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Decision-Making at the Intersection of Risk and Pleasure: A Qualitative Inquiry with Trans Women Engaged in Sex Work in Lima, Peru

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Abstract

To inform culturally relevant HIV prevention interventions, we explore the complexity of sex work among Peruvian transgender women. In 2015, we conducted twenty in-depth interviews and demographic surveys with transgender women in Lima, Peru to examine how transgender women enact individual- and community-level resistance strategies within a context of pervasive marginalization. Although 40% self-identified as “sex workers,” 70% recently exchanged sex for money. Participants described nuanced risk–benefit analyses surrounding paid sexual encounters. Classification of clients as “risky” or “rewarding” incorporated issues of health, violence, and pleasure. Interviews highlighted context-informed decision-making (rejecting disrespectful clients, asserting condom use with specific partner types) demonstrating that motivations were not limited to HIV prevention or economic renumeration, but considered safety, health, attraction, gender validation, hygiene, and convenience. These findings underscore the complex risk assessments employed by Peruvian trans women. These individual-level decision-making and context-specific health promotion strategies represent critical frameworks for HIV prevention efforts.

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Funding

This work was supported by the United States National Institute of Health under Grant Number R34 MH105272.

Author information

Authors and Affiliations

  1. Department of Medicine, Division of Infectious Diseases, Brigham and Women’s Hospital, 181 Longwood Ave, Boston, MA, 02115, USA

    Sarah Naz-McLean & Sari L. Reisner

  2. Department of Medicine, Division of Infectious Diseases, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA

    Jesse L. Clark

  3. Harvard T.H. Chan School of Public Health, Boston, MA, USA

    Sari L. Reisner & Kenneth H. Mayer

  4. The Fenway Institute, Fenway Health, Boston, MA, USA

    Sari L. Reisner & Kenneth H. Mayer

  5. Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA

    Joshua C. Prenner

  6. Patient Centered Outcomes Research Institute, Washington, DC, USA

    Brendan Weintraub

  7. Féminas, Lima, Peru

    Leyla Huerta

  8. Lima, Peru

    Ximena Salazar

  9. Asociación Civil Impacta Salud Y Educación, Lima, Peru

    Javier R. Lama

  10. Department of Global Health, University of Washington, Seattle, WA, USA

    Javier R. Lama

  11. Beth Israel Lahey Health, Boston, MA, USA

    Kenneth H. Mayer

  12. Harvard Medical School, Boston, MA, USA

    Kenneth H. Mayer

  13. Division of Social and Behavioural Health Sciences, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada

    Amaya Perez-Brumer

Authors
  1. Sarah Naz-McLean
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  2. Jesse L. Clark
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Contributions

APB, JLC, SLR, JRL, KHM conceptualized and designed the study. APB, LH, XS, SNM supported in data collecting. APB, SNM, JCP, BW, XS and JLC conducted data analysis and drafted manuscript. All authors reviewed manuscript and supported with edits.

Corresponding author

Correspondence to Sarah Naz-McLean.

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Conflict of interest

The authors have no financial conflicts of interest to disclose.

Ethical Approval

Protocols and study materials were approved by the UCLA Office for Human Research Participant Protections (IRB #13–001898), and the Comite de Etica of the Asociacion Civil Impacta Salud y Educacion (IRB #0089–2014-CE).

Consent for publication

All subjects provided verbal informed consent prior to participation and were informed, as part of the consent process, that data may be used for publication. No images or personal identifiers have been included in this manuscript.

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All subjects provided verbal informed consent prior to participation.

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Naz-McLean, S., Clark, J.L., Reisner, S.L. et al. Decision-Making at the Intersection of Risk and Pleasure: A Qualitative Inquiry with Trans Women Engaged in Sex Work in Lima, Peru. AIDS Behav 26, 843–852 (2022). https://doi.org/10.1007/s10461-021-03445-z

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