Towards increasing equity in healthcare among transgender women: a cross-sectional analysis of self-reported needs and health service utilization in Lima, Peru

PurposeGlobally, transgender women (TGW) experience wide-ranging barriers to health and care, with disproportionately high risks of infectious and chronic diseases. Despite these vulnerabilities, research on access to care for transgender populations in low- and middle-income countries is extremely limited. Furthermore, existing studies have primarily focused on human immunodeficiency virus infection and acquired immune deficiency syndrome (HIV/AIDS), with less emphasis on TGWs broader health needs. This study analyzed patterns of morbidity and health service uptake among TGW in Lima, Peru. The purpose was to better understand health outreach and service needs to inform targeting and design of future community-level interventions. MethodsThis cross-sectional study surveyed a convenience sample of 301 TGW in metropolitan Lima, Peru. Data was collected between September - October 2020. This paper provides descriptive statistics and results of bivariate and multivariable regression models. ResultsHealth coverage and access to care were suboptimal. Less education and older age were positively associated with illness and HIV and tuberculosis (TB) testing. Gender identity sub-group (i.e., woman, trans or transgender, transsexual, "transformista," "travesti," and other) was associated with HIV testing and pre-exposure prophylaxis (PrEP) usage. Both awareness of and interest in PrEP were low, as was usage among those who were interested in taking PrEP. ConclusionFuture public health efforts should be tailored to meet the diverse needs of TGW, expand TB testing, bridge the gap between PrEP interest and use, and increase insurance coverage and access to trans-friendly services to promote improved health outcomes.