Background Studies in current literature show high HIV prevalence rates in transgender women all around the world. Transgender women face very high-levels of marginalisation, violence, stigma and discrimination, which in turn affect their access to housing, employment, healthcare and put them in a high risk of STD. These characteristics are shared with sex workers, injecting drug users and men who have sex with men. However, gender identity has led to a particular combination of vulnerabilities, ultimately resulting in a much higher risk of HIV infection among the male-to-female transgender population as mentioned above.

Methods We conducted an exploratory descriptive study and collected data with surveys, in-depth interviews, focus groups and ethnographic strategies with 18 transgender women. The collected information was analysed, taking into account the following dimensions of interpretation: 1-Love, erotic, and sexual relations. 2- Gender and sexual identities. 3-Sexual behaviour and practices. 4-Self-care, HIV-risk perception and life goals.

Results Transgender women believed that they needed to perform an overtly feminine identity (hyperfeminine). They think this performance involves taking sexual risks assigned traditionally by the social space such as street prostitution. In this role transgender women's negotiation power is significantly reduced. Many transgender women assumed and accepted this gender disparity social structure that increased their vulnerability to STI/HIV.

Conclusions This research intended to identify the most significant ways in which sexuality is represented and imagined within the culture of transgender women in Colombia. Special emphasis was placed on discovering transgender women's logics, or thinking processes, which are capable of perpetuating their high vulnerability to HIV/AIDS. Transgender women in Colombia construct their gender identities within contexts of stigmatisation, social marginalisation, and multiple symbolic and physical forms of violence. Our work critiques approaches based on androcentrism that perceive gender identities as essential and fixed, and assume sexual binaries that oppress the lived experience of human bodies. We propose a peer-led educational strategy focused on the deconstruction and reconstruction of gender identities and interventions with transgender women that reduce stigma through enhancing autonomy, joy, and self-care. We argue that these are the central elements for a “life with quality” in which equal citizenship can be exercised.