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Decision-Making at the Intersection of Risk and Pleasure: A Qualitative Inquiry with Trans Women Engaged in Sex Work in Lima, Peru

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To inform culturally relevant HIV prevention interventions, we explore the complexity of sex work among Peruvian transgender women. In 2015, we conducted twenty in-depth interviews and demographic surveys with transgender women in Lima, Peru to examine how transgender women enact individual- and community-level resistance strategies within a context of pervasive marginalization. Although 40% self-identified as “sex workers,” 70% recently exchanged sex for money. Participants described nuanced risk–benefit analyses surrounding paid sexual encounters. Classification of clients as “risky” or “rewarding” incorporated issues of health, violence, and pleasure. Interviews highlighted context-informed decision-making (rejecting disrespectful clients, asserting condom use with specific partner types) demonstrating that motivations were not limited to HIV prevention or economic renumeration, but considered safety, health, attraction, gender validation, hygiene, and convenience. These findings underscore the complex risk assessments employed by Peruvian trans women. These individual-level decision-making and context-specific health promotion strategies represent critical frameworks for HIV prevention efforts.

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This work was supported by the United States National Institute of Health under Grant Number R34 MH105272.

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Authors and Affiliations



APB, JLC, SLR, JRL, KHM conceptualized and designed the study. APB, LH, XS, SNM supported in data collecting. APB, SNM, JCP, BW, XS and JLC conducted data analysis and drafted manuscript. All authors reviewed manuscript and supported with edits.

Corresponding author

Correspondence to Sarah Naz-McLean.

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The authors have no financial conflicts of interest to disclose.

Ethical Approval

Protocols and study materials were approved by the UCLA Office for Human Research Participant Protections (IRB #13–001898), and the Comite de Etica of the Asociacion Civil Impacta Salud y Educacion (IRB #0089–2014-CE).

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All subjects provided verbal informed consent prior to participation and were informed, as part of the consent process, that data may be used for publication. No images or personal identifiers have been included in this manuscript.

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Naz-McLean, S., Clark, J.L., Reisner, S.L. et al. Decision-Making at the Intersection of Risk and Pleasure: A Qualitative Inquiry with Trans Women Engaged in Sex Work in Lima, Peru. AIDS Behav 26, 843–852 (2022).

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