Migration is Associated With Increased HIV Vulnerability Among Young Transgender Women in Lima, Peru

Background: Latin America—amid its largest mass migration—has seen minimal progress in curbing new HIV infections. Transgender women (TW) in the region are disproportionately affected, but scant data examine HIV vulnerabilities alongside migration. Methods: Between February and July 2022, 211 young TW ages 16–24 in Lima participated in a cross-sectional quantitative study accompanied by serological testing (HIV, syphilis, chlamydia, gonorrhea, hepatitis B). Bivariate tests compared HIV and STI prevalence and related vulnerabilities among migrants to nonmigrants. Poisson regression modeling estimated the association between time in Lima (nonmigrant, 0–1 years, 2–5 years, $6 years) and HIV vulnerabilities (condom use). Findings: Of 204 young TW, 110 were migrants to Lima (54%); 45% arrived in Lima #5 years ago. Most migrants were Peruvian (70% from Jungle regions); 14% were from Venezuela. HIV prevalence was 44% among migrants and 39% among nonmigrants (P = 0.67). Compared with nonmigrants, migrants had higher prevalence of lifetime syphilis (65% vs 41%; P, 0.01) and poor health care access (29% vs 12% no medical insurance), lifetime sex work (78% vs 55%; P, 0.01) and sex work in past 30 days, (42% vs 8%; P, 0.01), and client violence (23% vs 6%; P, 0.01). Migrants arriving in Lima 0–1 years ago were more likely to report past 6-month condomless anal sex compared with nonmigrants (adjusted prevalence ratio = 1.54; 95% confidence interval = 1.02 to 2.32). Conclusions: Young TW face high rates of HIV and STIs, with vulnerabilities persisting even after resettlement for migrants. There is an urgent need for expanded HIV prevention and care for these women and sustained health and social services for migrants in urban centers postmigration.