Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
AIDS and Behavior
Published in: AIDS and Behavior 12/2017

01-12-2017 | Original Paper

Perceived Barriers and Facilitators to Integrating HIV Prevention and Treatment with Cross-Sex Hormone Therapy for Transgender Women in Lima, Peru

Authors: Sari L. Reisner, Amaya G. Perez-Brumer, Sarah A. McLean, Javier R. Lama, Alfonso Silva-Santisteban, Leyla Huerta, Jorge Sanchez, Jesse L. Clark, Matthew J. Mimiaga, Kenneth H. Mayer

Published in: AIDS and Behavior | Issue 12/2017

Login to get access

Abstract

Transgender women (TW) represent a vulnerable population at increased risk for HIV infection in Peru. A mixed-methods study with 48 TW and 19 healthcare professionals was conducted between January and February 2015 to explore barriers and facilitators to implementing a model of care that integrates HIV services with gender-affirmative medical care (i.e., hormone therapy) in Lima, Peru. Perceived acceptability of the integrated care model was high among TW and healthcare professionals alike. Barriers included stigma, lack of provider training or Peruvian guidelines regarding optimal TW care, and service delivery obstacles (e.g., legal documents, spatial placement of clinics, hours of operation). The hiring of TW staff was identified as a key facilitator for engagement in health care. Working in partnership with local TW and healthcare provider organizations is critical to overcoming existing barriers to successful implementation of an integrated HIV services and gender-affirmative medical care model for this key population in Peru.
Literature
1.
Poteat T, et al. Global epidemiology of HIV infection and related syndemics affecting transgender people. J Acquir Immune Defic Syndr. 2016;72(Suppl 3):S210–9.CrossRefPubMedPubMedCentral
2.
Baral SD, et al. Worldwide burden of HIV in transgender women: a systematic review and meta-analysis. Lancet Infect Dis. 2013;13(3):214–22.CrossRefPubMed
3.
Silva-Santisteban A, et al. Understanding the HIV/AIDS epidemic in transgender women of Lima, Peru: results from a sero-epidemiologic study using respondent driven sampling. AIDS Behav. 2012;16(4):872–81.CrossRefPubMed
4.
Clark JL, et al. Sampling methodologies for epidemiologic surveillance of men who have sex with men and transgender women in Latin America: an empiric comparison of convenience sampling, time space sampling, and respondent driven sampling. AIDS Behav. 2014;18(12):2338–48.CrossRefPubMedPubMedCentral
5.
Reisner S, et al. Global health burden and needs of transgender populations: a review. The Lancet. 2016;388(10042):412–36.CrossRef
6.
Poteat T, Reisner SL, Radix A. HIV epidemics among transgender women. Curr Opin HIV AIDS. 2014;9(2):168–73.CrossRefPubMed
7.
De Santis JP. HIV infection risk factors among male-to-female transgender persons: a review of the literature. J Assoc Nurses AIDS Care. 2009;20(5):362–72.CrossRefPubMed
8.
Reisner SL, Perkovich B, Mimiaga MJ. A mixed methods study of the sexual health needs of New England transmen who have sex with nontransgender men. AIDS Patient Care STDS. 2010;24(8):501–13.CrossRefPubMedPubMedCentral
9.
Nemoto T, et al. HIV-related risk behaviors among kathoey (male-to-female transgender) sex workers in Bangkok. Thailand. AIDS Care. 2012;24(2):210–9.PubMed
10.
Operario D, Soma T, Underhill K. Sex work and HIV status among transgender women: systematic review and meta-analysis. J Acquir Immune Defic Syndr. 2008;48(1):97–103.CrossRefPubMed
11.
Vittinghoff E, et al. Per-contact risk of human immunodeficiency virus transmission between male sexual partners. Am J Epidemiol. 1999;150(3):306–11.CrossRefPubMed
12.
Leon SR, et al. High prevalence of Chlamydia trachomatis and Neisseria gonorrhoeae infections in anal and pharyngeal sites among a community-based sample of men who have sex with men and transgender women in Lima, Peru. BMJ Open. 2016;6(1):e008245.CrossRefPubMedPubMedCentral
13.
Tang EC, et al. The syphilis care cascade: tracking the course of care after screening positive among men and transgender women who have sex with men in Lima, Peru. BMJ Open. 2015;5(9):e008552.CrossRefPubMedPubMedCentral
14.
Allan-Blitz LT, et al. High prevalence of extra-genital chlamydial or gonococcal infections among men who have sex with men and transgender women in Lima, Peru. Int J STD AIDS. 2016;28:138–44.CrossRefPubMed
15.
Castillo R, et al. HIV and sexually transmitted infection incidence and associated risk factors among high-risk MSM and male-to-female transgender women in Lima, Peru. J Acquir Immune Defic Syndr. 2015;69(5):567–75.CrossRefPubMedPubMedCentral
