AIDS and Behavior

, Volume 16, Issue 1, pp 214–224

Social Network Characteristics and HIV Vulnerability Among Transgender Persons in San Salvador: Identifying Opportunities for HIV Prevention Strategies

  • Clare Barrington
  • Cyprian Wejnert
  • Maria Elena Guardado
  • Ana Isabel Nieto
  • Gabriela Paz Bailey
Original Paper


The purpose of this study is to improve understanding of HIV vulnerability and opportunities for HIV prevention within the social networks of male-to-female transgender persons in San Salvador, El Salvador. We compare HIV prevalence and behavioral data from a sample of gay-identified men who have sex with men (MSM) (n = 279), heterosexual or bisexual identified MSM (n = 229) and transgender persons (n = 67) recruited using Respondent Driven Sampling. Transgender persons consistently reported higher rates of HIV risk behavior than the rest of the study population and were significantly more likely to be involved in sex work. While transgender persons reported the highest rates of exposure to HIV educational activities they had the lowest levels of HIV-related knowledge. Transgender respondents’ social networks were homophilous and efficient at recruiting other transgender persons. Findings suggest that transgender social networks could provide an effective and culturally relevant opportunity for HIV prevention efforts in this vulnerable population.


El Salvador Transgender HIV Men who have sex with men Sexually transmitted infections Respondent driven sampling 


El propósito de este estudio es mejorar los conocimientos de la vulnerabilidad de VIH y las oportunidades para prevención dentro de las redes sociales de personas transgéneros (masculino-al-femenino) en San Salvador, El Salvador. Comparamos prevalencia de VIH y datos de comportamiento en una muestra de hombres que tienen sexo con hombres (HSH) que se identifican gay (n = 279), HSH que se identifican heterosexual o bisexual (n = 229), y personas transgéneros (n = 67) reclutados por referencia de personas en sus redes sociales (RDS por sus siglas en ingles). De forma consistente, las personas transgéneros reportaron mayores niveles de comportamiento de riesgo para VIH que el resto de la población del estudio y fueron significativamente más probable a estar involucrado en el trabajo sexual. Mientras reportaron los niveles más altos de exposición a las actividades educativas de VIH, las personas transgéneros tuvieron los niveles más bajo de conocimientos de VIH. Las redes sociales de las personas transgéneros fueron homofilias y muy eficientes para reclutar otras personas transgénero. Los hallazgos sugieren que las redes sociales de las personas transgéneros podrían ofrecer una oportunidad efectiva y culturalmente relevante para esfuerzos de prevención del VIH con esta población vulnerable.


