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Perceived Barriers and Facilitators to Integrating HIV Prevention and Treatment with Cross-Sex Hormone Therapy for Transgender Women in Lima, Peru

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Abstract

Transgender women (TW) represent a vulnerable population at increased risk for HIV infection in Peru. A mixed-methods study with 48 TW and 19 healthcare professionals was conducted between January and February 2015 to explore barriers and facilitators to implementing a model of care that integrates HIV services with gender-affirmative medical care (i.e., hormone therapy) in Lima, Peru. Perceived acceptability of the integrated care model was high among TW and healthcare professionals alike. Barriers included stigma, lack of provider training or Peruvian guidelines regarding optimal TW care, and service delivery obstacles (e.g., legal documents, spatial placement of clinics, hours of operation). The hiring of TW staff was identified as a key facilitator for engagement in health care. Working in partnership with local TW and healthcare provider organizations is critical to overcoming existing barriers to successful implementation of an integrated HIV services and gender-affirmative medical care model for this key population in Peru.

Resumen

Las mujeres transgénero (MT) representan una población vulnerable con mayor riesgo de infección por el VIH en Perú. Entre enero y febrero de 2015 se realizó un estudio de métodos mixtos con 48 MT y 19 profesionales de la salud para explorar las barreras y los facilitadores para implementar un modelo de atención que integra servicios de VIH con atención médica para la afirmación de género. La percepción de aceptación del modelo integrado de atención fue alta entre los MT y los profesionales de la salud por igual. Las barreras incluyen el estigma, la falta de capacitación del proveedor o las guías peruanas sobre el cuidado óptimo de MT y los obstáculos en la prestación de servicios (por ejemplo, documentos legales, colocación espacial de las clínicas, horas de operación). La contratación del personal MT fue identificada como un facilitador clave para la participación en el cuidado de la salud. Trabajar en asociación con MT locales y organizaciones proveedoras de atención médica es fundamental para superar las barreras existentes para la implementación exitosa de un servicio integrado de VIH y un modelo de atención médica de afirmación de género para esta población clave en Perú.

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Acknowledgements

The authors would like to acknowledge Robert de la Grecca, Hugo Sanchez, Patricia Segura, and Milan Satcher for their contributions to this project, and especially thank the transgender women who shared their experiences and insights with us.

Funding

This study was funded by amfAR, The Foundation for AIDS Research, Grant No. 109071-57-HGMM (PI: Dr. Javier R. Lama). APB is supported by a National Institute of Child Health & Human Development T32 Grant (T32HD049339; PI: Nathanson).

Author information

Authors and Affiliations

  1. The Fenway Institute, Fenway Health, 1340 Boylston St, Boston, MA, 02215, USA

    Sari L. Reisner, Sarah A. McLean, Matthew J. Mimiaga & Kenneth H. Mayer

  2. Division of General Pediatrics, Boston Children’s Hospital and Harvard Medical School, 300 Longwood Ave, Boston, MA, 02215, USA

    Sari L. Reisner

  3. Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA, 02115, USA

    Sari L. Reisner & Matthew J. Mimiaga

  4. Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, 722 West 168th St, New York City, NY, 10032, USA

    Amaya G. Perez-Brumer

  5. Asociación Civil Impacta Salud y Educación, Av. Almte. Miguel Grau 1010, Barranco, Lima, Peru

    Javier R. Lama

  6. Department of Global Health, University of Washington, 1510 San Juan Rd, Seattle, WA, 98195, USA

    Javier R. Lama & Jorge Sanchez

  7. Universidad Peruana Cayetano Heredia, Av. Honorio Delgado 430, Lima, Peru

    Alfonso Silva-Santisteban & Jorge Sanchez

  8. Epicentro, Jr. Jaén 250A, Barranco, 15063, Lima, Peru

    Leyla Huerta

  9. Department of Medicine, Division of Infectious Diseases, University of California Los Angeles, 100 UCLA Medical Plaza, Los Angeles, CA, 90095, USA

    Jesse L. Clark

  10. The Institute for Community Health Promotion, Brown University School of Public Health, 121 South Main St, Providence, RI, 02903, USA

    Matthew J. Mimiaga

  11. Department of Medicine, Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA

    Kenneth H. Mayer

  12. Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA, 02115, USA

    Kenneth H. Mayer

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  1. Sari L. Reisner
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  2. Amaya G. Perez-Brumer
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  3. Sarah A. McLean
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  4. Javier R. Lama
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  5. Alfonso Silva-Santisteban
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  7. Jorge Sanchez
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  8. Jesse L. Clark
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  9. Matthew J. Mimiaga
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  10. Kenneth H. Mayer
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Correspondence to Sari L. Reisner.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Reisner, S.L., Perez-Brumer, A.G., McLean, S.A. et al. Perceived Barriers and Facilitators to Integrating HIV Prevention and Treatment with Cross-Sex Hormone Therapy for Transgender Women in Lima, Peru. AIDS Behav 21, 3299–3311 (2017). https://doi.org/10.1007/s10461-017-1768-8

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