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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
  • 30 Downloads

Abstract

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.

Keywords

Transgender Social Network HIV Prevention Peru 

Abstracto

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.

Notes

Acknowledgements

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)].

References

  1. 1.
    Baral SD, Poteat T, Stromdahl S, Wirtz AL, Guadamuz TE, Beyrer C. Worldwide burden of HIV in transgender women: a systematic review and meta-analysis. Lancet Infect Dis. 2013;13(3):214–22.Google Scholar
  2. 2.
    Poteat T, Scheim A, Xavier J, Reisner S, Baral S. Global epidemiology of HIV infection and related syndemics affecting transgender people. J Acquir Immune Defic Syndr. 2016;72(Suppl 3):S210–9.Google Scholar
  3. 3.
    Nemoto T, Operario D, Keatley J, Han L, Soma T. HIV risk behaviors among male-to-female transgender persons of color in San Francisco. Am J Public Health. 2004;94(7):1193–9.Google Scholar
  4. 4.
    Operario D, Nemoto T, Iwamoto M, Moore T. Risk for HIV and unprotected sexual behavior in male primary partners of transgender women. Arch Sex Behav. 2011;40(6):1255–61.Google Scholar
  5. 5.
    Carlos JA, Bingham TA, Stueve A, et al. The role of peer support on condom use among Black and Latino MSM in three urban areas. AIDS Educ Prev. 2010;22(5):430–44.Google Scholar
  6. 6.
    Levitt HM, Horne SG, Freeman-Coppadge D, Roberts T. HIV prevention in gay family and house networks: fostering self-determination and sexual safety. AIDS Behav. 2017;21(10):2973–86.Google Scholar
  7. 7.
    Smith AM, Grierson J, Wain D, Pitts M, Pattison P. Associations between the sexual behaviour of men who have sex with men and the structure and composition of their social networks. Sex Transm Infect. 2004;80(6):455–8.Google Scholar
  8. 8.
    Mehrotra ML, Rivet Amico K, McMahan V, et al. The role of social relationships in PrEP uptake and use among transgender women and men who have sex with men. AIDS Behav. 2018;22(1):3673–80.Google Scholar
  9. 9.
    Gomez GB, Borquez A, Caceres CF, et al. The potential impact of pre-exposure prophylaxis for HIV prevention among men who have sex with men and transwomen in Lima, Peru: a mathematical modelling study. PLoS Med. 2012;9(10):e1001323.Google Scholar
  10. 10.
    Miller WM, Miller WC, Barrington C, et al. The where and how for reaching transgender women and men who have sex with men with HIV prevention services in Guatemala. AIDS Behav. 2017;21(12):3279–86.Google Scholar
  11. 11.
    Lee SW, Deiss RG, Segura ER, 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.Google Scholar
  12. 12.
    Perez-Brumer AG, Konda KA, Salvatierra HJ, et al. Prevalence of HIV, STIs, and risk behaviors in a cross-sectional community- and clinic-based sample of men who have sex with men (MSM) in Lima, Peru. PLoS ONE. 2013;8(4):e59072.Google Scholar
  13. 13.
    Silva-Santisteban A, Raymond HF, Salazar X, 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.Google Scholar
  14. 14.
    Satcher MF, Segura ER, Silva-Santisteban A, Sanchez J, Lama JR, Clark JL. Partner-level factors associated with insertive and receptive condomless anal intercourse among transgender women in Lima, Peru. AIDS Behav. 2017;21(8):2439–51.Google Scholar
  15. 15.
    Verre MC, Peinado J, Segura ER, 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.Google Scholar
  16. 16.
    Caceres CF, Segura E, Silva-Santisteban A, Giron JM, Petrera M. Non-conforming gender identification as determinant of lower HIV care access among people living with HIV in Peru: the HIV, economic flows, and globalization study. AIDS 2010; Vienna, Austria 2010.Google Scholar
  17. 17.
    Caceres CF, Stall R. Commentary: The human immunodeficiency virus/AIDS epidemic among men who have sex with men in Latin America and the Caribbean: it is time to bridge the gap. Int J Epidemiol. 2003;32(5):740–3.Google Scholar
  18. 18.
    Clark J, Salvatierra J, Segura E, et al. Moderno love: sexual role-based identities and HIV/STI prevention among men who have sex with men in Lima, Peru. AIDS Behav. 2013;17(4):1313–28.Google Scholar
  19. 19.
