Place Matters: Sexual Practices, HIV Testing and HIV Status Among Transwomen Sex Workers in Peru

Background: Studies in Peru have shown that transwomen are at high risk of HIV/STIs and that sex work and compensated sex are associated with higher HIV/STI prevalences among transwomen. However, there has been no systematic description of transwomen sex workers (TSWs). Our objective was to describe TSWs in metropolitan Lima. 

Methods: Following extensive ethnographic mapping of sex work venues, we randomly selected venues and sampled the TSWs present with pre-established guidelines. We used smartphones to survey TSWs about their socio-demographic characteristics, recent sexual practices, and HIV testing history and status. We analyzed differences between groups of TSWs in different geographic zones using bivariate analyses and appropriate tests of association.

Results: We surveyed 261 TSWs from 28 sex work venues in central, south, north and east Lima. All TSWs reported male/transwomen sex partners, with 69% reporting only client partners. The frequency of receptive anal intercourse (RAI) with clients was high across zones (range: 94%-100%), with the highest non-condom use in east Lima (7% vs. 2% elsewhere, p<0.01). Insertive anal intercourse (IAI) with clients was lower in south Lima (20% vs. 54% elsewhere, p<0.01), accompanied by higher non-condom use in south Lima (16% vs. 6% elsewhere, p<0.01). Of the 81 TSWs reporting non-client male/transwomen sex partners, 91% had RAI with a median of 8% for non-condom use and 24% had IAI with a median of 33% for non-condom use. Ever HIV testing was lower in east (76%) and central (84%) Lima versus elsewhere (95%) (p=0.01). Among those tested, report of being HIV positive varied greatly: 5% (north), 12% (south), 17% (center), and 46% (east) (p<0.01).    

Conclusions: Our results show that sexual and HIV testing practices and HIV prevalences vary by geographic zone. This information should be used to better target future prevention efforts with TSWs in Lima.