XVIII International AIDS Conference


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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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