Introduction Partner type has been associated with condomless anal intercourse (CAI) among TW in Peru. We characterised the relationship between partnership characteristics and receptive (R-CAI) versus insertive CAI (I-CAI) among TW.
Methods We analysed cross-sectional, egocentric data from TW screened for a 2012–2014 Partner Management study in Lima, Peru. We included self-identified TW reporting anal intercourse (AI) with at least 1 of their last 3 non-female partners. Generalised estimating equations with Poisson distribution were used to assess prevalence ratios (PR) with 95% CIs for R-CAI and I-CAI during the last sexual encounter by partner type (adjusted for participant education, HIV status, STI history, pre-sex alcohol use, sexual role, and partner sexual role).
Results 138 TW (median age 27, IQR: 22–33) provided data on their last sexual encounter with 376 distinct partners (78% reporting 3 partners; 16% reporting 2; 6% reporting 1). Most (65.2%) TW practiced receptive AI exclusively, 3.6% practiced insertive AI exclusively, and 31.2% practiced both. I-CAI was more prevalent than R-CAI among TW with alcohol use disorders, drug use before sex, sexual role strain (performing a different role than preferred), and less than secondary education. I-CAI was more prevalent with transactional sex partners (PRadj: 1.54; p = 0.19; reference: primary partners) and casual partners (PRadj: 1.39; p = 0.31), while R-CAI was more common with stable compared with transactional (PRadj: 0.67, p = 0.06) and casual partners (PRadj: 0.70, p = 0.14). I-CAI was significantly lower among HIV-positive TW (PRadj: 0.53; p = 0.02; reference: HIV-negative), while R-CAI was significantly higher among TW with unknown HIV status (PRadj: 1.91; p = 0.048).
Conclusion Examining partner-level I-CAI/R-CAI separately reveals different HIV/STI risk contexts/behaviours among TW. Future studies should explore implications of partner and AI-associated risk behaviours, including experience of sexual role strain and differences in TW’s partner-specific perceptions of HIV/STI risk, sexual intimacy, gender affirmation, transactional sex demands, and condom use agency.
Disclosure of interest statement None.
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