Power, privilege and HIV prevalence: examination of sexual HIV-risk factors in MSM and transgender women who engage in transactional sex

Objective: To understand power-related predictors for risky sexual behavior among men who have sex with men (MSM) and Transgender Women (TW) at high risk for HIV infection in Lima, Peru. Methods: Survey data from a cross-sectional sample were analyzed. Risk of unprotected anal intercourse (UAI) associated with different transactional sex roles (i.e. giving money or goods for sex, receiving, both giving and receiving) was examined separately among only those participants who engaged in transactional sex in the last 6 months and among all partnerships (transactional and non-transactional) in the last 3 months. These analyses were conducted using multivariate logistic regression and generalized estimating equations (GEE), respectively. Results: In the inter-individual analysis among individuals engaged in transactional sex, those who engaged only in giving money and/or goods for sex had an increased risk of self-reported UAI during their last act of transactional sex compared with those who received money and/or goods in exchange for sex. This effect was modified by drug and/or alcohol use during sex and all categories of the interaction of transactional sex and use of alcohol and drugs had significantly higher odds of UAI than the referent (receiving goods/money and non-use of alcohol/drugs) (ORs: 2.4-5.9). In the population level analysis, when partnerships involving giving money/goods for sex were compared to all non-transactional sex partnerships, this group demonstrated a lower risk of UAI (OR 0.36; 95% CI: 0.20, 0.66). This association remained but was non-significant (p=0.10) when the comparator was limited to non-stable, non-transactional partnerships. Conclusions: More research is needed to explore the association of risky sexual behavior among MSM and TW and different transactional sex roles. In addition, interventions should consider tailoring efforts to individuals who participate in different transactional sex roles.