16.
Perez-Brumer AG, et al. Anonymous partnerships among MSM and transgender women (TW) recently diagnosed with HIV and other STIs in Lima, Peru: an individual-level and dyad-level analysis. Sex Transm Infect. 2016;92:554–7.CrossRef
17.
Verre MC, et al. Socialization patterns and their associations with unprotected anal intercourse, HIV, and syphilis among high-risk men who have sex with men and transgender women in Peru. AIDS Behav. 2014;18(10):2030–9.CrossRefPubMedPubMedCentral
18.
Cambou MC, et al. The risk of stable partnerships: associations between partnership characteristics and unprotected anal intercourse among men who have sex with men and transgender women recently diagnosed with HIV and/or STI in Lima, Peru. PLoS ONE. 2014;9(7):e102894.CrossRefPubMedPubMedCentral
19.
Lee SW, et al. A cross-sectional study of low HIV testing frequency and high-risk behaviour among men who have sex with men and transgender women in Lima. Peru. BMC Public Health. 2015;15:408.CrossRefPubMed
20.
Logie CH, et al. Adapting the minority stress model: associations between gender non-conformity stigma, HIV-related stigma and depression among men who have sex with men in South India. Soc Sci Med. 2012;74(8):1261–8.CrossRefPubMed
21.
Bockting WO, et al. Stigma, mental health, and resilience in an online sample of the US transgender population. Am J Public Health. 2013;103(5):943–51.CrossRefPubMedPubMedCentral
22.
Pollock L, et al. ‘You should build yourself up as a whole product’: transgender female identity in Lima, Peru. Glob Public Health. 2016;11(7–8):981–93.CrossRefPubMed
23.
Gamarel KE, et al. Gender minority stress, mental health, and relationship quality: a dyadic investigation of transgender women and their cisgender male partners. J Fam Psychol. 2014;28(4):437–47.CrossRefPubMedPubMedCentral
24.
Clements-Nolle K, et al. HIV prevalence, risk behaviors, health care use, and mental health status of transgender persons: implications for public health intervention. Am J Public Health. 2001;91(6):915–21.CrossRefPubMedPubMedCentral
25.
Clements-Nolle K, Marx R, Katz M. Attempted suicide among transgender persons: the influence of gender-based discrimination and victimization. J Homosex. 2006;51(3):53–69.CrossRefPubMed
26.
Hotton AL, et al. Substance use as a mediator of the relationship between life stress and sexual risk among young transgender women. AIDS Educ Prev. 2013;25(1):62–71.CrossRefPubMed
27.
Brennan J, et al. Syndemic theory and HIV-related risk among young transgender women: the role of multiple, co-occurring health problems and social marginalization. Am J Public Health. 2012;102(9):1751–7.CrossRefPubMedPubMedCentral
28.
Herbst JH, et al. Estimating HIV prevalence and risk behaviors of transgender persons in the United States: a systematic review. AIDS Behav. 2008;12(1):1–17.CrossRefPubMed
29.
Operario D, Nemoto T. HIV in transgender communities: syndemic dynamics and a need for multicomponent interventions. J Acquir Immune Defic Syndr. 2010;55(Suppl 2):S91–3.CrossRefPubMedPubMedCentral
30.
Chow JY, et al. Peru’s HIV care continuum among men who have sex with men and transgender women: opportunities to optimize treatment and prevention. Int J STD AIDS. 2016;27(12):1039–48.CrossRefPubMed
31.
Gardner EM, et al. The spectrum of engagement in HIV care and its relevance to test-and-treat strategies for prevention of HIV infection. Clin Infect Dis. 2011;52(6):793–800.CrossRefPubMedPubMedCentral
32.
World Health Organization (WHO). Antiretroviral Treatment as Prevention (TASP) of HIV and TB, in HIV/AIDS Programme. Geneva: WHO; 2012.
33.
Reisner SL, Radix A, Deutsch MB. Integrated and gender-affirming transgender clinical care and research. J Acquir Immune Defic Syndr. 2016;72(Suppl 3):S235–42.CrossRefPubMedPubMedCentral
34.
Sevelius JM, et al. Barriers and facilitators to engagement and retention in care among transgender women living with human immunodeficiency virus. Ann Behav Med. 2014;47(1):5–16.CrossRefPubMedPubMedCentral
35.
Sevelius JM, et al. Informing interventions: the importance of contextual factors in the prediction of sexual risk behaviors among transgender women. AIDS Educ Prev. 2009;21(2):113–27.CrossRefPubMedPubMedCentral
36.
Reisner S, et al. Discrimination and health in Massachusetts: a statewide survey of transgender and gender nonconforming adults. Boston: The Fenway Institute, Fenway Health; 2014.
37.
Coleman E, et al. World professional association for transgender health, standards of care for the health of transsexual, transgender, and gender-nonconforming people, Version 7. Int J Transgenderism. 2011;13:165–232.CrossRef