  1. 1.
    MSPAS. Situación del VIH/SIDA en El Salvador: Programa Nacional de VIH/SIDA de El Salvador; 2008.Google Scholar
  2. 2.
    Soto RJ, Ghee AE, Nunez CA, Mayorga R, Tapia KA, Astete SG, et al. Sentinel surveillance of sexually transmitted infections/HIV and risk behaviors in vulnerable populations in 5 Central American countries. J Acquir Immune Defic Syndr. 2007;46(1):101–11.PubMedGoogle Scholar
  3. 3.
    Beyrer C. Hidden yet happening: the epidemics of sexually transmitted infections and HIV among men who have sex with men in developing countries. Sex Transm Infect. 2008;84(6):410–2.PubMedCrossRefGoogle Scholar
  4. 4.
    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.PubMedCrossRefGoogle Scholar
  5. 5.
    DeSantis. HIV infection risk factors among male-to-female transgender personas: a review of the literature. J Assoc Nurses AIDS Care. 2009;20(5):362–72.CrossRefGoogle Scholar
  6. 6.
    PSI. Interpersonal Communication at PSI.2006: Available from:
  7. 7.
    PASMO. Perfil PASMO. 2009: Available from:
  8. 8.
    UNAIDS. El Salvador: Ministerial decree to reduce homophobia in health services 2009.
  9. 9.
    Nemoto T, Sausa LA, Operario D, Keatley J. Need for HIV/AIDS education and intervention for MTF transgenders: responding to the challenge. J Homosex. 2006;51(1):183–202.PubMedCrossRefGoogle Scholar
  10. 10.
    Reisner SL, Mimiaga MJ, Bland S, Mayer KH, Perkovich B, Safren SA. HIV risk and social networks among male-to-female transgender sex workers in Boston, Massachusetts. J Assoc Nurses AIDS Care. 2009;20(5):373–86.PubMedCrossRefGoogle Scholar
  11. 11.
    Schulden JD, Song B, Barros A, Mares-DelGrasso A, Martin CW, Ramirez R, et al. Rapid HIV testing in transgender communities by community-based organizations in three cities. Public Health Rep. 2008;123(Suppl 3):101–14.PubMedGoogle Scholar
  12. 12.
    PSI. El Salvador (2007): Estudio TRaC de VIH/SIDA entre hombres que tienen sexo con hombres en San Salvador, Sonsonate, Santa Ana, San Miguel y La Paz; 2008.Google Scholar
  13. 13.
    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.PubMedCrossRefGoogle Scholar
  14. 14.
    Bockting WO, Robinson BE, Forberg J, Scheltema K. Evaluation of a sexual health approach to reducing HIV/STD risk in the transgender community. AIDS Care. 2005;17(3):289–303.PubMedCrossRefGoogle Scholar
  15. 15.
    Melendez RM, Pinto RM. HIV prevention and primary care for transgender women in a community-based clinic. J Assoc Nurses AIDS Care. 2009;20(5):387–97.PubMedCrossRefGoogle Scholar
  16. 16.
    Pinto RM, Melendez RM, Spector AY. Male-to-female transgender individuals building social support and capital from within a gender-focused network. J Gay Lesbian Soc Serv. 2008;20(3):203–20.PubMedCrossRefGoogle Scholar
  17. 17.
    Broadhead RS, Heckathorn DD, Weakliem DL, Anthony DL, Madray H, Mills RJ, et al. Harnessing peer networks as an instrument for AIDS prevention: results from a peer-driven intervention. Public Health Rep. 1998;113(Suppl 1):42–57.PubMedGoogle Scholar
  18. 18.
    Latkin CA, Sherman S, Knowlton A. HIV prevention among drug users: outcome of a network-oriented peer outreach intervention. Health Psychol. 2003;22(4):332–9.PubMedCrossRefGoogle Scholar
  19. 19.
    Weeks MR, Li J, Dickson-Gomez J, Convey M, Martinez M, Radda K, et al. Outcomes of a peer HIV prevention program with injection drug and crack users: the Risk Avoidance Partnership. Subst Use Misuse. 2009;44(2):253–81.PubMedCrossRefGoogle Scholar
  20. 20.
    Amirkhanian YA, Kelly JA, Kabakchieva E, Kirsanova AV, Vassileva S, Takacs J, et al. A randomized social network HIV prevention trial with young men who have sex with men in Russia and Bulgaria. AIDS. 2005;19(16):1897–905.PubMedCrossRefGoogle Scholar
  21. 21.
    Kelly JA, St Lawrence JS, Stevenson LY, Hauth AC, Kalichman SC, Diaz YE, et al. Community AIDS/HIV risk reduction: the effects of endorsements by popular people in three cities. Am J Public Health. 1992;82(11):1483–9.PubMedCrossRefGoogle Scholar
  22. 22.
    Zhang H, Wu Z, Zheng Y, Wang J, Zhu J, Xu J. A pilot intervention to increase condom use and HIV testing and counseling among men who have sex with men in Anhui, China. J Acquir Immune Defic Syndr. 2010;53(Suppl 1):S88–92.PubMedGoogle Scholar