    Sanchez J, Lama JR, Kusunoki L, et al. HIV-1, sexually transmitted infections, and sexual behavior trends among men who have sex with men in Lima, Peru. J Acquir Immune Defic Syndr. 2007;44(5):578–85.Google Scholar
  20. 20.
    Silva-Santisteban A, Eng S, de la Iglesia G, Falistocco C, Mazin R. HIV prevention among transgender women in Latin America: implementation, gaps and challenges. J Int AIDS Soc. 2016;19(3 Suppl 2):20799.Google Scholar
  21. 21.
    Mayer KH, Grinsztejn B, El-Sadr WM. Transgender people and HIV prevention: what we know and what we need to know, a call to action. J Acquir Immune Defic Syndr. 2016;72(Suppl 3):S207–9.Google Scholar
  22. 22.
    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.Google Scholar
  23. 23.
    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.Google Scholar
  24. 24.
    Salazar X, Nunez-Curto A, Villayzan J, et al. How Peru introduced a plan for comprehensive HIV prevention and care for transwomen. J Int AIDS Soc. 2016;19(3 Suppl 2):20790.Google Scholar
  25. 25.
    Deutsch MB, Glidden DV, Sevelius J, et al. HIV pre-exposure prophylaxis in transgender women: a subgroup analysis of the iPrEx trial. Lancet HIV. 2015;2(12):e512–9.Google Scholar
  26. 26.
    Grant RM, Lama JR, Anderson PL, et al. Preexposure chemoprophylaxis for HIV prevention in men who have sex with men. N Engl J Med. 2010;363(27):2587–99.Google Scholar
  27. 27.
    Grinsztejn B, Hoagland B, Moreira RI, et al. Retention, engagement, and adherence to pre-exposure prophylaxis for men who have sex with men and transgender women in PrEP Brasil: 48 week results of a demonstration study. Lancet HIV. 2018;5(3):e136–45.Google Scholar
  28. 28.
    Grant RM, Anderson PL, McMahan V, et al. Uptake of pre-exposure prophylaxis, sexual practices, and HIV incidence in men and transgender women who have sex with men: a cohort study. Lancet Infect Dis. 2014;14(9):820–9.Google Scholar
  29. 29.
    Chow JY, Konda KA, Borquez A, 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.Google Scholar
  30. 30.
    Sevelius JM, Carrico A, Johnson MO. Antiretroviral therapy adherence among transgender women living with HIV. J Assoc Nurses AIDS Care. 2010;21(3):256–64.Google Scholar
  31. 31.
    Sevelius JM, Deutsch MB, Grant R. The future of PrEP among transgender women: the critical role of gender affirmation in research and clinical practices. J Int AIDS Soc. 2016;19(Suppl 6):21105.Google Scholar
  32. 32.
    Hoagland B, De Boni RB, Moreira RI, et al. Awareness and willingness to use pre-exposure prophylaxis (PrEP) among men who have sex with men and transgender women in Brazil. AIDS Behav. 2017;21(5):1278–87.Google Scholar
  33. 33.
    Bockting WO, Miner MH, Swinburne Romine RE, Hamilton A, Coleman E. Stigma, mental health, and resilience in an online sample of the US transgender population. Am J Public Health. 2013;103(5):943–51.Google Scholar
  34. 34.
    Nemoto T, Bodeker B, Iwamoto M. Social support, exposure to violence and transphobia, and correlates of depression among male-to-female transgender women with a history of sex work. Am J Public Health. 2011;101(10):1980–8.Google Scholar
  35. 35.
    Pflum SR, Testa RJ, Balsam KF, Goldblum PB, Bongar B. Social support, trans community connectedness, and mental health symptoms among transgender and gender nonconforming adults. Psychol Sex Orientat Gend Divers. 2015;2(3):281–6.Google Scholar
  36. 36.
    Pinto RM, Melendez RM, Spector AY. Male-to-female transgender individuals building social support and capital from within a gender-focused network. J Gay Lesbian Soc Serv. 2008;20(3):203–20.Google Scholar
  37. 37.
    Wong CF, Schrager SM, Holloway IW, Meyer IH, Kipke MD. Minority stress experiences and psychological well-being: the impact of support from and connection to social networks within the Los Angeles House and Ball communities. Prev Sci. 2014;15(1):44–55.Google Scholar
  38. 38.
    Brennan J, Kuhns LM, Johnson AK, 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.Google Scholar
  39. 39.
    Herbst JH, Jacobs ED, Finlayson TJ, 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.Google Scholar
  40. 40.
    Operario D, Nemoto T, Iwamoto M, Moore T. Unprotected sexual behavior and HIV risk in the context of primary partnerships for transgender women. AIDS Behav. 2011;15(3):674–82.Google Scholar
  41. 41.