38.
39.
Rotondi NK, et al. Nonprescribed hormone use and self-performed surgeries: “do-it-yourself” transitions in transgender communities in Ontario, Canada. Am J Public Health. 2013;103(10):1830–6.CrossRefPubMedPubMedCentral
40.
de Haan G, et al. Non-prescribed hormone use and barriers to care for transgender women in San Francisco. LGBT Health. 2015;2(4):313–23.CrossRefPubMed
41.
Gooren LJ, et al. Cross-sex hormone use, functional health and mental well-being among transgender men (Toms) and Transgender Women (Kathoeys) in Thailand. Cult Health Sex. 2015;17(1):92–103.CrossRefPubMed
42.
Polis CB, Phillips SJ, Curtis KM. Hormonal contraceptive use and female-to-male HIV transmission: a systematic review of the epidemiologic evidence. AIDS. 2013;27(4):493–505.CrossRefPubMed
43.
Deutsch MB, Feldman JL. Updated recommendations from the world professional association for transgender health standards of care. Am Fam Physician. 2013;87(2):89–93.PubMed
44.
Palys T. Purposive sampling. The sage encyclopedia of qualitative research methods. Thousand Oaks, CA: SAGE Publications; 2008. p. 698–9.
45.
Bastos FI, et al. AIDS in Latin America: assessing the current status of the epidemic and the ongoing response. Int J Epidemiol. 2008;37(4):729–37.CrossRefPubMed
46.
47.
Borkan J. Immersion/crystallization. In: Crabtree BFM, Miller WL, editors. Doing qualitative research. 2nd ed. Thousand Oaks: Sage Publications; 1999. p. 179–94.
48.
Coffey AJ, Atkinson P. Making sense of qualitative data: complementary research strategies. Thousand Oaks: Sage Publications; 1996.
49.
Bockting WO, Robinson BE, Rosser BR. Transgender HIV prevention: a qualitative needs assessment. AIDS Care. 1998;10(4):505–25.CrossRefPubMed
50.
Newfield E, et al. Female-to-male transgender quality of life. Qual Life Res. 2006;15(9):1447–57.CrossRefPubMed
51.
Sanchez NF, Sanchez JP, Danoff A. Health care utilization, barriers to care, and hormone usage among male-to-female transgender persons in New York City. Am J Public Health. 2009;99(4):713–9.CrossRefPubMedPubMedCentral
52.
Melendez RM, Pinto RM. HIV prevention and primary care for transgender women in a community-based clinic. J Assoc Nurses AIDS Care. 2009;20(5):387–97.CrossRefPubMedPubMedCentral
53.
Lurie S. Identifying training needs of health-care providers related to treatment and care of transgendered patients: a qualitative needs assessment conducted in New England. Int J Transgenderism. 2005;8(2–3):93–112.CrossRef
54.
Bradford JB, Coleman S, Cunningham W. HIV System Navigation: an emerging model to improve HIV care access. AIDS Patient Care STDS. 2007;21(Suppl 1):S49–58.PubMed
55.
Remien RH, et al. Barriers and facilitators to engagement of vulnerable populations in HIV primary care in New York City. J Acquir Immune Defic Syndr. 2015;69(Suppl 1):S16–24.CrossRefPubMedPubMedCentral
56.
Open Society Foundations (OSF), Transforming health: international rights-based advocacy for trans health. 2013, Open Society Foundations Public Health Program Washington, DC.
57.
Reisner S, et al. Transgender community voices: a participatory population perspective. Lancet. 2016;388(10042):327–30.CrossRefPubMed
58.
Bradford J, et al. Experiences of transgender-related discrimination and implications for health: results from the Virginia Transgender Health Initiative Study. Am J Public Health. 2013;103(10):1820–9.CrossRefPubMedPubMedCentral
59.
Poteat T, German D, Kerrigan D. Managing uncertainty: a grounded theory of stigma in transgender health care encounters. Soc Sci Med. 2013;84:22–9.CrossRefPubMed
60.
White Hughto JM, Reisner SL, Pachankis JE. Transgender stigma and health: a critical review of stigma determinants, mechanisms, and interventions. Soc Sci Med. 2015;147:222–31.CrossRefPubMedPubMedCentral
61.
Salazar X, et al. Gender, masculinities and HIV/AIDS: perspectives from Peru. In: Boesten J, Poku NK, editors. Gender and HIV/AIDS: critical perspectives from the developing world. Farnham: Ashgate Publishing Surrey; 2009. p. 47–66.
62.
Metadata
Title
Perceived Barriers and Facilitators to Integrating HIV Prevention and Treatment with Cross-Sex Hormone Therapy for Transgender Women in Lima, Peru
Authors
Sari L. Reisner
Amaya G. Perez-Brumer
Sarah A. McLean
Javier R. Lama
Alfonso Silva-Santisteban
Leyla Huerta
Jorge Sanchez
Jesse L. Clark
Matthew J. Mimiaga
Kenneth H. Mayer
Publication date
01-12-2017
Publisher
Springer US
Published in
AIDS and Behavior / Issue 12/2017
Print ISSN: 1090-7165
Electronic ISSN: 1573-3254
DOI
https://doi.org/10.1007/s10461-017-1768-8

