Uneven Geographies of HIV Care In Peru: Evidence from Lima and the Peruvian Amazon

Background and Purpose: Social work’s commitment to social justice requires engagement with global systems shaping health inequities. Yet disparities are often framed as domestic resource constraints, obscuring the transnational political-economic forces that structure access to care, particularly in Global South contexts. This study advances a global social work perspective by examining how HIV care disruptions in Peru reflect patterns of global marginality across urban and Amazonian regions. The purpose is to examine how these dynamics shape care access and inform policy to advance health equity for people living with HIV.

Methods: Data come from the Cuida Positivo study, which conducted semi-structured interviews with HIV healthcare providers across Lima and Loreto, Peru (N=23) between March-September 2025. Providers included physicians, nurses, psychologists, obstetricians, and community health workers across hospital- and primary-level settings. Interviews explored HIV care delivery and structural constraints. Data were analyzed using constructivist grounded theory, constant comparison, memoing, and community advisory board member-checking.

Results: Analysis identified three interrelated themes that conceptualize global marginality as a driver of persistent disruptions in HIV care, rooted in Peru’s position within global systems. 1) Unequal diffusion of biomedical innovation: Providers described delayed access to emerging HIV technologies as a consequence of global pharmaceutical hierarchies that prioritize high-income countries. Patients were often aware of new treatments yet unable to access them locally. These delays reflected global market dynamics shaping affordability, availability, and rollout. 2) Displacement and the redistribution of care burdens: Providers in Lima described how health systems absorb pressures associated with transnational displacement, particularly among Venezuelan migrants, with administrative and documentation barriers disrupting access to care despite formal entitlements. These accounts situate care disruptions within broader conditions of economic and political crisis driving mass out-migration from Venezuela, with policy scholarship suggesting that U.S. sanctions have contributed to economic contraction and may have intensified migration pressures. Providers’ narratives reflect increased demand and access challenges associated with displacement. 3) Extractive economies, environmental disruption, and geographic isolation: Providers in Amazonian regions related care disruptions to extractive labor systems and climate-related environmental change. Health harms associated with mining and resource extraction were localized within under-resourced clinics, while environmental disruptions, including severe drought limiting river-based transportation, intensified geographic isolation and restricted access to HIV services. These conditions reflect broader climate inequalities, in which low- and middle-income regions contribute minimally to global emissions yet experience disproportionate environmental vulnerability. Environmental change functioned as a structural constraint on care, particularly where rivers serve as primary infrastructure.

Conclusion and Implications: Findings demonstrate that HIV care inequities in Peru are produced through uneven geographies of care shaped by global marginality, extending beyond national health system limitations. By situating provider experiences within global systems of pharmaceutical access, migration, and environmental inequality, this study reframes health disparities as products of transnational systems of inequality. Implications include integrating global political-economic analysis into health research, strengthening advocacy addressing transnational determinants of care, and supporting community-informed strategies that mitigate structural barriers. These findings underscore social work’s role in advancing equitable health policy and practice within an interconnected global context.