Abstract
In Latin America, transgender women (transwomen or male to female transgenders) have been included in MSM research but without addressing their specific needs in terms of the HIV/AIDS. We present results of the first seroepidemiologic study designed for transwomen in Peru. We conducted a study using respondent driven sampling to recruit transwomen from Lima. Our survey explored sociodemographic characteristics, gender enhancement procedures and sexual behavior. In addition, we conducted laboratory based HIV, genital herpes (HSV2) and syphilis testing. A total of 450 transwomen were recruited between April and July 2009. HIV prevalence was 30%, HSV2: 79% and syphilis: 23%. Sex-work was the main economic activity (64%). Gender enhancement procedures were reported by 70% of the population. Multivariable analysis showed HIV infection to be associated with being older than 35 recent, syphilis infection and HSV2 infection. Transwomen are the group most vulnerable to HIV/AIDS in Peru.
Resumen
En Latinoamérica, las mujeres trans (personas trans de masculino a femenino) han sido incluídas en la investigación con población HSH sin abordar sus necesidades específicas en relación a la epidemia de VIH/SIDA. Presentamos los resultados del primer estudio sero-epidemiológico diseñado para mujeres trans en el Perú. Utilizamos un diseño transversal con respondent driven sampling (RDS). Las características socio-demográficas de la población, los procesos de transformación del cuerpo y las conductas sexuales fueron exploradas a través de una entrevista. Se realizaron pruebas de laboratorio para VIH, herpes genital (HSV2) y sífilis. Un total de 450 mujeres trans fueron enroladas en Lima entre abril y junio del 2009. La prevalencia de VIH encontrada fue de 30%, HSV2: 79% y sífilis: 23%. El trabajo sexual fue la principal actividad económica reportada (64%). Los procesos de modificación del cuerpo fueron reportados por el 70% de la población. El análisis mutivariable asoció la infección por VIH a una edad mayor a 35 años, la infección reciente por sífilis y la infección con HSV2. Este estudio muestra que las mujeres trans constituyen la población con mayor vulnerabilidad al VIH en el Perú.
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References
Caceres CF, Aggleton P, Galea JT. Sexual diversity, social inclusion and HIV/AIDS. AIDS. 2008;22(Suppl 2):S45–55.
Caceres CF. HIV among gay and other men who have sex with men in Latin America and the Caribbean: a hidden epidemic? AIDS. 2002;16(Suppl 3):S23–33.
Sanchez J, Lama JR, Kusunoki L, et al. HIV-1, sexually transmitted infections, and sexual behavior trends among men who have sex with men in Lima, Peru. J Acquir Immune Defic Syndr. 2007;44(5):578–85.
van Griensven F, de Lind van Wijngaarden JW, Baral S, Grulich A. The global epidemic of HIV infection among men who have sex with men. Curr Opin HIV AIDS. 2009;4(4):300–7.
Tabet S, Sanchez J, Lama J, et al. HIV, syphilis and heterosexual bridging among Peruvian men who have sex with men. AIDS. 2002;16(9):1271–7.
Clements-Nolle K, Marx R, Guzman R, Katz M. HIV prevalence, risk behaviors, health care use, and mental health status of transgender persons: implications for public health intervention. Am J Public Health. 2001;91(6):915–21.
Nemoto T, Operario D, Keatley J, Han L, Soma T. HIV risk behaviors among male-to-female transgender persons of color in San Francisco. Am J Public Health. 2004;94(7):1193–9.
Nuttbrock L, Hwahng S, Bockting W, et al. Lifetime risk factors for HIV/sexually transmitted infections among male-to-female transgender persons. J Acquir Immune Defic Syndr. 2009;52:417–21.
Pisani E, Girault P, Gultom M, et al. HIV, syphilis infection, and sexual practices among transgenders, male sex workers, and other men who have sex with men in Jakarta, Indonesia. Sex Transm Infect. 2004;80(6):536–40.
Herbst JH, Jacobs ED, Finlayson TJ, McKleroy VS, Neumann MS, Crepaz N. Estimating HIV prevalence and risk behaviors of transgender persons in the United States: a systematic review. AIDS Behav. 2008;12(1):1–17.
Caceres CF, Mendoza W, Konda K, Lescano A. Nuevas Evidencias para las políticas y programs de salud en VIH/SIDA e infecciones de transmisión sexual en el Perú. Lima: UPCH; 2007.
Caceres CF, Giron JM, Sandoval C, et al. Implementation effects of GFATM-supported HIV/AIDS projects on the health sector, civil society, affected communities in Peru–2007. Glob Public Health. 2004;13:1–19.
