Co-occurring psychosocial conditions are associated with increased HIV acquisition and transmission risk among young transgender women in Lima, Peru

In Peru, transgender women (TW) are highly burdened by the HIV epidemic and stigma-related psychosocial conditions. Yet, a dearth of research has assessed co-occurring psychosocial conditions and HIV vulnerability among young TW. From February-July 2022, a community-recruited sample of young TW ages 16–24 years (N = 211) completed a cross-sectional socio-behavioral survey and HIV testing in Lima. Poisson regression models with robust variance estimated the association of indexes of co-occurring psychosocial conditions—childhood (family rejection, bullying, adverse childhood experiences, childhood sexual abuse), violence (psychological, physical, sexual, police violence), mental health (psychological distress, posttraumatic stress disorder, alcohol use disorder, non-injection drug use), and all (range = 0–12)—with past 6-month anal or vaginal condomless sex. Median age was 23 years, the majority were ethno-racial minority (35.1% Indigenous, 34.1% Mestiza, 12.3% Afro-Peruvian), 50.7% reported past 30-day sex work, 33.6% were HIV seropositive, and 42.0% reported past 6-month condomless sex. In separate multivariable sociodemographic-adjusted models, each index was associated with elevated prevalence of past 6-month condomless sex (all p < 0.05). For the overall index, each psychosocial condition increased the prevalence of past 6-month condomless sex by 16% (range = 8-23%). Understanding and intervening on co-occurring psychosocial conditions will be vital to mitigate HIV vulnerability among young TW in this context.