n = 11), and even less had some post-secondary training (n = 2). Most gay/bisexual youth were working full time (n = 18) or studying (n = 6), half of them in office environments. All transgender youth were also working, but most as sex workers (n = 25) and four as hair dressers. Many Trans participants reported combining sex work with other types of work (e.g. street vendors and entertainers). While the invitation was also directed to lesbian and bisexual women, recruitment was unsuccessful in getting a sufficient number of participants to form a focus group.

All youth reported experiences of direct, structural, and cultural violence. However, different LGBTIQ groups experience violence at varying frequencies and intensity. Further, participants’ narratives of their responses to violence uncovered two global themes of distinctive individual and collective resilience pathways.

1. Daily Experiences of Violence: Everywhere and for Anything

Participants discussed experiencing direct and structural violence as a daily phenomenon that occurred in private or public places, for particular or non-particular reasons. The central themes about violence were about their unrestricted and commonplace nature in youth lives. While all youth reported experiences of structural and cultural violence, transgender youth reported more instances of direct violence and structural violence.

• 1.1. Direct violence as unobstructed: Anything can be used as an excuse for violence

The report of direct violence, such as physical and sexual violence, was unquestionable in transgender youth and less frequent on the reports of gay/bisexual youth. Participants commonly reported this almost unobstructed violence caused them fear and symptoms of depression. Violence was perpetrated by unknown people but also by members of immediate networks such as school peers or intimate sexual partners.

For transgender youth, violence happens [mainly] because we look different. The direct violence they witnessed included numerous random killings and beatings of trans-youth, which was reported to be more frequent in Ayacucho than in Lima.

At night we are alone, for example, most of us are ‘operated’ [had surgery to transform physical appearance] and we are more visible because of these changes, and sometimes that frightens us. In an instance, a friend has her buttocks sliced. On top of that they steal and beat you up and take you to ‘Huatatas’ [an isolated place] to rape you and leave you without shoes. (Trans youth, Ayacucho)

We have had a murder here last month [it was May], just this past year there were already three murders. Typically, it is a group of homophobic people that grab you, if it was one on one, we could defend ourselves. (Trans youth, Ayacucho)

There is another ‘amiga’ [transwoman friend] who has been killed 2 months ago but it was outside the city and she still is in the morgue. It is really scary and it made us fearful. (Trans youth, Ayacucho)

Trans youth also talked about tensions amongst different LGBTIQ groups. Gender identity appears to divide LGBTIQ youth based on visual markers of appearance. Moreover, this divide acts as a precipitating factor for violence.

A trans and a gay often cannot see each other; because gays would also attack trans. Gays don’t accept us because we are too effeminate. (Trans youth, Lima)

For transvestites the ‘macho’ looks are just cover-up. People are careful, because when they go shopping together and some boy starts bothering them calling them male names like “Arturo” or “Juan” they can step up and fight back punching and kicking. (Trans youth, Lima)

For gay youth, violence against us has a legal license. The main reflection from gay youth was that aggressions toward them occur easily since they are not legally viewed as ‘hate crimes’ and punished accordingly. The impacts of the impunity of the violence perpetrated against LGTB youth included mental health difficulties such as depression and fear of disclosing one’s sexual orientation.

I entered college in fear because they told me they were going to discriminate against me like they did at school; everything I experienced at school was a constant chaos. For example, to go to the washroom, I had to wait for the end of recess because they would make fun of me, show me their genitals and they would fondle me or beat me. It was traumatic for me. I felt hopeless and depressed. (Gay youth, Ayacucho)

Gay youth frequently disclosed interpersonal violence in the context of sexual and/ or romantic partners, as well as the emotional impact of this type of violence. The desire of having a romantic or sexual encounter is often discouraged by fear of these encounters resulting in violence.

I know a gay guy who was stabbed by his ‘partner’, a military man. I think they are the ones we should be careful, know whom to choose and whom to go out with, this can happen to anyone’. (Gay youth, Lima)

If you have sex with someone you don’t know, some people will drug you to steal your things and when you wake up your stuff is gone. Mostly we contact guys that are known to prevent issues like this. From these experiences you learn, but it also makes you really depressed and full of fear. I think one becomes a psychologist [through these experiences], one learns to know people and one learns how to handle loneliness. (Gay youth, Ayacucho)

• 1.2 Structural and Cultural violence: ‘Machismo and homophobia [and transphobia] allow for discrimination at all levels’

Youth participants perceived the combined impact of transphobia, machismo, and homophobia as all contributing to perpetuating the violence they experienced. They identified discrimination as a principal component of structural violence which is fostered by elements of cultural violence expressed as machismo, transphobia and homophobia. Most participants identified common markers of structural violence such as discrimination through unequal employment opportunities and social exclusion. They expressed despair and hopelessness as main reactions to this environment, but also a strong desire to change it. This type of violence mainly stems from society at large or large social networks, but similarly to experiences with direct violence, it also comes from their immediate social networks.

For transgender youth not only workplaces and schools, our families are also transphobic. Transgender youth reported higher levels of structural violence. They observed structural violence in everyday discrimination. For example, they have few alternate employment options to sex work and experience extreme poverty.

I’ve lived on the street since I was 14. I’ve always been ‘piranha’ [street mugger], which means I was tough enough to sleep on the street and eat garbage. I do not want others to go through what I have gone through, that’s what I went through in Lima. (Trans youth, Lima)

Most of us have turned to prostitution because we have not had the understanding from our parents. So, there was nothing left for us but to go to the corner and stand there, it is not that we like it … [it is our] necessity [that] forces us to do it. (Trans youth, Ayacucho)

In the context of health risks, as consequence of the discrimination experienced by transwomen, sexual health was reported as the upmost concern since sex work was identified as an unavoidable survival choice for many.

