WP 14 Clients of Male and Transwomen Sex Workers in Peru: Sexual Partners and Practices and HIV Testing and Status

Tuesday, June 10, 2014
Pre-function Lobby (M2)
David Díaz, Clinical Psychologist1, Angela Bayer, Assistant Professor2, Patricia Mallma, Biostatistician1, Patricia Garcia, President of ALACITS ID: PE-0011, Cesar Carcamo, Investigator1 and Thomas Coates, Professor2, 1School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru, 2Division of Infectious Diseases, Department of Medicine, University of California, Los Angeles, Los Angeles, CA

Background:  Globally, little is known about the clients of sex workers, particularly male and transwomen sex workers (MTSWs). Clients represent a bridge population between high-risk MTSWs and clients’ female partners. Our objective was to describe the clients of MTSWs in Lima, Peru.

Methods:  Following ethnographic mapping of sex work venues, we revisited venues to survey clients of MTSWs. We used smartphones to ask clients about their socio-demographics, recent sexual practices (last 3 months), and HIV testing history and status. We present descriptive analyses.

Results: We surveyed 102 clients from 25 sex work venues. Clients were well-educated (41% complete secondary, 27% at least some post-secondary education). They identified as bisexual (47%), homosexual (34%) and heterosexual (19%). Forty-three (42%) had stable romantic partners; 67% were women. All participants had male/transwomen sex partners, with a median of 7 [IQR 4-12] total partners and 6 [IQR 2-10] sex worker partners. Only 26% reported male/transwomen partners who were not sex workers. Clients reported only insertive anal intercourse (44%), only receptive anal intercourse (23%) and both insertive and receptive anal intercourse (25%) with male/transwomen sex workers, with 94% consistent condom use. Half of participants had recent female sex partners, with a median of 0.5 [IQR 0-2] partners. Seventy-one percent had only non-sex worker female partners and 22% both sex worker and non-sex worker partners. Among those with non-sex worker female partners: 100% reported vaginal sex, with 66% inconsistent condom use; and 47% reported anal sex, with 36% inconsistent condom use. Ever HIV testing was 69%, with 29% testing in the last 6 months. Thirteen percent reported being HIV positive.

Conclusions:  Clients of MTSWs have diverse types of sex partners and practices, with sub-optimal prevention practices, particularly with female partners. This information should be used to guide prevention efforts with clients and their female partners in Lima.