    Factor RJ, Rothblum ED. A study of transgender adults and their non-transgender siblings on demographic characteristics, social support, and experiences of violence. J LGBT Health Res. 2007;3(3):11–30.Google Scholar
  42. 42.
    Poteat T, Wirtz AL, Radix A, et al. HIV risk and preventive interventions in transgender women sex workers. Lancet. 2015;385(9964):274–86.Google Scholar
  43. 43.
    Graham LF, Crissman HP, Tocco J, Hughes LA, Snow RC, Padilla MB. Interpersonal relationships and social support in transitioning narratives of Black transgender women in Detroit. Int J Trans. 2014;15(2):100–14.Google Scholar
  44. 44.
    Barrington C, Wejnert C, Guardado ME, Nieto AI, Bailey GP. Social network characteristics and HIV vulnerability among transgender persons in San Salvador: identifying opportunities for HIV prevention strategies. AIDS Behav. 2012;16(1):214–24.Google Scholar
  45. 45.
    Socias ME, Marshall BD, Aristegui I, et al. Factors associated with healthcare avoidance among transgender women in Argentina. Int J Equity Health. 2014;13(1):81.Google Scholar
  46. 46.
    Tucker C, Arandi CG, Bolanos JH, Paz-Bailey G, Barrington C. Understanding social and sexual networks of sexual minority men and transgender women in Guatemala city to improve HIV prevention efforts. J Health Care Poor Underserved. 2014;25(4):1698–717.Google Scholar
  47. 47.
    Perez-Brumer AG, Reisner SL, McLean SA, et al. Leveraging social capital: multilevel stigma, associated HIV vulnerabilities, and social resilience strategies among transgender women in Lima, Peru. J Int AIDS Soc. 2017;20(1):21462.Google Scholar
  48. 48.
    Reisner SL, Perez-Brumer AG, McLean SA, et al. Perceived barriers and facilitators to integrating hiv prevention and treatment with cross-sex hormone therapy for transgender women in Lima, Peru. AIDS Behav. 2017;21(12):3299–311.Google Scholar
  49. 49.
    Krueger RA, Casey MA. Focus groups: a practical guide for applied research. Thousand Oaks: SAGE Publications; 2000.Google Scholar
  50. 50.
    Maiorana A, Kegeles S, Salazar X, Konda K, Silva-Santisteban A, Caceres C. ‘Proyecto Orgullo’, an HIV prevention, empowerment and community mobilisation intervention for gay men and transgender women in Callao/Lima, Peru. Glob Public Health. 2016;11(7–8):1076–92.Google Scholar
  51. 51.
    Pollock L, Silva-Santisteban A, Sevelius J, Salazar X. ‘You should build yourself up as a whole product’: transgender female identity in Lima, Peru. Glob Public Health. 2016;11(7–8):981–93.Google Scholar
  52. 52.
    Caceres CF, Konda KA, Salazar X, et al. New populations at high risk of HIV/STIs in low-income, urban coastal Peru. AIDS Behav. 2008;12(4):544–51.Google Scholar
  53. 53.
    Clark JL, Perez-Brumer A, Salazar X. “Manejar la Situacion”: partner notification, partner management, and conceptual frameworks for HIV/STI control among MSM in Peru. AIDS Behav. 2015;19(12):2245–54.Google Scholar
  54. 54.
    Salazar X, Caceres C, Maiorana A, et al. Influence of socio-cultural context on risk perception and negotiation of protection among poor homosexual males on the Peruvian coast. Cad Saude Publica. 2006;22(10):2097–104.Google Scholar
  55. 55.
    Palys T. Purposive sampling. In: Given LM, editor. The SAGE encyclopedia of qualitative research methods. Los Angeles: Sage; 2008. p. 697–8.Google Scholar
  56. 56.
    Borkan J. Immersion/crystallization. In: Crabtree BF, Miller WL, editors. Doing qualitative research. Thousand Oaks: Sage Publications; 1999. p. 179–94.Google Scholar
  57. 57.
    Reisner SL, Mimiaga MJ, Bland S, Mayer KH, Perkovich B, Safren SA. HIV risk and social networks among male-to-female transgender sex workers in Boston, Massachusetts. J Assoc Nurses AIDS Care. 2009;20(5):373–86.Google Scholar
  58. 58.
    Reisner SL, Bradford J, Hopwood R, et al. Comprehensive transgender healthcare: the gender affirming clinical and public health model of Fenway Health. J Urban Health. 2015;92(3):584–92.Google Scholar
  59. 59.
    Granovetter MS. The strength of weak ties. Am J Soc. 1973;78(6):1360–80.Google Scholar
  60. 60.
    Granovetter MS. The strength of weak ties: a network theory revisited. Soc Theory. 1983;1:201–33.Google Scholar

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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