Here people are ‘machistas’ and they are not used to dealing with people like us. Perhaps they are better with dealing with gays, but for us who dress as women, it is a problem. For example, here we are all prostitutes, very few are hairdressers; but even in our own gay community there is discrimination, they call us ‘sluts’, so what other option do we have? (Trans youth, Ayacucho)

The risk is not only HIV, [but] also gonorrhea, syphilis, fungi; for them when you go to work you have to get protected … but there are people offering you extra money for having unprotected sex and when we are a bit drunk we forget to use [protection]. (Trans youth, Lima)

Trans women reported frequent discrimination in the health care system because of their gender. They associated this to the lack of legal protection on their basic human rights.

We have had to fight discrimination there … First we had to fight with the obstetrician who said: “Wait.” Because at the health centers, we have no choice for appointments. If you're trans, they put you at the end of the queue. Ladies are first and then they cater to us. (Trans youth, Ayacucho)

For gay youth: sometimes workplaces are more inclusive than our own families. Gay youth often reported lack of family support and inclusion. This resulted in participants questioning their belongingness in their social networks and society as a whole.

Machismo in Peru leads to exclusion, aggression and insults toward people of different behaviour, and in many cases this occurs towards gay people, but in the workplace, it is the gay person that is viewed as very efficient and even more creative. (Gay youth, Lima)

In my family the subject of homosexuality was always taboo. Growing up gay from the school age was difficult because they only classify people in two ways: boy or girl, and it is hard not knowing where to go”. (Gay youth, Ayacucho)

I just could not tell my family because if I told my brother, then he was going to laugh. If I told my uncle, he would hit me with his belt, and even my mother was homophobic. So, what do you do in this case? (Gay youth, Ayacucho)

Gay youth recognized that some places are more accepting and inclusive than others. The difference between urban and rural areas in term of acceptance and discrimination was often noted among participants.

I come from a very homophobic place in the north. There are no gays in those towns because they would get targeted, stoned. These towns have maximum 2000 residents; everybody knows everybody; if somebody’s son turns out to be gay, his or her parents, siblings and the subsequent generations will be discriminated. They would like all of us to move out to live somewhere else. (Gay youth, Lima)

When one is effeminate, they call you a faggot. I was the only effeminate one in my town and everyone discriminated against me, even the school teachers discriminated against me, I couldn’t even fix my eyebrows”. (Gay youth, Ayacucho)

While physical appearance was a recognized risk enhancer of direct violence, several participants did not believe it makes a difference in the case of insults and discrimination against gay persons. However, they did recognize the differential discrimination among LGBTIQ groups because of physical appearance. That is, even when LGBTIQ persons behave or dress heteronormatively, they may still experience discrimination.

People do not know how to differentiate between someone [that is] gay, trans, or bisexual. Everyone is called the same thing on the streets: ‘maricón’ [faggot]. (Gay youth, Ayacucho)

It is a constant struggle. There are places where you feel welcome and comfortable like in some bars and nightclubs. But there are places that if I go wearing a different hairstyle, for example, I will not be allowed inside. But if I go to that same location with a masculine look, they will let me in”. (Gay youth, Lima)

They do not have problems [lesbians or masculine women], only gays do. Women are not seen as anything else but women. Our case is strong because of machismo. If they are men, then they have to be men. If we dance effeminately, they do not accept us because we have to act like men. (Gay youth, Lima)

Participating gay youth in Lima and Ayacucho represented a more advantageous socioeconomic segment of the population, as most were either full time post-secondary students or working professionals. Despite acknowledgment of their own economic privilege, they reflected on the intersection of homophobia and isolation with class, among the entire gay community.

We are segregated by many factors … depends on … the level of education, how you dress, what zone you live, where do you work, if you have this or that. I think that gays themselves are the most divided LGBTIQ group and in every possible way. (Gay youth, Lima)

I think it depends on the level of education you’ve had, Lima’s society has very strong influences either: religious, economic, and cultural; but that depends on the socio-economic status of the family which influences the treatment you receive. But on the same token, there is always going to be a reaction from the family that finds out. There are also types of reactions, like the reaction of the parent who is victimized, feeling that it is an offense to them. (Gay youth, Lima)

Discrimination, homophobia, and overall lack of human rights protections impact the ability for gay youth to secure strong intimate relationships. The risk and desire for sexual and romantic encounters also created despair, as long-term relationships were often considered rare or even unrealistic.

Stable gay couples … are very few due to the pressure of society. Society does not want them to be established and this makes the gays less afraid to go out and meet other people on a more permanent basis. (Gay youth, Lima)

I believe that society thinks that gays have no rights … [to have partners], is hopeless. We cannot expose our partner, as they would be rejected by society … Our relationship lasts depending on the pressure that society places, because if you are picking up your partner from work, they will tell you ‘my work is ruined because of you, you’ve ruined it’. (Gay youth, Ayacucho)

When examining the dynamics of gay couples or relationships beyond the context of risk, gay youth were also comparing themselves with stereotypes of heteronormative dynamics.

