Understanding the HIV/AIDS epidemic in the male to female transgender population of Lima, Peru: results from a cross-sectional survey using respondent driven sampling
A. Silva-Santisteban1, X. Salazar1, H.F. Raymond2, J. Villayzan3, C. Caceres1
1Universidad Peruana Cayetano Heredia, Unidad de Salud, Sexualidad y Desarrollo Humano, Lima, Peru, 2San Francisco Deparment of Public Health, San Francisco, United States, 3Red Trans Peru, Lima, Peru
Background: For many years in Peru and Latin America transgender people (TGP) have been conflated within the category MSM without addressing their specific vulnerabilities and needs in terms of the HIV/AIDS epidemic. Although TGP have always been the sub-group with the highest HIV prevalence in MSM surveillance studies in Peru, no specific information representative of this population is available. We present results of the first seroepidemiologic study designed for TGP in Peru.
Methods: Cross-sectional study using respondent driven sampling (RDS) to recruit TGP from Lima, Peru. Exploration of socio-demographic characteristics, body transformation processes, access to health services and sexual conducts were carried out through an interview plus HIV, genital herpes (HSV2) and syphilis testing. All results were adjusted for RDS sampling design. Multivariate analysis used individualized weights generated by the RDS-Analysis-Tool software.
Results: Using RDS 450 TGP (including 10 seeds) from Lima were recruited between April and July 2009. HIV prevalence was 30% (95%CI: 24-37), HSV2: 79% (95%.CI: 75-86) and syphilis: 23% (95%CI: 17-26). Median age was 28 (range 18-63). Sex-work was the main economic activity [64% (95%CI: 58-73)] followed by hairdressing [28% (95%CI: 19-34)]. Body modification procedures were reported by 70% (95%CI: 61-76) of the population (83% hormone use, 40% industrial silicone injection). Condom use in last sexual encounter (CU) was 75% (95%CI: 70-81). A general linear model associated HIV infection with syphilis infection [prevalence ratio (PR): 2.1 (95%CI: 1.3-3.3)] and CU [PR: 0.7 (95%CI: 0.4-0.9)].
Conclusions: TGP are the group most vulnerable to HIV/AIDS in Peru. Although the study identifies only syphilis and condom use associated with HIV infection, most likely it is the complex interaction of unique factors (from a structural to an individual level) in TGP that explains the extremely high HIV and other STIs prevalence found. Several research questions have arisen from this first effort that deserve further exploration.
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