  23. 23.
    Salganik MJ, Heckathorn DD. Sampling and estimation in hidden populations using respondent driven sampling. Sociol Methodol. 2004;34:193–239.CrossRefGoogle Scholar
  24. 24.
    Volz E, Heckathorn DD. Probability-based estimation theory for respondent driven sampling. J Off Stat. 2008;24:79–97.Google Scholar
  25. 25.
    Wejnert C. An empirical test of respondent driven sampling: point estimates, variance, degree measures, and out-of-equilibrium data. Sociol Methodol. 2009;39:73–116.PubMedCrossRefGoogle Scholar
  26. 26.
    Johnston LG, Malekinejad M, Kendall C, Iuppa IM, Rutherford GW. Implementation challenges to using respondent-driven sampling methodology for HIV biological and behavioral surveillance: field experiences in international settings. AIDS Behav. 2008;12(4 Suppl):S131–41.PubMedCrossRefGoogle Scholar
  27. 27.
    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.PubMedCrossRefGoogle Scholar
  28. 28.
    Creswell J, Guardado ME, Molina G, Hernandez W, Bellare N, Batres J, et al. Evaluacion formative de las experiencias de los trabajadores sexuales para informar la encuesta de comportamientos en San Salvador y San Miguel. Informe Final. San Salvador, El Salvador; 2008.Google Scholar
  29. 29.
    UVG. Pilot study using audio computer-assisted self-interviewing (ACASI) methodology in the following vulnerable populations: sex workers, MSM, people living with HIV/AIDS and Garifuna in three areas in Guatemala. Guatemala City: Centro de Estudios para la Salud Universidad del Valle de Guatemala; 2005.Google Scholar
  30. 30.
    UNAIDS. UNGASS guidelines on construction of core indicators. Geneva: UNAIDS; 2009.Google Scholar
  31. 31.
    Volz E, Wejnert C, Degani I, Heckathorn DD. Respondent driven sampling analysis tool (RDSAT), version 5.6. Ithaca: Cornell University; 2007.Google Scholar
  32. 32.
    Heckathorn DD. Respondent driven sampling II: deriving valid population estimates from chain referral samples of hidden populations. Soc Probl. 2002;49:11–34.CrossRefGoogle Scholar
  33. 33.
    McPherson M, Smith-Lovin L, Cook JM. Birds of a feather: homophily in social networks. Annu Rev Sociol. 2001;27:415–44.CrossRefGoogle Scholar
  34. 34.
    Wejnert C. Social network analysis with respondent-driven sampling data: a study of racial integration on campus. Soc Netw. 2010;1(32):112–24.CrossRefGoogle Scholar
  35. 35.
    Goel S, Salganik MJ. Assessing respondent-driven sampling. Proc Natl Acad Sci USA. 2010;107(15):6743–7.PubMedCrossRefGoogle Scholar
  36. 36.
    Nemoto T, Operario D, Keatley J, Nguyen H, Sugano E. Promoting health for transgender women: Transgender Resources and Neighborhood Space (TRANS) program in San Francisco. Am J Public Health. 2005;95(3):382–4.PubMedCrossRefGoogle Scholar
  37. 37.
    Ramos RL, Ferreira-Pinto JB, Rusch ML, Ramos ME. Pasa la voz (spread the word): using women’s social networks for HIV education and testing. Public Health Rep. 2010;125(4):528–33.PubMedGoogle Scholar
  38. 38.
    Kelly JA. Popular opinion leaders and HIV prevention peer education: resolving discrepant findings, and implications for the development of effective community programmes. AIDS Care. 2004;16(2):139–50.PubMedCrossRefGoogle Scholar
  39. 39.
    Heckathorn DD, Broadhead RS, Anthony DL, Weakliem DL. AIDS and social networks: HIV prevention through network mobilization. Sociol Focus. 1999;32:159–79.Google Scholar
  40. 40.
    Gile KJ, Handcock MS. Respondent driven sampling: an assessment of current methodology. Sociol Methodol. 2010;40:285–327.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Clare Barrington
    • 1
  • Cyprian Wejnert
    • 2
  • Maria Elena Guardado
    • 3
  • Ana Isabel Nieto
    • 4
  • Gabriela Paz Bailey
    • 3
    • 5
  1. 1.Department of Health Behavior and Health Education, Gillings School of Global Public HealthUniversity of North Carolina at Chapel HillChapel HillUSA
  2. 2.Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB PreventionCenters for Disease Control and PreventionAtlantaUSA
  3. 3.Tephinet, Inc.AtlantaUSA
  4. 4.National AIDS ProgramMinistry of HealthSan SalvadorEl Salvador
  5. 5.Center for Health StudiesDel Valle UniversityGuatemala CityGuatemala

Personalised recommendations