HIV and STI Prevalence Among Vulnerable Populations in Lima, Peru

Abstract

Peru has a concentrated HIV and STI epidemic, with a prevalence of human immunodeficiency virus (HIV) infection up to 40% among young transgender women (TGW), a high prevalence compared to the general population which has less than a 1% rate. Also, curable sexually transmitted infections (STIs) are moderately prevalent, especially syphilis, which also disproportionately affects transgender women (TGW) and men who have sex with other men (MSM) and certainly, chlamydia and gonorrhoea affecting non/urogenital sites. The evidence shows that several risk factors facilitate the transmission of HIV and STI in certain communities, these factors can explain the higher prevalences found throughout the literature.
In this thesis, I synthetize eleven selected peer-reviewed articles from my research conducted between 2009 and 2019 covering the epidemiology and diagnostics of HIV and STI, which provide the basis for my commentary. Across my research portfolio, we used different approaches and methodologies, including descriptive, analytical, and experimental study designs; I also facilitated some technology transfer and laboratory implementation.
All my studies were conducted in Peru, especially in Lima, the Peruvian capital city. The populations involved in all the studies were vulnerable urban-marginal people, with several barriers in terms of education, access to healthcare, who also face stigma and discrimination. Subgroups of target populations invited as participants were TGW, MSM, women and men, and in addition, we also identified some self-defined groups among them, called Movidas (young women who have sex and share social spaces with Esquineros), and Esquineros (unemployed men who spend their time in street corners and sport-fields), groups who have a specific interaction, which includes sexual intercourse, compensated sex and consumption of substances.
It is important to highlight the crucial impact of the implementation of testing over the study of HIV and STI, with the incorporation of new laboratories at two universities facilitating the rapid acquisition and implementation of several research trials with special emphasis in HIV and syphilis rapid testing and new techniques such as Nucleic Acid Amplification Testing (NAAT) for the detection of chlamydia and gonorrhoea and the analysis of antibiotic resistance in syphilis. Also, with the advent and use of rapid testing, the studies were able to go to the affected communities and provide access to HIV and STI testing, accompanied by prevention packages, condoms, and counselling.
My research demonstrates key contributions to understand the epidemiology of HIV and STI and has generated crucial information for public health officers and academics, allowing the creation and implementation of specific interventions for preventing new infections in the community. It is hoped the long term impact will be more accurate and timely diagnostics with a consequent decrease in the incidence and prevalence of STIs.

Date of Award	1 Apr 2026
Original language	English
Awarding Institution	University of Portsmouth
Supervisor	Rebecca Stores (Supervisor) & Jason Oakley (Supervisor)