Reisner Sari L, Apedaile Dorothy, Silva-Santisteban Alfonso, Huerta Leyla, Aguayo-Romero Rodrigo, Perez-Brumer Amaya
Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA.
Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
Int J STD AIDS. 2025 Feb;36(2):141-150. doi: 10.1177/09564624241272940. Epub 2024 Nov 17.
Transgender women are a key population in the HIV epidemic globally, including in Peru. This cross-sectional epidemiological study characterized the pre-exposure prophylaxis (PrEP) cascade in adolescent and young adult transgender women in Peru to inform roll-out of early HIV prevention efforts.
Between February-July 2022, a community-recruited sample of HIV-negative or status unknown young transgender women ( = 140) in Peru completed a socio-behavioral survey and biological testing for HIV and bacterial STIs. Logistic regression models estimated the association of sociodemographic, healthcare, and behavioral factors to PrEP indication and willingness.
Median age was 22 years (range = 16-24 years); 65.7% reported sex work and 28.6% homelessness. Overall, 45.7% had a PrEP indication based on past 6 months HIV behavioral risk profiles. In a multivariable model, sex work (aRR = 2.27; 95% CI = 1.24-4.17) and homelessness (aRR = 1.27; 95% CI = 1.00-1.60) were associated with PrEP indication. More than one-third (38.6%) had never been HIV tested; 25.3% were tested >1 year ago. Only 34.3% heard of daily oral PrEP, 8.6% reported ever PrEP use, and 5.0% current PrEP use. Nearly half (49.3%) reported willingness to take daily oral PrEP. In a multivariable model, younger age was associated with increased willingness to use PrEP (aRR = 0.92; 95% CI = 0.87-0.98). Highest ranked PrEP preferences were a daily oral pill (35.7%), implant (32.1%), and injection by a provider (10.0%).
PrEP indication and willingness were high in this sample, but HIV testing and PrEP uptake were low. Findings highlight opportunities for age-responsive and contextually-relevant interventions to increase HIV prevention among young transgender women in Peru.
跨性别女性是全球包括秘鲁在内的艾滋病流行中的关键人群。这项横断面流行病学研究对秘鲁青少年和年轻成年跨性别女性的暴露前预防（PrEP）流程进行了特征描述，以为早期艾滋病预防工作的开展提供信息。
2022年2月至7月期间，秘鲁一个通过社区招募的HIV阴性或感染状况未知的年轻跨性别女性样本（n = 140）完成了一项社会行为调查以及HIV和细菌性性传播感染的生物学检测。逻辑回归模型估计了社会人口统计学、医疗保健和行为因素与PrEP指征及意愿之间的关联。
中位年龄为22岁（范围 = 16 - 24岁）；65.7%报告从事性工作，28.6%无家可归。总体而言，45.7%根据过去6个月的HIV行为风险概况有PrEP指征。在多变量模型中，性工作（调整后风险比[aRR] = 2.27；95%置信区间[CI] = 1.24 - 4.17）和无家可归（aRR = 1.27；95% CI = 1.00 - 1.60）与PrEP指征相关。超过三分之一（38.6%）的人从未接受过HIV检测；25.3%的人在1年多以前接受过检测。只有34.3%听说过每日口服PrEP，8.6%报告曾使用过PrEP，5.0%目前正在使用PrEP。近一半（49.3%）的人报告愿意每日口服PrEP。在多变量模型中，年龄较小与使用PrEP的意愿增加相关（aRR = 0.92；95% CI = 0.87 - 0.98）。PrEP的最高偏好依次为每日口服 pill（35.7%）、植入剂（32.1%）和由医护人员注射（10.0%）。
该样本中PrEP指征和意愿较高，但HIV检测和PrEP的接受度较低。研究结果凸显了开展针对年龄且与实际情况相关的干预措施以增加秘鲁年轻跨性别女性艾滋病预防的机会。
