AIDS and Behavior

, Volume 21, Issue 12, pp 3299–3311 | Cite as

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

  • Sari L. Reisner
  • Amaya G. Perez-Brumer
  • Sarah A. McLean
  • Javier R. Lama
  • Alfonso Silva-Santisteban
  • Leyla Huerta
  • Jorge Sanchez
  • Jesse L. Clark
  • Matthew J. Mimiaga
  • Kenneth H. Mayer
Original Paper


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.


Transgender women HIV infection Models of care 


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.



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.


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).

Compliance with Ethical Standards

Conflicts of interest

All authors declare that they have no conflicts of interest.

Research involving human participants

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.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer Science+Business Media New York 2017

Authors and Affiliations

  • Sari L. Reisner
    • 1
    • 2
    • 3
  • Amaya G. Perez-Brumer
    • 4
  • Sarah A. McLean
    • 1
  • Javier R. Lama
    • 5
    • 6
  • Alfonso Silva-Santisteban
    • 7
  • Leyla Huerta
    • 8
  • Jorge Sanchez
    • 6
    • 7
  • Jesse L. Clark
    • 9
  • Matthew J. Mimiaga
    • 1
    • 3
    • 10
  • Kenneth H. Mayer
    • 1
    • 11
    • 12
  1. 1.The Fenway InstituteFenway HealthBostonUSA
  2. 2.Division of General PediatricsBoston Children’s Hospital and Harvard Medical SchoolBostonUSA
  3. 3.Department of EpidemiologyHarvard T.H. Chan School of Public HealthBostonUSA
  4. 4.Department of Sociomedical SciencesColumbia University Mailman School of Public HealthNew York CityUSA
  5. 5.Asociación Civil Impacta Salud y EducaciónLimaPeru
  6. 6.Department of Global HealthUniversity of WashingtonSeattleUSA
  7. 7.Universidad Peruana Cayetano HerediaLimaPeru
  8. 8.EpicentroLimaPeru
  9. 9.Department of Medicine, Division of Infectious DiseasesUniversity of California Los AngelesLos AngelesUSA
  10. 10.The Institute for Community Health PromotionBrown University School of Public HealthProvidenceUSA
  11. 11.Department of MedicineHarvard Medical SchoolBostonUSA
  12. 12.Department of Global Health and PopulationHarvard T.H. Chan School of Public HealthBostonUSA

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