Other articles of this Issue 12/2017

AIDS and Behavior 12/2017 Go to the issue

Original Paper

Caregivers’ Support Network Characteristics Associated with Viral Suppression among HIV Care Recipients

Substantive Review

Leveraging the U.S. Criminal Justice System to Access Women for HIV Interventions

Original Paper

Neighborhood Characteristics Associated with Achievement and Maintenance of HIV Viral Suppression Among Persons Newly Diagnosed with HIV in New York City

Original Paper

Project nGage: Results of a Randomized Controlled Trial of a Dyadic Network Support Intervention to Retain Young Black Men Who Have Sex With Men in HIV Care

Original Paper

Characterizing the HIV Prevention and Care Continua in a Sample of Transgender Youth in the U.S.

Substantive Review

Structural Interventions in HIV Prevention: A Taxonomy and Descriptive Systematic Review
Obesity Clinical Trial Summary

At a glance: The STEP trials

Read more

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Highlights from the ACC 2024 Congress

Year in Review: Pediatric cardiology

Pediatric Cardiology Video

Watch Dr. Anne Marie Valente present the last year's highlights in pediatric and congenital heart disease in the official ACC.24 Year in Review session.

Year in Review: Pulmonary vascular disease

Cardiopulmonary Comorbidity Video

The last year's highlights in pulmonary vascular disease are presented by Dr. Jane Leopold in this official video from ACC.24.

Year in Review: Valvular heart disease

Valvular Heart Disease Video

Watch Prof. William Zoghbi present the last year's highlights in valvular heart disease from the official ACC.24 Year in Review session.

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discuss last year's major advances in heart failure and cardiomyopathies.

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discuss last year's major advances in heart failure and cardiomyopathies.

Watch now

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

16-04-2024 Type 2 Diabetes News

Incentivised to exercise

11-04-2024 Lifestyle Modifications News

New intervention for STEMI-related cardiogenic shock

10-04-2024 Myocardial Infarction News

» View more highlights on the ACC 2024 congress hub page

Image Credits