Background : As we approach the 4th decade of HIV prevention and treatment, there is a need for differentiated and nuanced understanding of key populations who are vulnerable to HIV. MSM and transgender women (TW) remain the primary key populations in Peru, and we use information from the baseline of an HIV prevention and engagement in care trial to compare them and provide insight into their needs.
Methods : MSM/TW recruiters and long chain peer recruitment were used to enroll participants in two large, understudied Lima districts. The survey was interviewer-administered to participants using computer-assisted methods.
Results : We enrolled 277 MSM and 136 TW, whose average age was 31. TW reported significantly less formal employment and education than MSM, but similar abilities to cover basic needs. TW were more open about their gender identity than MSM were open about their sexual identity. There was no difference in alcohol abuse, while TW reported more recreational drug use. TW reported more experiences of stigma due to sexual or gender identity and because whereas MSM can "pass", transgender women are identifiable. There were no significant differences between MSM and TW in depression, experiences of stigma in health care settings, sexual risk, or social support (all p-values >0.05). Although MSM reported more condomless insertive anal sex, there was no difference in condomless receptive sex. But while TW had nearly twice the HIV prevalence of MSM, among those living with HIV there was no difference in linkage-to-care, ART use, or self-reported undetectable viral loads (all p-values >0.05).
Conclusions : MSM and TW have both similar and different experiences, influencing their risk profile for HIV and care engagement. TW had more socioeconomic vulnerabilities. The more frequent experiences of stigma among TW is explicable given more societal rejection of TW and the inability to hide their gender identity. MSM were more able to hide their sexual identity and, perhaps consequently, reported less stigma. That health care related stigma was similar may be related to self-selection into facilities accustomed to working with these populations. HIV prevalence reflects those found in similar populations elsewhere, but viral suppression remains low for both groups.