Social Network Organization, Structure, and Patterns of Influence Within a Community of Transgender Women in Lima, Peru: Implications for Biomedical HIV Prevention

  • J. L. ClarkEmail author
  • A. G. Perez-Brumer
  • S. L. Reisner
  • X. Salazar
  • S. McLean
  • L. Huerta
  • A. Silva-Santisteban
  • K. M. Moriarty
  • M. J. Mimiaga
  • J. Sanchez
  • K. H. Mayer
  • J. R. Lama
Original Paper


Understanding social network structures can contribute to the introduction of new HIV prevention strategies with socially marginalized populations like transgender women (TW). We conducted 20 semi-structured interviews and four focus groups (n = 32) with TW from selected social networks in Lima, Peru between May and July, 2015. Participants described layers of social influence from diverse actors in their social networks. The majority identified a close relative as their primary social support, with whom they confided secrets but avoided issues of transgender identity, sexuality, and sex work. Participants described close circles of TW friends with whom they shared information about gender identity, body modification, and sexual partners, but avoided issues like HIV. Community leadership included political leaders (who advocated for transgender rights) as well as social leaders (who introduced TW to hormone therapy, body modification, and commercial sex). Detailed analysis of TW social networks can contribute to implementation and acceptability of new HIV prevention technologies.


Transgender Social Network HIV Prevention Peru 


Comprender la estructura de las redes sociales puede contribuir a introducir nuevas tecnologías de prevención del VIH en poblaciones marginalizadas como las mujeres trans (MT). Realizamos 20 entrevistas semi-estructuradas y 4 grupos focales (n = 32) con MT de redes sociales seleccionadas en Lima, Perú entre Mayo y Julio del 2015. Las participantes describieron niveles de influencias sociales por parte de diversos actores dentro de sus redes sociales. La mayoría identificó a un familiar cercano como su principal apoyo social, a quien confiaron secretos mas no temas de identidad transgénero, sexualidad, y trabajo sexual. Las participantes describieron círculos cercanos de amigas MT con quienes compartieron información sobre identidad de género, modificación del cuerpo, y parejas sexuales, pero evitaron temas como el VIH. El liderazgo comunitario estuvo representado por líderes políticos (que hacían abogacía en pro de los derechos de personas transgénero) y también líderes sociales (que presentaron la terapia hormonal, modificación del cuerpo y el sexo comercial ante las MT). El análisis detallado de las redes sociales de MT puede contribuir a la implementación y aceptabilidad de nuevas tecnologías para la prevención del VIH.



The authors thank Joshua Prenner and Brendan Weintraub for their work in coding qualitative transcripts. We also thank the study participants for sharing their lives and their experiences with us. Funding provided by [Grant No. R34 MH104072 (MPI: JLC, MJM, SR), Grant No. T32 HD 049339 (PI: Nathanson), and Grant No. P30 MH058107 (PI: Shoptaw)].


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • J. L. Clark
    • 1
    Email author
  • A. G. Perez-Brumer
    • 2
  • S. L. Reisner
    • 3
    • 4
    • 5
  • X. Salazar
    • 6
  • S. McLean
    • 5
  • L. Huerta
    • 7
  • A. Silva-Santisteban
    • 6
  • K. M. Moriarty
    • 1
    • 8
  • M. J. Mimiaga
    • 9
    • 10
    • 11
  • J. Sanchez
    • 7
    • 12
    • 13
  • K. H. Mayer
    • 5
  • J. R. Lama
    • 7
    • 13
  1. 1.Division of Infectious Diseases, Department of MedicineDavid Geffen School of Medicine at UCLALos AngelesUSA
  2. 2.Department of Sociomedical SciencesColumbia University Mailman School of Public HealthNew YorkUSA
  3. 3.Department of PediatricsHarvard Medical School and Boston Children’s HospitalBostonUSA
  4. 4.Department of EpidemiologyHarvard T. H. Chan School of Public HealthBostonUSA
  5. 5.The Fenway Institute, Fenway HealthBostonUSA
  6. 6.Instituto de Estudios de Sexualidad y Derechos Humanos, Universidad Peruana Cayetano HerediaLimaPeru
  7. 7.Asociacion Civil Impacta Salud y EducacionLimaPeru
  8. 8.Brown University Alpert School of MedicineProvidenceUSA
  9. 9.Center for Health Equity ResearchBrown UniversityProvidenceUSA
  10. 10.Departments of Behavioral and Social Sciences and EpidemiologyBrown University School of Public HealthProvidenceUSA
  11. 11.Department of Psychiatry and Human BehaviorBrown University Alpert School of MedicineProvidenceUSA
  12. 12.CITBM, Universidad Nacional Mayor San MarcosLimaPeru
  13. 13.Department of Global HealthUniversity of Washington School of MedicineSeattleUSA

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