# Lifetime homelessness among young transgender women in Lima, Peru is associated with HIV vulnerability: Results from a cross-sectional survey

## TL;DR

Young transgender women in Lima, Peru who experience homelessness are more likely to engage in risky sexual behaviors and face higher HIV vulnerability.

## Contribution

This study identifies a strong link between homelessness and HIV risk factors among young transgender women in Peru.

## Key findings

- 32.5% of young transgender women in the study had experienced homelessness.
- Homeless participants were more likely to engage in condomless sex and report higher rates of sex work, violence, and PTSD.
- HIV prevalence was 44.6% among those with a history of homelessness, though not significantly different from non-homeless participants.

## Abstract

Transgender youth face disproportionately high rates of homelessness, which can increase vulnerability to HIV. In Peru, the incidence of HIV among transgender women has increased 19% since 2010 and young transgender women are a priority population for HIV prevention. We sought to estimate the proportion of young transgender women experiencing homelessness and associations between homelessness and HIV vulnerabilities. We recruited transgender women ages 16–24 years (N = 209) to participate in a biobehavioural survey and HIV and STI testing (chlamydia, syphilis, gonorrhea). Poisson regression models with robust standard errors were fit to estimate the association between past homelessness and past 6-month condomless sex, adjusted for potential confounding by age, education, sex work, non-injection drug use, post-traumatic stress disorder (PTSD), and violence. Among participants (median age 23 years), 68 (32.5%) had ever been homeless and 19 (9.1%) reported homelessness in the past 3 months. Overall, 51.5% of those who had been homeless reported past 6-month condomless sex compared to 29.1% of those who had never been homeless (p < 0.001). HIV prevalence was 44.6% among those with a history of homelessness and 39.6% among those who had never been homeless (p = 0.65); lifetime homelessness was significantly associated with increased sex work (p < 0.001), violence (p < 0.01), and PTSD (p < 0.001). In the model adjusting for age, education, and behavioural risk (sex work, non-injection drug use), participants who had been homeless had 1.43 times higher prevalence of past 6-month condomless sex (95% CI = 1.05-1.96); results were attenuated when adjusting for violence and PTSD. The high prevalence of homelessness among young transgender women sampled underscores the compounding HIV vulnerabilities faced by this population. Efforts to prevent homelessness and improve access to housing are urgently needed alongside healthcare services, including HIV prevention and treatment, to address the disproportionate HIV epidemic among young Peruvian transgender women.