Melendez RM, Pinto R. ‘It’s really a hard life’: love, gender and HIV risk among male-to-female transgender persons. Cult Health Sex. 2007;9(3):233–45.
Ramirez-Valles J, Garcia D, Campbell RT, Diaz RM, Heckathorn DD. HIV infection, sexual risk behavior, and substance use among Latino gay and bisexual men and transgender persons. Am J Public Health. 2008;98(6):1036–42.
Sevelius JM, Reznick OG, Hart SL, Schwarcz S. Informing interventions: the importance of contextual factors in the prediction of sexual risk behaviors among transgender women. AIDS Educ Prev. 2009;21(2):113–27.
Wilson EC, Garofalo R, Harris DR, Belzer M. Sexual risk taking among transgender male-to-female youths with different partner types. Am J Public Health. 2010;100(8):1500–5.
Salazar, X. Resultados de los grupos focales con trabajadoras sexuales travestis sobre el trabajo sexual y los clientes. Lima, 2008.
De Santis JP. HIV infection risk factors among male-to-female transgender persons: a review of the literature. J Assoc Nurses AIDS Care. 2009;20(5):362–72.
Silva-Santisteban A, Salazar X. Informe final de mapeo y encuesta sociodemográfica del trabajo sexual en cuatro ciudades del Perú. Lima: UNFPA; 2009.
Caceres CF, Segura E, Silva-Santisteban A, et al. 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 [WEPE0766]. Presented at AIDS 2010—XVIII International AIDS Conference.
Salazar X, Villayzan J. Outlines for multisectorial work with transgender populations, human rights, sex work and HIV/AIDS. Lima: IEESDEH, UNFPA; 2010.
Heckathorn DD. Respondent driven sampling: a new approach to the study of hidden populations. Soc Probl. 1997;44(2):174–99.
Johnston LG, Khanam R, Reza M, et al. The effectiveness of respondent driven sampling for recruiting males who have sex with males in Dhaka, Bangladesh. AIDS Behav. 2008;12(2):294–304.
Lane T, Raymond HF, Dladla S, et al. High HIV prevalence among men who have sex with men in Soweto, South Africa: results from the Soweto men’s study. AIDS Behav. 2011;15(3):626–34.
Malekinejad M, Johnston LG, Kendall C, Kerr LR, Rifkin MR, Rutherford GW. Using respondent-driven sampling methodology for HIV biological and behavioral surveillance in international settings: a systematic review. AIDS Behav. 2008;12(4 Suppl):S105–30.
Magnani R, Sabin K, Saidel T, Heckathorn D. Review of sampling hard-to-reach and hidden populations for HIV surveillance. AIDS. 2005;19(Suppl 2):S67–72.
Salganik MJ. Variance estimation, design effects, and sample size calculations for respondent-driven sampling. J Urban Health. 2006;83(6 Suppl):i98–112.
Larsen SA, Steiner BM, Rudolph AH. Laboratory diagnosis and interpretation of tests for syphilis. Clin Microbiol Rev. 1995;8(1):1–21.
Heckathorn D. Extensions of respondent-driven sampling: analyzing continuous variables and controlling for differential recruitment. Sociol Methodol. 2007;37:151–207.
Ruan S, Yang H, Zhu Y, et al. Rising HIV prevalence among married and unmarried among men who have sex with men: Jinan, China. AIDS Behav. 2009;13(4):671–6.
Corey L, Wald A, Celum CL, Quinn TC. The effects of herpes simplex virus-2 on HIV-1 acquisition and transmission: a review of two overlapping epidemics. J Acquir Immune Defic Syndr. 2004;35(5):435–45.
Lama JR, Lucchetti A, Suarez L, et al. Association of herpes simplex virus type 2 infection and syphilis with human immunodeficiency virus infection among men who have sex with men in Peru. J Infect Dis. 2006;194(10):1459–66.
Zetola NM, Bernstein KT, Wong E, Louie B, Klausner JD. Exploring the relationship between sexually transmitted diseases and HIV acquisition by using different study designs. J Acquir Immune Defic Syndr. 2009;50(5):546–51.
Snowden JM, Konda KA, Leon SR, et al. Recent syphilis infection prevalence and risk factors among male low-income populations in coastal Peruvian cities. Sex Transm Dis. 2010;37(2):75–80.
Konda KA, Klausner JD, Lescano AG, et al. The epidemiology of herpes simplex virus type 2 infection in low-income urban populations in coastal Peru. Sex Transm Dis. 2005;32(9):534–41.
