Acceptability of venue-based HIV testing and prevention interventions for men who have sex with transgender women and transgender women in Lima, Perú: a formative, qualitative study

Figures & data

Table 1. Participant characteristics.

	MSTW interviews n = 7	MSTW focus group n = 9	TW focus group n = 8	Venue owner interviews n = 2
Age (years)
Mean (SD)	28 (4.9)	30 (5.5)	28 (8.3)	63 (1.0)
Range	21–36	21–39	19–41	62–64
Sexual orientation, n (%)
Heterosexual	4 (57%)	1 (11%)	–	–
Bisexual	3 (43%)	6 (67%)	–	–
Homosexual/Gay	–	1 (11%)	–	2 (100%)
Not reported	–	1 (11%)	–	–
Monthly income (PEN)*
Mean (SD)	789 (604)	985 (552)	1467 (320)	–
Range	300–2000	300–1800	1000–1800	–
Not reported	0	2	2	2
Highest education, n (%)
All of secondary school	5 (71%)	6 (67%)	5 (63%)	0
Technical school	0	1 (22%)	1 (13%)	0
At least some university	2 (29%)	2 (11%)	2 (25%)	2 (100%)

MSTW: men who have sex with transgender women; TW: transgender women; SD; standard deviation

* At the time of this study, 1000 PEN (Peruvian Nuevos Soles) was approximately $300 USD, and the minimum full-time monthly wage in Peru was 850 PEN.

Table 2. Acceptability of venue-based HIV interventions for MSTW and TW in Lima, Peru.

Intervention	Theoretical Framework of Acceptability (TFA) domain*							Overall acceptability
	Affective attitude	Ethicality	Intervention coherence	Perceived effectiveness	Self-efficacy	Opportunity costs	Burden
	How an individual feels about intervention	Extent to which intervention has a good fit with individual’s value system	Extent to which participant understands intervention and how it works	Extent to which intervention is perceived as likely to achieve its purpose	Participant’s confidence that they can perform behavior to participate	Extent to which benefits, profits, or values must be given up engaging in intervention	The perceived amount of effort required to participate	–
	Higher = greater acceptability					Lower = greater acceptability
Rapid HIV testing	Low Incongruent with venue environment	High Value free testing by professionals	Moderate Familiar with HIV testing (via blood draw), more sceptical of rapid tests	Moderate Variable uptake in the past; depends on location, incentives, perceived privacy	Low Inability to handle learning results at venue	High Act of testing or positive result could derail night’s plans/business	Low Easy to access test (no need to travel to clinic)	Moderate
HIV self-test distribution	Low Incongruent with venue environment	Moderate Value free testing but not without professionals	Low Little understanding of self-tests	Low Low trust in self-tests	Low Concern about receiving results in the absence of professional support	High Act of testing or positive result could derail night’s plans	High Navigating result in the absence of health provider would be a heavy burden	Low
Condom/lube distribution	High People like receiving free things	High People like activities that help prevent HIV	High Straightforward intervention	Low Motivation to use condom, not access, is main barrier	High People know how to use condoms	Low No cost to individual	Low Free distribution of condoms	High
Mobile app supporting HIV prevention	High Most very interested in receiving information	High Most value easier access to quality health information	High Most people very familiar with navigating apps	Moderate May increase knowledge, but unsure if would lead to behaviour change	Moderate Familiarity with apps; may need to accommodate low literacy	Low Minimal financial cost for data; little time required	Moderate Some concern about privacy	High

MSTW: men who have sex with transgender women; TW: transgender women

* Adapted from Sekhon et al. [33] The synthesis presented here considers all interviews and focus groups included in this study (participants: MSTW, TW, venue owners). It is subject to the authors’ interpretation of the themes and other salient points from interviews and focus group discussions.

Table 3. Facilitators and barriers for acceptable implementation of venue-based HIV testing and prevention interventions among MSTW and TW in Lima, Peru.

Intervention	Facilitators	Barriers
Rapid HIV testing	Trust in professionally-administered HIV tests Experiences healthcare professional available on-site for post-test counseling Convenience of not having to travel to clinic for test Precedent for venue-based HIV testing Incentives provided (free test, gifts/money given)	Fear of testing positive Purpose/atmosphere of some venues (e.g. nightclubs) incongruent with potentially life-altering outcome of HIV testing Alcohol intoxication impedes ability to cope with results Limited privacy available for testing Perception of non-clinical sites as unsanitary for medical procedures Precedent necessitates incentives
HIV self-test distribution	Ability to receive testing kit discreetly Ability to test at home or other private location Flexibility to determine when the test is performed Convenience of not having to travel to clinic for test No judgment from healthcare providers (TW specifically)	Less familiarity and trust with this type of HIV test Low confidence in ability to self-administer test Low self-efficacy to handle result without professionals Fear of testing positive Intoxication impedes ability to cope with results, especially if healthcare professionals not present
Condom/lube distribution	No stigma around providing condoms/lube Can be integrated into existing entertainment at venues Can be distributed discreetly	Low motivation to use condoms among many MSTW Intoxication further reduces motivation to use condoms TW lack agency over condom use
Mobile app supporting HIV prevention	Existing motivation to learn Strong interest in receiving timely and trustworthy updates on health information Connection and ability to have dialogue with professionals	Low digital technology literacy (especially among TW) Potential privacy concerns Redundancy with information that can be found easily on web

MSTW: men who have sex with transgender women; TW: transgender women

Sekhon M, Cartwright M, Francis JJ. Acceptability of healthcare interventions: an overview of reviews and development of a theoretical framework. BMC Health Serv Res. 2017;17(1):88. Available from:

 PubMed Web of Science ®Google Scholar

Data availability statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.