| Summary: | Abstract In Peru, transgender women (TW) are highly burdened by the HIV epidemic and stigma-related psychosocial conditions. Yet, a dearth of research has assessed co-occurring psychosocial conditions and HIV vulnerability among young TW. From February-July 2022, a community-recruited sample of young TW ages 16–24 years (N = 211) completed a cross-sectional socio-behavioral survey and HIV testing in Lima. Poisson regression models with robust variance estimated the association of indexes of co-occurring psychosocial conditions—childhood (family rejection, bullying, adverse childhood experiences, childhood sexual abuse), violence (psychological, physical, sexual, police violence), mental health (psychological distress, posttraumatic stress disorder, alcohol use disorder, non-injection drug use), and all (range = 0–12)—with past 6-month anal or vaginal condomless sex. Median age was 23 years, the majority were ethno-racial minority (35.1% Indigenous, 34.1% Mestiza, 12.3% Afro-Peruvian), 50.7% reported past 30-day sex work, 33.6% were HIV seropositive, and 42.0% reported past 6-month condomless sex. In separate multivariable sociodemographic-adjusted models, each index was associated with elevated prevalence of past 6-month condomless sex (all p < 0.05). For the overall index, each psychosocial condition increased the prevalence of past 6-month condomless sex by 16% (range = 8-23%). Understanding and intervening on co-occurring psychosocial conditions will be vital to mitigate HIV vulnerability among young TW in this context.
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