Centers for Disease Control and Prevention. Program collaboration and service integration: enhancing the prevention and control of HIV/AIDS, viral hepatitis, sexually transmitted diseases, and tuberculosis in the United States. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention; 2009.
Hall HI, An Q, Hutchinson AB, Sansom S. Estimating the lifetime risk of a diagnosis of the HIV infection in 33 states, 2004–2005. J Acquir Immune Defic Syndr. 2008;49(3):294–7.
Parker R, Aggleton P. HIV and AIDS-related stigma and discrimination: a conceptual framework and implications for action. Soc Sci Med. 2003;57(1):13–24.
Kosenko KA. Contextual influences on sexual risk-taking in the transgender community. J Sex Res. 2010;24:1–12.
Lombardi EL, Wilchins RA, Priesing D, Malouf D. Gender violence: transgender experiences with violence and discrimination. J Homosex. 2001;42(1):89–101.
Lombardi E. Varieties of transgender/transsexual lives and their relationship with transphobia. J Homosex. 2009;56(8):977–92.
Infante C, Sosa-Rubi SG, Cuadra SM. Sex work in Mexico: vulnerability of male, travesti, transgender and transsexual sex workers. Cult Health Sex. 2009;11(2):125–37.
Nuttbrock L, Hwahng S, Bockting W, et al. Lifetime risk factors for HIV/sexually transmitted infections among male-to-female transgender persons. J Acquir Immune Defic Syndr. 2009;52(3):417–21.
Bockting WO, Robinson BE, Rosser BR. Transgender HIV prevention: a qualitative needs assessment. AIDS Care. 1998;10(4):505–25.
Garofalo R, Deleon J, Osmer E, Doll M, Harper GW. Overlooked, misunderstood and at-risk: exploring the lives and HIV risk of ethnic minority male-to-female transgender youth. J Adolesc Health. 2006;38(3):230–6.
Nemoto T, Operario D, Keatley J, Villegas D. Social context of HIV risk behaviours among male-to-female transgenders of colour. AIDS Care. 2004;16(6):724–35.
Berrill KT, Herek GM. Primary and secondary victimization in anti-gay hate crimes: official response and public policy. J Interpers Violence. 1990;5:401–13.
Operario D, Soma T, Underhill K. Sex work and HIV status among transgender women: systematic review and meta-analysis. J Acquir Immune Defic Syndr. 2008;48(1):97–103.
Wimonsate W, Naorat S, Varangrat A, et al. Risk behavior, hormone use, surgical history and HIV infection among transgendered persons (TG) in Thailand, 2005 [MOPE0349]. Presented at AIDS 2006—XVI International AIDS Conference.
Newfield E, Hart S, Dibble S, Kohler L. Female-to-male transgender quality of life. Qual Life Res. 2006;15(9):1447–57.
Gagizi E, Ferreira E, Abbate MC. Biosecurity on using industrial liquid silicon and female sexual hormones by transvestis and transgenders in São Paulo City, Brazil [CDC1677]. Presented at AIDS 2006—XVI International AIDS Conference.
Hage JJ, Kanhai RC, Oen AL, van Diest PJ, Karim RB. The devastating outcome of massive subcutaneous injection of highly viscous fluids in male-to-female transsexuals. Plast Reconstr Surg. 2001;107(3):734–41.
Heckathorn DD. Respondent driven sampling II: deriving valid population estimates from chain-referral samples of hiddenpopulations. Soc Probl. 2002;49(1):11–34.
Burt RD, Hagan H, Sabin K, Thiede H. Evaluating respondent-driven sampling in a major metropolitan area: comparing injection drug users in the 2005 Seattle area national HIV behavioral surveillance system survey with participants in the RAVEN and Kiwi studies. Ann Epidemiol. 2010;20(2):159–67.
Acknowledgments
This study was conducted in all its phases in collaboration with Red Trans Peru, an organization that brings together transwomen from across the country and performs important work to pursue the fulfillment of rights of transwomen. It would not have been possible to design the instrument or the logistics of a feasible study without the participation of the population, demonstrating the important synergy obtained in a horizontal work between academia and grassroots organizations in research processes. Study funded by amfAR, American Foundation for AIDS Research (Grant no. 107266-44-IAMM).
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Silva-Santisteban, A., Raymond, H.F., Salazar, X. et al. Understanding the HIV/AIDS Epidemic in Transgender Women of Lima, Peru: Results from a Sero-Epidemiologic Study Using Respondent Driven Sampling. AIDS Behav 16, 872–881 (2012). https://doi.org/10.1007/s10461-011-0053-5
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DOI: https://doi.org/10.1007/s10461-011-0053-5