I think in the case of heterosexuals, it is the woman who puts the limits. In the case of gays there is no one who puts the limits, which is why there are more casual sexual encounters between gay people. (Gay youth, Lima)

As described in the above sections, direct and structural violence was experienced by LGBTIQ youth participants as an everyday occurrence. Participants reported unsafe spaces in their communities (e.g. streets, discriminatory businesses) and perpetrated by various people, ranging from family members to strangers. While the intersection of gender, class, and sexual orientation appear to influence the extent of violence a youth may experience, all participants reported a narrative of common risk and exposure to violence in their lives. In response to this overbearing environment, participants communicated a common narrative of resulting fear and/or despair and a strong desire to change it.

2.	Pathways of Resilience:

Youth perceptions of what supports their resilience and the challenges of their survival appear to have notable differences between the two cities, and between the two groups’ distinctive experiences of violence. Two themes appear to unify these different perspectives: the significance of their own strengths in their 1. Individual and/or 2. Collective resilience. While transgender youth, both in Lima and Ayacucho, relied more on their collective resilience, gay/ bisexual youth relied on a high level of individual resilience. Overall, the people and places of their immediate environment played a role in either fostering or inhibiting their individual and/or collective resilience in surviving experiences of violence.

• 2.1. Pathways to Individual Resilience

Participants found support for individual resilience through themselves, empowering people, and safe spaces. In both cities, LGBTIQ youth participants demonstrated a high level of individual resilience. Among all focus groups, there were common elements inhibiting or enhancing a higher individual resilience: their own strengths, existence of safe spaces, and support from key people in their communities. However, the pathways of fostering this resilience were different in the two cities and between groups.

2.1.1 Self-esteem was maintained either by self-acceptance and community acceptance, depending on which city participants resided. While Lima participants focused on self-acceptance, Ayacucho youth yearned for community acceptance and recognition. Nevertheless, both gay youth focus groups cited self-esteem as an important individual surviving resource. Participants attributed the success of resilience to those  … who have high self-esteem (Gay youth, Lima). Many indicated that it is important to love themselves first (Gay youth, Lima).

Because the participants have embodied specific societal stereotypes towards LGBTIQ communities, the process of accepting their own identity was challenging. One participant indicated that it was a little traumatizing …  to self-disclose, especially at the beginning, even for one self it is shocking (Gay youth, Lima). Others explained:

At first, it took a little work to accept myself, because I felt I identified with the stereotypes that society has for gays, which is very striking or dressing as a woman, [in] outrageous, colourful [clothing]. Then I realized that even though I did not fit with that stereotype, I had to accept myself. (Gay youth, Lima)

The problem begins from adolescence, and then we seek an identity, and also how to adapt to our way of life. We project a long-term view of how we want to perceive ourselves. (Gay youth, Lima)

With self-acceptance comes self-esteem, which was important resilient factor for gay youth in Lima. Participants have agreed that it was important to give themselves time to know ourselves, and their abilities and motivations (Gay youth, Lima). Resilient gay youth were perceived as people who have strong motivation and vision, and these traits are connected with self-esteem and self-acceptance. When discussing strong resilient gay youth, the participants indicated that they have motivation, they are determined people … they are persistent, [and that] despite the problems that arise … [they] have ‘lots of self-esteem, and are ‘.thinking into the future, to achieve goals, they have a [long-term]vision’ (Gay youth, Lima).

The narrative of acceptance, including self-acceptance was also prevalent among the transgender groups. Though the transgender groups largely relied on collective resilience, self-acceptance was important for them and served as a protective factor in the minds of direct and structural violence:  … [It is necessary] to accept yourself, in order to take care of your own in the streets, stay away from bad elements …  (Trans youth, Ayacucho)

Lima youth participants talked about self-acceptance, which leads to self-esteem. Ayacucho youth talked about the importance of community acceptance and recognition. Gay youth in Ayacucho wanted to be recognized in their community for their individual achievements. They wanted the ability to visualize and vocalize all personal/professional identities, and for society not to focus on their sexual orientation. For Ayacucho gay youth, the resilience pathway was interlinked with social recognition through demonstrating specific achievements.

But I realized that in demonstrating how capable I was, even in my studies, eventually almost the entire college became my friends. (Gay youth, Ayacucho).

… They now accept me at the agency where I work. Even tourists commented ‘this guy is a good worker, keep him around’. In the college they value me as a person. (Gay youth, Ayacucho).

Gay youth in Ayacucho would like to be treated equally, and not let the stereotypes define them. It became a double journey for them to get societal recognition and acceptance of who they are because heterosexuality is usually privileged, while homosexuality leads to marginalization. One of the participants shared personal accounts of this ‘double’ experience:

At that time, my personality did not count, but my work and effort, and even if they whispered about it, it was demonstrated that there is no difference, and it just depends on how eagerly you work. There comes the recognition that you feel capable and you can do it here or anywhere. One way to gain respect, for example at school, in my case was to get good grades, because if I was titled the “donkey” of the house, I would have been the “lorna” [stupid] of the class. I had to prove it otherwise. If not, more bullying would have followed. (Gay youth, Ayacucho)

Professionally, success was discussed as a key trait by other participants, who stressed the pressures that gay youth had to excel in their studies and work in order to gain respect from others.

We have to find a way to gain respect. Therefore, we have to tell the story to help young people. I have helped a lot of people to excel in their work. We have to regain our strength and remain vigilant. Help each other out, support ourselves, and be smart. We have to give each other strength and support. Above all, we have to develop confidence in ourselves. (Gay youth, Ayacucho)

• 2.1.2 Support from community agencies or from peers and allies was dependent on which city participants were from. Youth in Lima relied on community organizations for empowered resilience, while Ayacucho youth mainly turned to peers and allies.

