When identity claims: risky processes of body modification among the male to female transgender population of Lima, Peru
Presented by Alfonso Silva-Santisteban (Peru).
A. Silva-Santisteban1, X. Salazar1, L. Pollock2, J. Villayzan3, C.F. Caceres1
1Universidad Peruana Cayetano Heredia, Unidad de Salud, Sexualidad y Desarrollo Humano, Lima, Peru, 2UCSF, Medical School, San Francisco, United States, 3Red Trans, Lima, Peru
Background: Male-to-female transgender people (TGP) in Lima are the most vulnerable group to HIV/AIDS in Peru, with a prevalence of 30% and yet the least studied population. Issues around transgender identity such as body modification need to be explored and contextualized in terms of their vulnerability to the epidemic. We present characteristics of body modification procedures among TGP that have not been previously described in a public health context.
Methods: Using respondent driven sampling (RDS), 8 initial seeds generated a sample of 450 TGP from Lima in 2009. Socio-demographic characteristics, body modification procedures, among others were explored through an interview plus testing for HIV and other STI´s. Estimates were adjusted for RDS sampling design.
Results: Body modification procedures were reported by 70% (95%CI: 61-76) of participants. The commonest was hormone use [83% (95%CI: 80-87)] (66% hormone injection) followed by the injection of industrial silicone, commonly known as airplane oil, in 40% (95%CI: 32-45) of the population. Most procedures were not medically supervised [71% (95%CI: 59-80)]. Hormone use was mainly indicated by a friend [67% (95%CI 60-80)] and had no medical follow up in 95 % (95%CI: 91-98) of the cases, while 41% (95%CI: 29 - 49) reported at least one health problem related to these procedures such as skin infections [18% (CI95%: 4-36)].
Conclusions: TGP in Lima undergo invasive medical procedures outside the health system to feminize their appearance. This reflects the desire to create a body that conforms to identity in a context of extreme exclusion which needs to be further explored. There is an urgent need to integrate these procedures into comprehensive care programs for this population, which could increase access to HIV prevention programs as seen in other settings. Further research needs to determine a potential role of these practices in HIV transmission, through possible needle reuse or other mechanisms.
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