Migration is associated with increased HIV vulnerability among young transgender women in Lima, Peru.

Background: Latin America-amidst 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 examines HIV vulnerabilities alongside migration.

Methods: Between February-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 non-migrants. Poisson regression modeling estimated the association between time in Lima (non-migrant, 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 non-migrants (p=0.67). Compared to non-migrants, migrants had higher prevalence of lifetime syphilis (65% vs 41%; p<0.01) and poor healthcare 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 to non-migrants (adjusted prevalence ratio=1.54; 95% confidence interval=1.02-2.32).

Conclusion: 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 post-migration.