Gay and Trans youth in Lima were somewhat reluctant to trust other people, as they tried to protect themselves on their own. As on participant noted, ..[the rule is to] not rely on anyone because they can hurt us. (Gay youth, Lima). The few people they trusted were from specialized gay community centers or health agencies. Specifically, Lima gay youth reported their resilience was fostered by being accepted and receiving support in these places and by being free to be their own self. One of the participants mentioned that, I do not need to change … to appear to be a better person before anyone else or to be accepted by them (Gay youth, Lima).

In specialized health settings they were also free to be ‘self’ without performing specific roles, which the general public wanted them to perform in order to get social acceptance. Physical appearance, tone of voice, clothing’s style, mannerisms all were mentioned as symbols of what can be identifiable markers of their sexuality or gender. Often, participants felt compelled to ‘perform’ in ‘heterosexual’ ways in order to be treated better. Thus, gay youth usually seek support in specialized health agencies because they were not pressured to perform heteronormatively. These specialized health services offer more direct, personalized and comfortable care. [In addition,] you get assurance that you will not get treated poorly, unlike what can happen in a public entity (Gay youth, Lima).

In Ayacucho, there are no specialized centers and the youth could not find agency support to foster resilience. Instead, transgender youth looked for support from allies, family, friends, and their extended network.

Ayacucho is not great and there are few places for socialization and people know where to find us. The only one [safe] place is ‘Señora’ Hortensia office [chief nurse in the HIV clinic] “At one point there was the HIV scare, and it was one or two community programs here, but they cut the programs because there were no economic means to finance them. (Trans youth, Ayacucho)

Though general health services are available for LGBTIQ support and counselling in Ayacucho, the personnel working in these centres were often reported as not supportive and usually discriminatory towards gay and trans youth.

If a person is abused, discriminated against and being teased, that person will not want to go to health centres. So, I, as a peer promoter, I have to try to be kind so they [other gay clients] come back, because it's their health and they are allowed to seek counselling. (Gay youth, Ayacucho)

Due to the lack of specialized community centres and rampant discrimination within mainstream agencies, stronger connections were built within the lay LGTB community. When there were cases of distress, Ayacucho gay youth were looking for support and advice from other members of this community.

When you have problems, you always look for someone to share them. That person advises you and gives you information so you can better yourself. (Gay youth, Ayacucho)

All participants reported acceptance from family and friends was critical to their resilience. Some of the transgender youth in Ayacucho noted that they would seek support first from family and then friends.

First, I go to my family then to my friends. Mostly we requested support from friends, but when we have already been accepted within the family, and in the event of a difficulty we go first to them. (Trans youth, Ayacucho).

Then I met a friend and told him my problem, and it turned out that he also went through the same thing and we started share our secrets. This is how I started to meet new people and socialize and meet more people like me. (Gay youth, Ayacucho)

Also, youth in Lima reported looking for older individuals who could serve as a role model that they could trust and seek advice from.

Young gay people look for an older gay, trustworthy person that can provide support or assistance. Someone that has had the same difficulty as you and can understand you … I have the calling to do so, because when I needed someone, I had somebody that advised me. (Gay youth, Lima)

In Ayacucho, gay youth have less organized support networks. For instance, they have gay circles but lack community centres and have fewer mentors/gay role models in the community. Many stressed the importance of talking, sharing, and seeking advice from peers, family and friends. In contrast, some participants preferred to keep silence and ‘hide’ when encountering difficulties. This is due to deep-rooted discrimination against gay people. One participant shared: One had to remain silent. There was a taboo and I was always ashamed. So, I would run and hide (Gay youth, Ayacucho).

Intersecting dynamics between self, places, and people appears to influence how youth perceive the pathways of their individual resilience in this study. Notoriously, their accounts of individual resilience are more distinctive between groups than between cities. Overall for gay youth, self, people, and places are ranked in this order as impacting their resilience. In contrast, for transgender youth, their narratives point at people, place, and self as an ordered ranking.

• 2.2 Pathways to Collective Resilience

2.2.1 Collective Resilience to Resistance Supported by People: Advocates in Lima vs. Unity, Allies and Activism in Ayacucho: Compared to gay/bisexual youth, transgender youth in Lima and Ayacucho relied on their collective resilience rather than individual resilience. Transgender focus groups reported that their resilience was fostered by by their own social action and by people rather than places. In fact, they reported support from allies and peers as the result of the struggle to create spaces for themselves.

In their narratives, a we voice was very vivid and strong, calling for actions and activism. In their conversations, they stressed that it is their unity, which makes them stronger to fight oppression. The unity made their voice louder and sharper. They indicated that importance of raising your voice to fight discrimination and to make sure that society sees what we are so that we can walk freely. (Trans youth, Ayacucho)

Collective unity is an important resiliency factor for Ayacucho transgender youth, who are specifically proud of their unity:

We are united among us in Ayacucho, I know most of Peru and I could see that elsewhere, transvestites are not as united. Here in Ayacucho we fight every now and then, but we are all united. (Trans youth activist, Ayacucho)

This unity created a platform for resilience to foster resistance against discrimination. The collective voice of these groups empowered participants to make change in their communities. Transgender and gay youth in Lima talked about making people respect them and the significance of having support from advocates, some of them members of the Congress.

Before it was awful, we couldn’t even come close to coming out. Now, we make others respect us by sending people to hell, this way they respect us. Anyway, the Congress is also fighting for our rights, look for example Carlos Bruce [gay member of the Peruvian parliament]. (Gay youth, Lima)

However, when advocates and superficial promises fail to make change, LGBTIQ youth feel that it is their duty to lead activism toward social shifts.

