Condomless anal intercourse among transgender women (TW) in Peru has been shown to vary by the type of partner involved (e.g. primary vs. casual vs. transactional sex partner), but no previous studies have explored variations in partner-level patterns of condom use according to type of anal intercourse. We evaluated the relationship between partnership characteristics and condom use during insertive (IAI) versus receptive anal intercourse (RAI) among TW with recent, non-female partners. Condomless IAI was more common with transactional and casual sex partners and by TW who self-reported HIV-uninfected serostatus (p < 0.05), alcohol use disorders, or substance use before sex. Condomless RAI was more common with primary partners and by TW who described their HIV serostatus as unknown (p < 0.05). Examining partner-level differences between condomless IAI and RAI reveals distinct patterns of HIV/STI risk among TW, suggesting a need for HIV prevention strategies tailored to the specific contexts of partners, practices, and networks.
Las investigaciones sobre mujeres trans en Perú han encontrado una asociación entre el tipo de pareja y el sexo anal sin condón, pero aún no se han investigado los patrones del uso del condón entre parejas según tipos específicos de sexo anal. Evaluamos la asociación entre las características de las parejas masculinas de mujeres trans y el uso del condón durante sexo anal insertivo y receptivo. El sexo anal insertivo sin condón fue más común con parejas casuales y comerciales, y también entre mujeres trans que reportaron estatus VIH-negativo (p < 0.05), trastornos de uso de alcohol, y uso de alcohol y drogas previos al acto sexual. El sexo anal receptivo sin condón fue más común con parejas estables y entre mujeres trans que no sabían su estatus de VIH (p < 0.05). La investigación diferenciada según uso de condón durante el sexo anal insertivo y receptivo muestra patrones distintos del riesgo de VIH/ITS entre mujeres trans que sugieren la necesidad de desarrollar estrategias distintas de prevención que sean específicas para sus parejas, practicas, redes y contextos sexuales.
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Silva-Santisteban A, Raymond H, 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. 2012;16:872–81.
Lipsitz MC, Segura ER, Castro JL, et al. Bringing testing to the people—benefits of mobile unit HIV/syphilis testing in Lima, Peru, 2007–2009. Int J STD AIDS. 2014;25(5):325–31.
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.
MINSA. National report on progress achieved in the country Peru. Lima: Ministry of Health, Joint United Nations Program on HIV/AIDS; 2012.
UNAIDS. Global report: UNAIDS report on the global AIDS epidemic. 2013. http://www.unaids.org/en/resources/campaigns/globalreport2013/globalreport.
Perez-Brumer AG, Konda KA, Salvatierra HJ, et al. Prevalence of HIV, STIs, and risk behaviors in a cross-sectional community- and clinic-based sample of men who have sex with men (MSM) in Lima, Peru. PLoS One. 2013;8(4):e59072.
Goodreau SM, Carnegie NB, Vittinghoff E, et al. What drives the US and Peruvian HIV epidemics in men who have sex with men (MSM)? PLoS One. 2012;7(11):e50522.
Nureña CR, Zúñiga M, Zunt J, Mejía C, Montano S, Sánchez JL. Diversity of commercial sex among men and male-born trans people in three Peruvian cities. Cult Health Sex. 2011;13(10):1207–21.
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.
Goodreau SM, Goicochea LP, Sanchez J. Sexual role and transmission of HIV type 1 among men who have sex with men, in Peru. J Infect Dis. 2005;1(191 Suppl 1):S147–58.
Clark J, Salvatierra J, Segura E, et al. Moderno love: sexual role-based identities and HIV/STI prevention among men who have sex with men in Lima, Peru. AIDS Behav. 2013;17(4):1313–28.
Deiss RG, Clark JL, Konda KA, et al. Problem drinking is associated with increased prevalence of sexual risk behaviors among men who have sex with men (MSM) in Lima, Peru. Drug Alcohol Depend. 2013;132(1–2):134–9.
Ludford KT, Vagenas P, Lama JR, et al. Screening for drug and alcohol use disorders and their association with HIV-related sexual risk behaviors among men who have sex with men in Peru. PLoS One. 2013;8(8):e69966.
Nagaraj S, Segura ER, Peinado J, et al. A cross-sectional study of knowledge of sex partner serostatus among high-risk Peruvian men who have sex with men and transgender women: implications for HIV prevention. BMC Public Health. 2013;13:181.
Verre M, Peinado J, Segura ER, et al. Socialization patterns and their associations with unprotected anal intercourse, HIV, and syphilis among high-risk men who have sex with men and transgender women in Peru. AIDS Behav. 2014;18(10):2030–9.
Salazar X, Villayzán J, Silva-Santisteban A, Caceres C. Las personas trans y la epidemia del VIH/SIDA en el Perú. Lima: IESSDEH, UPCH, ONUSIDA, amfAR; 2010.
Bockting WO, Robinson BE, Rosser BR. Transgender HIV prevention: a qualitative needs assessment. AIDS Care. 1998;10(4):505–25.
Bianchi FT, Reisen CA, Zea MC, et al. Sex work among men who have sex with men and transgender women in Bogotá. Arch Sex Behav. 2014;43(8):1637–50.
Sevelius JM. Gender affirmation: a framework for conceptualizing risk behavior among transgender women of color. Sex Roles. 2013;68(11–12):675–89.
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.
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.
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.
Bowers JR, Branson CM, Fletcher JB, Reback CJ. Predictors of HIV sexual risk behavior among men who have sex with men, men who have sex with men and women, and transgender women. Int J Sex Health Off J World Assoc Sex Health. 2012;24(4):290–302.
