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

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.