We go to the institutions and they never listen to you, they tell you that they will make changes and make things happen. But it also depends on what kind of change. I believe nothing is going to happens if we don’t make it happen. (Gay youth, Lima)

In Lima, transgender sex workers did not talk about unity as much as they did in Ayacucho. In Lima, they largely discussed access to services where they get psychological counselling and tests through kind and respectful treatment. Also, participants in Lima talked about places of support as community centers such as Epicentro or Via Libre where they feel heard, respected and supported.

In Ayacucho, as these safe places were not available to transgender or gay youth [other than few mentioned exceptions]. Thus, they had to be united and organize themselves. Transgender youth actively fought discrimination with the help of their peers and allies. They used diverse strategies such as humour and competitive sports to engage with the larger community. They reported that they exercise, try to eat healthy, and get check-ups to stay physically and mentally healthy. Transgender youth in Ayacucho also seek acceptance in the community by engaging in social activities of charitable nature. One of the participants, a well-known transwoman activist, explained:

We do good community work, we go to retirement homes and at Christmas we make ‘mondongada’ and chocolate for all children, not asking anyone and with our own resources. We have not been supported by any authority, only by Mrs. Hortensia. (Trans youth, Ayacucho)

In the midst of ongoing discrimination towards gay youth in Ayacucho, gay participants were talking about unity among all LGBTIQ communities and support for the same age heterosexual ally activism. They discussed the necessity to unite and become a source of pride for their families, and not a source of shame.

Get support so you can be one force, because now is every gay man for himself as we are disbanded; we should be a model for other places. We want to move forward and not be the ugly duckling of the family or the destitute person of the family and especially knowing that there are others like me. (Gay youth, Ayacucho)

Ayacucho gay youth also indicated personal and collective responsibility of disrupting the stereotypes towards gays. They also called for the importance of unity among gay youth to strive for respect and recognition.

I think you have to behave well with everyone, to show that the “mariconcito” isn’t only good for cooking, bed [sex], or as a hairdresser but also has an IQ equal to or greater than heterosexuals. (Gay youth, Ayacucho)

We need to guide work together in a self-managed enterprise. We are disunited. We are willing to learn because we are not ignorant … Gays can achieve much more than others and can go far professionally and thus can earn the respect of many people. (Gay youth, Ayacucho)

2.2.2 Collective Resilience Supported by Pride on Place: Occasional National Pride in Lima versus Strong Regional Pride in Ayacucho: In Ayacucho, a remarkable source of strength for both gay and transgender youth was regional pride, which differed from the other narratives of pride found in the research. They were proud to be Peruvian, but specifically of being an Ayacuchano [from Ayacucho] I am very proud to be Ayacuchano; I am the ambassador of my place (Ayacucho gay youth). However, participants shared that experiencing discrimination for being from Ayacucho depends on the place and time.

I don’t have a choice; I do feel proud of Ayacucho. But it depends on the time, for example my friend and I, have spent many difficulties in Lima before, being from this province, you were discriminated against and considered ‘terrucos’ [ terrorists, remnant of Ayacucho stigma as center of past Peruvian armed conflict in the 80’s]. Now if I can, I assert proudly that I am from Ayacucho, because times have changed. (Trans youth, Ayacucho)

The findings were very different in Lima, where some participants rejected the Peruvian culture and did not talk much about Lima as region. Indeed, transgender and gay youth in Lima expressed diverse views about the Peruvian identity: some wanted to leave the country, while others were proud to be Peruvian. One gay youth from Lima said I think there is a fairly strong rejection [among them] of Peruvian culture and another added, they [LGBTIQ youth] value more other cultures than their own.

In contrast, youth also expressed the necessity for unity and moving forward, regardless of their social environment: Who will not be proud of this country? Does not matter how they treat us. We show that we can move forward and we do not give up (Gay youth, Ayacucho).

This section has demonstrated the importance of places, self, and people in shaping individual and/or collective resilience of gay and transgender youth in Ayacucho and Lima. While this description is congruent with a socio-ecological perspective in resilience, it also points to further complex elements influencing the resilience pathways of LGBTIQ youth such as desire and action in transforming these social ecologies.

Limitations

Despite numerous strengths, this preliminary research also has several limitations. Focus groups allow for diverse opinions on social and health issues (Rana et al., 2015), but can also produce results influenced by dominant voices, the role of moderators and normative discourses (Smithson, 2000). This is an important limitation to consider in this study because some of the research-strategies allowed focus-group-facilitators that belonged to the same group as the participants, and purposely allowed space for dissenting voices, as part of the process for forming a collective opinion or voice based on group interactions. Data analysis used a reflexive approach that considered the focus groups, as Janet Smithson (2000) argues, not only as a way to collect group information but also as a ‘performance’ or a discussion happening in a controlled setting. Despite its potential for empowerment, the social dynamics in focus groups may also preclude the sharing of narratives of individual experiences that participants may have been more eager to share in individual interviews. To minimize these limitations, in addition to the collaboration of peer researchers, analysis of findings was discussed in community forums where all participants were invited though not all attended. The latter also allow the control of knowledge generated to reside with the research participants, an important characteristic of culturally responsive research (DiFulvio, 2011).

