Abstract

Compensated sex among low-income gay- and bisexually-identified males and male to female transgender persons in Peru

A. Bayer¹, J. Clark¹, X. Salazar², K. Konda¹, E. Segura², J. Salvatierra³, C. Cáceres², T. Coates<sup>1

1</sup>University of California, Los Angeles, Division of Infectious Diseases, David Geffen School of Medicine, Los Angeles, United States, ²Universidad Peruana Cayetano Heredia, Institute of Studies in Health, Sexuality and Human Development, School of Public Health and Administration, Lima, Peru, ³“Alberto Barton” STI Clinic, Lima, Peru

Background: In Peru, compensated sex has been described among low-income heterosexually-identified males, but not in other populations. We examined the practice of compensated sex among low-income gay- and bisexually-identified males and male to female transgender persons in Lima.
Methods: We held in-depth interviews (n=8) about sexual risk behavior and sexual identity with gay- and bisexually-identified males and male to female transgender persons from a low-income neighborhood. Interviews were recorded, transcribed and analyzed using the grounded theory approach. The majority of participants made repeated unsolicited comments about compensated sex, which they considered as distinct from sex work.
Results: Compensated sex (CS) emerged as a natural part of the dialogue in most interviews, affirming the frequency of CS in this setting. Interviewees strictly delineated between sex with CS-partners and non-CS partners: with non-CS partners, they feel love or pleasure; and with CS partners, they usually don't enjoy the interaction and focus on the benefit. During CS encounters, interviewees reported engaging in unprotected intercourse or varying their preferred sex role in exchange for compensation. Condom use also differed by partner type, with interviewees confirming that they don't use condoms with people they know, including stable partners, friends and longer-term CS clients (chicos de la casa). Interviewees explained that they avoid explicitly asking their CS partners for money, even if the benefit is monetary. Instead, they ask for food or drinks, clothing or shoes, bus or taxi fare, or even coins and many have stable CS partners (puntos) who they seek out in times of need.
Conclusions: Compensated sex is frequent and acknowledged in this population. It is important to further explore CS in this context and integrate these and future findings into behavioral interventions to prevent HIV and other STIs.