Center for Interdisciplinary Research in Sexuality, AIDS and Society, Universidad Peruana Cayetano Heredia, Lima, Peru.
Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
J Int AIDS Soc. 2024 Jul;27(7):e26299. doi: 10.1002/jia2.26299.
Peruvian young transgender women (YTW) ages 16-24 years are a critical but understudied group for primary HIV prevention efforts, due to sharp increases in HIV prevalence among TW ages 25 years and older.
Between February and July 2022, a cross-sectional quantitative study with YTW ages 16-24 years in Peru (N = 211) was conducted consisting of a bio-behavioural survey accompanied by laboratory-based testing for HIV and sexually transmitted infections (STIs). Bivariate and multivariable Poisson regression models were used to estimate prevalence ratios between socio-demographic and behavioural characteristics and HIV status.
HIV prevalence was 41.5% (95% CI: 33.9-49.4%), recent syphilis acquisition 19.4% (95% CI: 12.7-28.4), chlamydia 6.3% (95% CI: 3.1-11.1) and gonorrhoea 12.3% (95% CI: 7.9-18.7). Almost half (47.9%) reported condomless anal sex in the past 6 months, 50.7% reported sex work in the past 30 days and 13.7% reported accepting more money for condomless sex. There were no significant differences in reported sexual behaviours by HIV status. Only 60.8% of participants reported ever having been tested for HIV, and 25.6% reported a past 6-month STI test. More than two-thirds (67.8%) had not heard of antiretroviral pre-exposure prophylaxis (PrEP) and only 4.7% had taken PrEP in the past month. Current moderate-to-severe psychological distress was endorsed by 20.3%, 10.0% reported attempting suicide in the past 6 months and 85.4% reported alcohol misuse.
Findings show that the HIV epidemic for YTW in Lima, Peru is situated in the context of widespread social exclusion, including economic vulnerabilities, violence victimization and the mental health sequelae of transphobic stigma that starts early in life. Future research should aim to further understand the intersection of these vulnerabilities. Moreover, there is an urgent necessity to design and evaluate HIV prevention programmes that address the root systems driving HIV vulnerabilities in YTW and that focus on developmentally specific clusters of stigma-related conditions.
秘鲁年龄在 16-24 岁的跨性别年轻女性（YTW）是原发性 HIV 预防工作的一个关键但研究不足的群体，因为 25 岁及以上 TW 的 HIV 感染率急剧上升。
2022 年 2 月至 7 月期间，在秘鲁进行了一项横断面定量研究，纳入了 211 名年龄在 16-24 岁的 YTW，包括生物行为调查和基于实验室的 HIV 和性传播感染（STI）检测。使用二变量和多变量 Poisson 回归模型来估计社会人口统计学和行为特征与 HIV 状态之间的患病率比。
HIV 感染率为 41.5%（95%CI：33.9-49.4%），最近梅毒感染率为 19.4%（95%CI：12.7-28.4%），衣原体感染率为 6.3%（95%CI：3.1-11.1%），淋病感染率为 12.3%（95%CI：7.9-18.7%）。近一半（47.9%）的人报告在过去 6 个月中有过无保护肛交，50.7%的人报告在过去 30 天内从事过性工作，13.7%的人报告为无保护性行为接受了更多的钱。HIV 感染者的报告性行为没有显著差异。只有 60.8%的参与者报告曾接受过 HIV 检测，25.6%的人报告在过去 6 个月内接受过性传播感染检测。超过三分之二（67.8%）的人没有听说过抗逆转录病毒暴露前预防（PrEP），只有 4.7%的人在过去一个月内服用过 PrEP。目前有中度至重度心理困扰的人占 20.3%，10.0%的人报告在过去 6 个月内有自杀企图，85.4%的人报告有酗酒行为。
研究结果表明，秘鲁利马的 YTW 艾滋病毒流行情况存在于广泛的社会排斥之中，包括经济脆弱性、暴力受害和跨性别歧视的心理健康后果，这些问题在生命早期就开始出现。未来的研究应旨在进一步了解这些脆弱性的交叉点。此外，迫切需要设计和评估艾滋病毒预防方案，以解决导致 YTW 艾滋病毒脆弱性的根本系统，并侧重于与耻辱感相关的特定条件的发展性集群。