An important limitation of the study was the unsuccessful recruitment of a sufficient number of lesbian and bisexual women for a separate focus group. This limitation reflects global issues of intersectional heterosexism: where lesbian and bisexual women are overlooked in LGBTIQ studies, particularly HIV research, which typically focuses on gay men (Logie, 2014). There is an urgent need to understand the priorities of lesbian and bisexual women in global sexual health research (Logie & Gibson, 2013) and to develop sensitive strategies to increase their participation in research. Finally, the study also was unable to have focus groups with transgender youth that were not involved with sex work, which preclude considerations on the intersecting impact of class and income in the resilience of these youth. Despite these limitations, focus groups proved to be a particularly useful method for establishing preliminary findings that will inform more comprehensive inquiries on the resilience strategies of LGBTIQ youth.

Discussion

Our study found that gay and transgender youth in Ayacucho and Lima faced direct and structural violence on an everyday basis, in numerous locations throughout their communities. These incidents were perpetrated by social systems and/or individuals, some of whom were well-known to them. Despite these experiences of everyday violence, youth also displayed remarkable resilience. These findings expand the current literature on resiliency by examining the perceptions of youth about the safe places and empowering people, as well as their own strengths and emotions in shaping these experiences.

In regards to pathways of resilience, we found that depending on the level of discrimination and exposure to direct and structural violence, resilience strategies were distinctively fitting occurrences of either individual or collective resilience. Youth perceptions of what supports their resilience appear to have notable differences within the two cities, as well as between groups. Transgender youth in both cities count more on their collective resilience and own resources (e.g. humour, work, social action) for survival, but have almost no outside social supports except a small circle of allies. Consequently, it is these conditions that have encouraged them to develop strong activist skills against direct and structural violence. While organized trans activism in Peru has been reported (Fraser, 2016; Salazar & Villayzan, 2010; Villayzan, 2016), these reports are largely based on experiences in large cities. As researchers, we were privileged to witness grassroots trans activism in Ayacucho, which is a mid-size city. For instance, the focus group with transgender youth in Ayacucho was held at a peer sustained temporary refuge for homeless transwoman sex workers.

In contrast, gay youth in Lima or Ayacucho rely more on their individual resilience, counting on their own resources (e.g. educational and professional skills). For gay youth in Lima, we found gay community centres, large social networks, friendly media outlets, and role models to be useful. Unfortunately, Ayacucho gay youth have less organized network support. For example, they have gay networks but not gay community centres and fewer mentors or role models within their community.

Based on the study findings, there are noteworthy theoretical reflections about LGBTIQ youth resilience to everyday experiences of violence. Although the resilience strategies of youth in this study are consistent with the informing framework emphasizing the social ecologies of resilience (Ungar, 2012), the importance of the interactions between place, people and self in the development of resilience appears to move beyond a socio-ecological approach. Indeed, several youth resilience strategies are related with political and social action, thus, beyond systems interactions and more about transformation of systems.

Place theory can help us to understand the complexity of resilience and resistance processes that challenge power arrangements embedded in unwelcoming places and people occupying those places. Anthropologist Setha Low (2009) acknowledges that place and space are always embodied. This lens outlines a process-oriented, person-based, view of place that allows for action and new opportunities. Place theory is particularly connected to transgender youth, as they aim to construct new and safe places. It appears that the prevailing views of resilience as contextualized primarily by social environments have underestimated the role of physical environments in wellbeing (Akesson et al., 2017). In this study, the sense of belonging to safe places, in their own environment, appears to be critical for youth resilience, either as an strength in the case of regional and national pride, or a as shortfall in the case of unsafe and unwelcoming spaces. Hence, place theory can be a welcomed addition to frameworks seeking to understand the complex nuances of LGBTIQ youth’s resilience in adverse environments, worldwide.

Further, we uncovered that LGBTIQ resistance plays a role in transforming place (Agnew, 2004). John Agnew (2004) prompts us to the different views of place as a space for activities, as a location for social transformation, and as a site for identification. Our findings reflect this perspective through the values of social action and activism related to place. For instance, transgender youth used collectivism to create new norms within the Trans community and worked to transfer these norms to the larger society. Thus, aiming to alter the activities and interactions that occur in their cities. It was found that depending on the level of discrimination and exposure to direct and structural violence, survival tools used by youth varied from resilience to resistance, meaning that they went from coping with the environment, to actively attempting to change this adverse environment. Resilience refers to the individual’s capacity to survive well despite adversity, while resistance refers to the individual own efforts to resist oppression and exercise of power, by explicitly ‘challenging’ adversity. While both processes can exist simultaneously, resistance does not always result in the intended outcome, e.g. to change power relations (Hollander & Einwohner, 2004). Resistance can be either overt (e.g. protests, rebellions) or covert through everyday forms resistance acts (e.g. subtly disobeying orders or using distraction techniques). While the strategies of all domination forms presume the existence of determined resistance (Guo & Tsui, 2010; Wade, 1997), little is understood about how acts of resistance contribute to resilient outcomes and ultimately changes oppressive contexts (Suarez & Suarez, 2015). Based on the findings of this preliminary study, we suggest the use of a social resistance framework, which considers how power relations in society encourage members of minority groups to actively engage in everyday resistance practices (Factor et al., 2011), helps us to better capture the experiences of this study’s participants. The use of this framework has the potential to better explain the relationships between resistance and resilience, and the formulation on inquiries in this context.

Gloria DiFulvio (2011) also observes the importance of ‘collective identity’ in the resilience of SGM youth, as important development before stating ‘collective action’. We argue here that the collective action of youth in this study has clear intentions of resisting rather than only surviving the widespread discrimination they experienced. Similar to other groups of marginalized youth (Coe et al., 2012; Rios, 2012) feeling accepted and respected was a fundamental struggle for participating youth, in order to move towards this goal. In doing so, they practice distinct forms of resistance, even if these did not follow social standards, or led only to temporary changes. For instance, responding to hostile offenses in the street with also hostile and antagonistic behaviours was an example of how transgender youth attempted to gain some control and sense of agency in an environment that constantly excludes and marginalizes them.

