Non-conforming gender identification as
determinant of lower HIV care access among people living with HIV in Peru: the
HIV, economic flows and globalization study
C.F. Caceres1, E. Segura1,2, A. Silva-Santisteban1, M. Giron1, M. Petrera1
1Cayetano Heredia University, Unit of Health, Sexuality and Human Development, Lima, Peru, 2Institute of Studies in Health, Sexuality and Human Development, Lima, Peru
Background: This study aimed to assess access
to HIV-related health care among adult people living with HIV (PLHA), and
explore the relationship between such access and key socio-demographic
characteristics. Additionally, the distribution of coverage of HIV care by
various Peruvian health providers in relation to funding source was described.
Methods: To avoid bias from facility-based sampling,
we conducted structured interviews with PLHA using respondent-driven sampling
(RDS). 'Seeds' came from PLHA organizations from 4 cities in Peru: Lima/Callao,
Chiclayo, Arequipa and Iquitos.
Variables included access to HIV care including antiretroviral treatment
(ARVT), socio-demographics (including sexual /gender identification), and a household
welfare index (SISFOH). Data analysis, adjusted for sampling (RDS II estimate)
explored the relationship between access and sociodemographic variables.
Results: 863 individuals (Age mean=35
years, median=35, range=18-62), 63% male; 36% self-identified as
non-heterosexual (3.4% as transgender), 58% employed, 29% poor/extremely poor, 52%
uninsured were interviewed. 96% reported access to HIV care (82% from a public
source), 77% were receiving ARVT, and 22% of those not in ARVT already had
indication to start ARVT. Transgender identity and age < 35 years old were
associated with lower access to care (p < 0.05). 40% of interviewees covered by health
insurance other than the Ministry of Health (MoH) received HIV services at MoH
facilities, and constituted 8% of all users of MoH HIV care services.
Conclusions: Access to care reported by PLHA recruited
independently from health services was nearly universal, although the
proportion of PLHA waitlisted for treatment initiation seemed high. While among
people under 35 lower access may relate to age-dependent health seeking, among
transgender persons it reflects secular social exclusion, particularly
difficult given that HIV prevalence in that group is highest. The apparent MoH subsidy
of ARVT for a substantial number of insured PLHA deserves further analysis to
ensure financing sustainability and rationality.
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