Martins TA, Kerr LRFS, Macena RHM, et al. Travestis, an unexplored population at risk of HIV in a large metropolis of northeast Brazil: a respondent-driven sampling survey. AIDS Care. 2013;25(5):606–12.
Nemoto T, Bödeker B, Iwamoto M, Sakata M. Practices of receptive and insertive anal sex among transgender women in relation to partner types, sociocultural factors, and background variables. AIDS Care. 2014;26(4):434–40.
Wilson EC, Santos G-M, Raymond HF. Sexual mixing and the risk environment of sexually active transgender women: data from a respondent-driven sampling study of HIV risk among transwomen in San Francisco, 2010. BMC Infect Dis. 2014;14:430.
Cambou MC, Perez-Brumer AG, Segura ER, et al. The risk of stable partnerships: associations between partnership characteristics and unprotected anal intercourse among men who have sex with men and transgender women recently diagnosed with HIV and/or STI in Lima, Peru. PLoS One. 2014;9(7):e102894.
Reisner SL, Vetters R, White JM, et al. Laboratory-confirmed HIV and sexually transmitted infection seropositivity and risk behavior among sexually active transgender patients at an adolescent and young adult urban community health center. AIDS Care. 2015;27(8):1031–6.
Babor T, Higgins-Biddle JC, Saunders JB, Monteiro MG. The alcohol use disorders identification test (AUDIT): guidelines for use in primary care. Geneva: World Health Organization; 2001.
Cui J. QIC program and model selection in GEE analyses. Stata J. 2007;7(2):209–20.
Barros AJD, Hirakata VN. Alternatives for logistic regression in cross-sectional studies: an empirical comparison of models that directly estimate the prevalence ratio. BMC Med Res Methodol. 2003;20(3):21.
Hanley JA, Negassa A, deB Edwardes MD, Forrester JE. Statistical analysis of correlated data using generalized estimating equations: an orientation. Am J Epidemiol. 2003;157(4):364–75.
Bockting W, Miner M, Rosser BRS. Latino men’s sexual behavior with transgender persons. Arch Sex Behav. 2007;36(6):778–86.
Reisner S, Mimiaga M, Bland SE, Driscoll MA, Cranston K, Mayer KH. Pathways to embodiment of HIV risk: black men who have sex with transgender partners, Boston, Massachusetts. AIDS Educ Prev Off Publ Int Soc AIDS Educ. 2012;24(1):15–26.
Operario D, Nemoto T, Iwamoto M, Moore T. Unprotected sexual behavior and HIV risk in the context of primary partnerships for transgender women. AIDS Behav. 2011;15(3):674–82.
Blas MM, Alva IE, Cabello R, Carcamo C, Kurth AE. Risk behaviors and reasons for not getting tested for HIV among men who have sex with men: an online survey in Peru. PLoS One. 2011;6(11):e27334.
Silva-Santisteban A, Segura E, Sandoval C, Girón M, Petrera M, Caceres C. Determinants of unequal HIV care access among people living with HIV in Peru. Glob Health. 2013;17(9):22.
Ainsworth TA, Spiegel JH. Quality of life of individuals with and without facial feminization surgery or gender reassignment surgery. Qual Life Res Int J Qual Life Asp Treat Care Rehabil. 2010;19(7):1019–24.
Gerhardstein KR, Anderson VN. There’s more than meets the eye: facial appearance and evaluations of transsexual people. Sex Roles. 2010;62(5–6):361–73.
Poteat T, Wirtz AL, Radix A, et al. HIV risk and preventive interventions in transgender women sex workers. Lancet. 2015;385(9964):274–86.
Patel P, Borkowf CB, Brooks JT, Lasry A, Lansky A, Mermin J. Estimating per-act HIV transmission risk: a systematic review. AIDS Lond Engl. 2014;28(10):1509–19.
Nemoto T, Iwamoto M, Perngparn U, Areesantichai C, Kamitani E, Sakata M. HIV-related risk behaviors among kathoey (male-to-female transgender) sex workers in Bangkok, Thailand. AIDS Care. 2012;24(2):210–9.
Jin F, Prestage GP, Mao L, et al. “Any condomless anal intercourse” is no longer an accurate measure of HIV sexual risk behavior in gay and other men who have sex with men. Front Immunol. 2015;6:86.
We would like to express gratitude to the study participants, peer recruiters, and staff of the Asociación Civil Impacta Salud y Educación, particularly Jessica Rios, for their contributions to this study. Without their involvement, this study would not have been possible. Milan F. Satcher received funding from the UCLA South American Program in HIV Prevention Research (SAPHIR; NIH R25 MH087222). The primary research for this secondary data analysis was funded by the NIH/NIMH (NIH R21 MH092232 and K23 MH084611).
This study was funded by NIMH (K23 MH084611, NIH R21 MH092232) and NIH (NIH R25 MH087222).
Conflict of Interest
Milan Satcher declares that she has no conflict of interest. Eddy Segura declares that he has no conflict of interest. Alfonso Silva-Santisteban declares that he has no conflict of interest. Jorge Sanchez declares that he has no conflict of interest. Javier Lama declares that he has no conflict of interest. Jesse Clark declares that he has no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
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Satcher, M.F., Segura, E.R., Silva-Santisteban, A. et al. Partner-Level Factors Associated with Insertive and Receptive Condomless Anal Intercourse Among Transgender Women in Lima, Peru. AIDS Behav 21, 2439–2451 (2017). https://doi.org/10.1007/s10461-016-1503-x
- Transgender women
- Sexual partnerships
- Condomless anal intercourse
- Mujeres trans
- Parejas sexuales
- Sexo anal sin condón