In addition, to the protective and interactive resilience factors of the youth participating in this study, the findings also support the conceptualisation of resilience as a dynamic process, which varies across individuals and social contexts, suggesting that resilience will be better conceptualised as specific outcomes in front of specific risk situations, as indicated by Latin American scholars Kalawski and Haz (2003). In this study, the interactive impact of place, people, and self in how resilience is expressed in front of diverse experiences of violence confirms Kalawski and colleagues’ theoretical assertion in regards to the dynamic specificity of resilience in several risk contexts.

In regards of experiences of violence, this study revealed marked differences between the two populations of youth rather than between the two cities, despite the geographical and cultural differences. However, the central themes about violence were about the unrestricted and commonplace nature of youth lives. Transgender youth in both cities experience higher level of both direct and structural violence. Gay youth experience structural violence more than direct violence, but both were constantly reported in a lesser extent than transgender youth. Overall, structural violence was an aspect that disturbed most dimensions of the youth’s lives. This was exemplified through gay youth’s reports of having more choices and access to education and diverse type of occupations. These options were minimal or often fully restricted to transgender youth, leading them to often engage in sex work as their only option to have some income. These findings are consistent with observations from other LMI countries, where transgender woman or men are often forced into sex work simply as result of social exclusion (Abdullah et al., 2012; Crosby & Pitts, 2007). Direct violence against sex workers, in particular gender based violence, has been documented across many social contexts, including Latin America (Evens et al., 2019; Scorgie et al., 2013). While it is highly prevalent, in most cases it is overlooked by society, as reported by youth of this study.

As described by youth, a common emotional response to structural violence was despair. However, hints of anger were also found in their narratives that may have been driving their acts of resistance and social action. Though youth felt vulnerable when institutional promises to decrease structural violence failed, they used these instances to collectively advocate for themselves both explicitly and implicitly. In contrast, the common emotional response to direct violence was fear. In this case, action served as individual level protective and survival measures. This preliminary examination of the role of emotions in responses to the different forms of violence, as well as the links with resilience, deserve further explorations in order to enhance mental health supports services for LGBTIQ youth.

An essential component of the violent experiences reported by participants was the daily occurrence of these incidents. Accordingly, in addition to structural violence, we argue for the use of the everyday violence concept. Everyday violence refers to the normalization of violence that renders it unnoticed because of its routine pervasiveness (Scheper-Hughes, 2008). The youth’s narratives also indicate that they are aware of the ‘normalization’ of violence as a sort of punishment or segregation because they divert from societal norms of sexuality and gender. A metanalysis on rape myths has indicated that sexism and other oppressive beliefs, such as homophobia, racism, ageism and classism, are highly associated with sexual violence and serve to perpetuate it in society (Suarez & Gadalla, 2010). It is therefore unsurprising that youth often mention ‘machismo’ as driving force of homophobia and transphobia since these discriminatory attitudes and behaviours are likely highly interconnected in the social contexts of these youth. The latter also explains why the youth experience different forms discriminatory based on the visual markers of distinctive gender diversity features. As one gay youth in Ayacucho stated: You need to fit into accepted ‘normality’. For youth, the message was clear; if you want to participate more in society and diminish the possibility of violence, then you should look ‘normal’ and not look or act ‘different’.

The transgressions to their human rights are also intimately related to the experiences of violence reported by youth in this study. Indeed, the key rights stated in The Yogyakarta Principles (2007, 2017), universal enjoyment of human rights, equality, and non-discrimination, are certainly reported in this study as constantly being violated for gay and transgender youth. Many of the additional 10 principles to the initial Yogyakarta declaration (2017) are also not present in the lives of most of participating youth, especially for transgender youth. For instance, their narratives clearly indicate no state protection of their rights (principle 30) and no rights to protection to poverty (principle 34). A deeper analysis of the range of violence narrated by youth in this study from a human’s right lens is not only a task for this group of researchers, but also for many others working in similar projects worldwide.

Furthermore, we would like to highlight the connections between the discrimination experienced by youth and the right to obtain the highest attainable standard of health (Principle 17). The latter is particularly concerning in the area of sexual health. Gay youth not involved in sex work reported not following safe sex practices with sexual partners due to the occasional nature of many of these encounters or the desire to please partners, among other reasons. Unsafe sex practices were also connected in this study with the lack of self – esteem reported by gay youth that allows for disregard in devaluing their bodies and their own health. Reports from other social contexts such as U.S.A. (Gillum & DiFulvio, 2012) appear to confirm the extent of these challenges in sexual and romantic relationships among sexual minority youth. We also found that even when high standards of protective tools for healthy sexual practices were available, most transgender youth and gay youth involved in sex work did not use these tools due to the disempowering conditions of sex work. Similar conditions of marginalization have been reported with transgender women in different social contexts such as Jamaica (Logie et al., 2016), Lesotho (Mathopeng, 2016) Pakistan (Abdullah et al., 2012) and U.S.A. (Crosby & Pitts, 2007). This indicates the discrimination suffered by transgender populations worldwide.

