Substance use and other correlates of HIV infection among transwomen and men who have sex with men in Perú: Implications for targeted HIV prevention strategies for transwomen

Elena Cyrus; Javier R Lama; Jorge Sanchez; Daniell S Sullivan; Segundo Leon; Manuel V Villaran; Panagiotis Vagenas; David Vu; Makella Coudray; Frederick L Altice

doi:10.1371/journal.pgph.0001464

Substance use and other correlates of HIV infection among transwomen and men who have sex with men in Perú: Implications for targeted HIV prevention strategies for transwomen

PLOS Glob Public Health. 2023 Jan 12;3(1):e0001464. doi: 10.1371/journal.pgph.0001464. eCollection 2023.

Authors

Affiliations

¹ Department of Population Health Sciences, College of Medicine, University of Central Florida, Orlando, FL, United States of America.
² Department of Global Health, Yale School of Public Health, New Haven, CT, United States of America.
³ Associación Civil Impacta Salud y Educación (IMPACTA), Lima, Perú.
⁴ Centro de Investigaciones Tecnológicas, Biomédicas y Medioambientales, Universidad Nacional Mayor de San Marcos, Lima, Peru.
⁵ College of Medicine, Univeristy of Central Florida, Orlando, FL, United States of America.
⁶ San Juan Bautista Privada, Lima, Perú.
⁷ Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, WA, United States of America.
⁸ Berkeley Research Development Office, University of California Berkeley, Berkeley, CA, United States of America.

Abstract

Characterization of HIV risk factors among transwomen and men who have sex with men (MSM) should be assessed separately and independently. However, due to several constraints, these populations continue to be conflated in clinical research and data. There are limited datasets globally powered to make such comparisons. The study aimed to use one of the largest surveys of transwomen and MSM in Latin America to determine differences in HIV risk and related correlates between the two populations. Secondary data analysis was completed using a cross-sectional biobehavioral survey of 4413 MSM and 714 transwomen living in Perú. Chi Square analysis of selected HIV correlates was conducted to examine differences between transwomen and MSM. Additionally, stratified binary logistic regression was used to split data for further comparative analyses of correlates associated with transwomen and MSM separately. HIV prevalence among transwomen was two-fold greater than among MSM (14.9% vs. 7.0%, p<0.001). Transwomen had a higher prevalence of most HIV risk factors assessed, including presence of alcohol dependence (16.4% vs. 19.0%; p < .001) and drug use in the past 3 months (17.0% vs. 14.9%). MSM were more likely to use marijuana (68.0% vs. 50.0%, p < .001), and transwomen were more likely to engage in inhaled cocaine use (70.0% vs. 51.1%, p < .001). The regression exposed differences in correlates driving sub-epidemics in transwomen vs. MSM, with a trend of substance use increasing HIV risk for transwomen only. Transwomen were more likely to be HIV-infected and had different risk factors from MSM. Targeted prevention strategies are needed for transwomen that are at highest risk. Additionally, further research is needed to determine if these observations in Perú regarding substance use patterns and the role of substance use in HIV risk relate to other trans populations globally.

Copyright: © 2023 Cyrus et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Grants and funding

This project was supported by the National Institute on Drug Abuse (NIDA) at the National Institutes of Health (NIH) (https://nida.nih.gov/), award #K99/R00DA046311. This project was also supported by The Loan Repayment Program at the National Institute on Alcohol Abuse and Alcoholism (NIAAA) at the NIH (https://www.niaaa.nih.gov/), as well as an NIH Research Training Grant #R25 TW009338 funded by the Fogarty International Center (https://www.fic.nih.gov/). This project received nonspecific support from the National Heart, Lung and Blood Institute at the NIH (https://www.nhlbi.nih.gov/), the NIH Office of the Director: Office of Research on Women's Health (https://orwh.od.nih.gov/), and the NIH Office of the Director Office of AIDS Research (https://www.oar.nih.gov/). E.C. received all financial support awarded for this study. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.