AIDS and Behavior

, Volume 22, Supplement 1, pp 45–56 | Cite as

Risk Behaviors and Perceptions Among Self-identified Men Who Have Sex with Men (MSM), Bisexuals, Transvestites, and Transgender Women in Western Guatemala

  • Janet M. IkedaEmail author
  • Oliver Racancoj
  • Susie Welty
  • Kimberly Page
  • Norman Hearst
  • Willi McFarland
Original Paper


Guatemala has a concentrated HIV epidemic disproportionately affecting men who have sex with men (MSM) and transgender women. We recruited 205 self-identified MSM, bisexuals, transvestites, and transgender women in western Guatemala using long-chain peer referral, wherein “seed” participants were asked to invite as many as three acquaintances to participate in the study. Self-reported sexual or gender identity was MSM, 46%; bisexual, 28%; transvestite, 21%, and transgender woman, 5%. Median age of the participants was 23 years, and 36% self-identified as being indigenous. Indigenous persons were more likely to self-identity as transvestite (32.9% vs 13.8%, P = 0.04), strongly perceive themselves at risk for HIV (87.7% vs 51.5%, P = 0.001), have had an HIV test in the last 12 months and know the result (97.3% vs 85.4%, P = 0.008), and experience barriers to testing and treatment (86.3% vs 67.7%, P = 0.004). HIV prevention services for indigenous MSM should especially target transvestites and how to overcome stigmatization and barriers to care.


MSM Transgender women HIV Indigenous Guatemala 


Guatemala enfrenta una epidemia de VIH, que afecta desproporcionadamente a hombres que tienen relaciones sexuales con hombres (HSH) y mujeres transgénero. Reclutamos 205 participantes quienes se auto-identificaron como HSH, bisexual, travestis y transgenero, en el Occidente de Guatemala usando como referencias de pares de cadena larga (long-chain peer referral), en donde se pidió a los participantes ‘semillas’ que invitarán hasta tres conocidos a participar en el estudio. Los auto-identificados fueron: el 46% HSH, el 28% bisexuales, el 21% travesti y el 5% transgénero. La edad media fue de 23 años y el 36% se auto-identificó como indígenas. Las personas indígenas son más probables para auto-identificarse como travesti (32.9% vs. 13.8%, P = 0.04), se perciben fuertemente en riesgo del VIH (87.7% vs 51.5%, P = 0.001), se han realizado la prueba de VIH en los últimos 12 meses y conocen su resultado (97.3% vs 85.4%, P = 0.008), y experimentan barreras para el testeo y el tratamiento (86.3% vs 67.7% P = 0.004). Los servicios de prevención del VIH para HSH indígena deberían dirigirse especialmente a los travestis y superar el estigma y las barreras a la atención.

Palabras Claves

HSH Mujeres transgénero VIH Indígena Guatemala 



We wish to acknowledge support from the University of California, San Francisco’s International Traineeships in AIDS Prevention Studies (ITAPS), U.S. NIMH, R25MH064712. We also wish to acknowledge all the participants who gave of their time for the study, as well as HIVOS Guatemala and the community-based organizations who contributed. We thank Josué Benjamin Moya Montes, Ana Lapara and Alma Citalán from the Association IDEI for their dedication supervising and coordinating the data collection.


This study was funded by the Investigation, Development and Integral Education Association.

Compliance with Ethical Standards

Conflict of interest

All authors declare that they have no conflict of interest.

Ethical Approval

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

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


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Janet M. Ikeda
    • 1
    Email author
  • Oliver Racancoj
    • 1
  • Susie Welty
    • 2
  • Kimberly Page
    • 3
  • Norman Hearst
    • 2
    • 4
  • Willi McFarland
    • 2
  1. 1.Investigation, Development and Integral Education AssociationQuetzaltenangoGuatemala
  2. 2.Department of Epidemiology and BiostatisticsUniversity of California at San FranciscoSan FranciscoUSA
  3. 3.Department of Internal MedicineUniversity of New MexicoAlbuquerqueUSA
  4. 4.Department of Family and Community MedicineUniversity of California at San FranciscoSan FranciscoUSA

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