The dangers of risky sexual behaviours are exacerbated by LGBTIQ youth’s reluctancy to use heteronormative sexual health services. In our study, youth participants expressed the need to ‘hide’ their gender diversity or sexual orientation as they only anticipate discriminatory responses from health care settings. As Joseph Tucker et al. (2019) assert, many evidence-based STI interventions are unavailable globally because those at greatest risk conceal their sexual desires and practices from health clinics and services. Based on the community forums discussion, developing sexual health services that may ‘fit all’ appears to be a daunting task. Despite these difficulties there is an urgent need to develop these tools due to the highest representation of youth under 21 in new HIV cases in Peru (Guillen, 2013), and the overrepresentation of men who have sex with men (MSM) and sex workers in HIV/ STI cases in Peru (Pérez-Brumer et al., 2013). A study by Harcourt and Donovan (2005) on global sex work issues concludes that the development of wide-ranging sexual health programs entails a comprehensive understanding of the different types of sex work within a particular social context. If we add to these the needs of other LGBTIQ groups, it certainly increases the difficulties of creating ‘all-inclusive’ preventative approaches to sexual health.

In part, inadequate sexual health practices come from the failure of developing messages that are able to reach all populations, including those with the limited literacy skill levels, which is common among marginalized youth. It is well known that low health literacy is associated with poorer health outcomes (Berkman et al., 2011). Recent statistics on regional health literacy levels are not available for Peru. However, in Canada, about 60% of all adults – those 16 years or age and older – “lack the capacity to obtain, understand and act upon health information and services and to make appropriate health decisions on their own’ (Canadian Council on Learning, 2008, p. 5). One can expect the average health literacy level among Peruvian young adults to be similar or lower than that of Canada. We found that violence and oppression not only impose direct harm to the LGBTIQ population, but are fundamental in causing stigma, self-depreciation, and low health literacy. These factors all contribute to LGBTIQ youth’s barriers to access and utilization of quality health care. As part of the research team agenda, our future research will include examination of health literacy skills for key populations of LGBTIQ youth. Other stakeholders, such as researchers and practitioners will be included in the discussions around this topic. In sum, the interactive impact of individual, structural, and community factors in the everyday violence experienced by LGBTIQ are certainly multilayered as well as their responses to this violence which range from resilience to resistance to such oppressive environment.

Conclusion

The diversity of frameworks and theories informing this project had common goals that were in line with our program objectives, which was to enhance LGBTIQ youth resilience-building capacity and knowledge co-creation through an emphasis on action and participation. A socio – ecological perspective of resilience fosters an understanding of the negotiated transactions between the individual and their social and physical ecologies that are necessary for resilience outcomes. Conceptualizing different categories of violence (everyday, direct, cultural and structural) allows us to better understand how a range of gendered power relations shape a context within which violence may occur, and also allows us to move beyond the typical individualistic approach that views resilience as determined by individual agency. However, the study findings suggest that additional frameworks can complement this theory; for instance, place theory may help to explain the intersecting impact of places and people in producing pathways towards resistance and resilient outcomes. Most importantly, a social resistance framework explains how Peruvian gay and transgender youth survive an environment that expose them to instances of everyday violence while also engaging in ‘everyday resistance’ to challenge power structures. In turn, structural violence theory explains how the violence SGM youth experience is normalized by power norms in society, such as exclusionary legislation. The Yogyakarta Principles connect a resistance framework with structural violence by visualizing the obligations of communities and states to protect the human rights of LGBTIQ youth. These principles establish a more objective platform to launch further critical research and action towards those goals. Components of action research methodology were appropriate strategies to promote the social action and change this project envisions. An action research approach offered the potential to engage youth in producing and mobilizing knowledge, and to involve community members in envisioning joint solutions. By combining methods, such as focus groups and community forums, there were collective efforts to accurately reflect the complex experiences of resilience and resistance of participating youth. Research involving community members can be powerful in fostering partnerships among LGBTIQ people and allies, as stories of shared oppression and resistance strategies provide a platform for solidarity and networking. The first author of this article kept in contact with collaborators in both cities and has witnessed the recent development of collective networks aiming at unifying LGBTIQ groups and their families. The case of the Collective LGTBIQ* ‘Chiparaq Soncco’ (2019) in Ayacucho is a successful example of these initiatives. This study has also identified several areas where more research is necessary, for instance, on emotional responses to violence and its connection with resilience and resistance, the importance of physical places of resilience, and a deeper examination of everyday violence in the context of violations of human rights.

A key contribution of the study is an enhanced understanding of the conceptual fluidity of resistance and resilience based on the perceptions of gay and transgender youth from Lima and Ayacucho. The latter suggests that interventions for resilience building need to recognize how resistance efforts are ingrained with strategies of survival and social justice contestation. Traditionally, resilience theory has focused on individual factors rather than the complex responses to adversity, such as rebellion or resistance. Yet, how resilience is conceptualized is central to resilience building interventions. Therefore, LGBTIQ youth need to be supported in their own terms of how they envision their pathways to resilience and their tenacious resistance.

Acknowledgements

The authors thank all participants of the focus groups and key-informant interviews, as well as the two peer researchers, without them this study could not be possible. Many thanks to Señora Hortensia Quispe Remozo, RN (Unidad de VIH - Hospital Regional Ayacucho), Epicentro, Via Libre, Impacta, and all collaborators in Lima and Ayacucho for welcoming, inspiring, and supporting this study. ES and CL formulated the original idea for this article. ES, HS and JFA carried out the focus groups and key-informant interviews. ES and TS conducted the data analysis, ES wrote the first draft and CL, HS, and JFA revised the draft. ES prepared the final draft and all authors read the final manuscript.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

The study was funded by a grant [FRN: 132302] from the Canadian Institute of Health Research (CIHR) given to ES as the Principal Investigator.