To inform culturally relevant HIV prevention interventions, we explore the complexity of sex work among Peruvian transgender women. In 2015, we conducted twenty in-depth interviews and demographic surveys with transgender women in Lima, Peru to examine how transgender women enact individual- and community-level resistance strategies within a context of pervasive marginalization. Although 40% self-identified as “sex workers,” 70% recently exchanged sex for money. Participants described nuanced risk–benefit analyses surrounding paid sexual encounters. Classification of clients as “risky” or “rewarding” incorporated issues of health, violence, and pleasure. Interviews highlighted context-informed decision-making (rejecting disrespectful clients, asserting condom use with specific partner types) demonstrating that motivations were not limited to HIV prevention or economic renumeration, but considered safety, health, attraction, gender validation, hygiene, and convenience. These findings underscore the complex risk assessments employed by Peruvian trans women. These individual-level decision-making and context-specific health promotion strategies represent critical frameworks for HIV prevention efforts.

为了告知与文化相关的 HIV 预防干预措施，我们探讨了秘鲁跨性别女性性工作的复杂性。2015 年，我们在秘鲁利马对跨性别女性进行了 20 次深度访谈和人口统计调查，以研究跨性别女性如何在普遍边缘化的背景下制定个人和社区层面的抵抗策略。尽管 40% 的人自称是“性工作者”，但 70% 的人最近用性换取了金钱。参与者描述了围绕有偿性接触进行的细致入微的风险收益分析。将客户分类为“有风险”或“有回报”包括健康、暴力和快乐等问题。访谈强调了基于上下文的决策（拒绝无礼的客户，断言对特定类型的伴侣使用安全套）表明动机不仅限于预防艾滋病毒或经济报酬，还考虑了安全、健康、吸引力、性别验证、卫生和便利。这些发现强调了秘鲁跨性别女性采用的复杂风险评估。这些个人层面的决策制定和针对具体情况的健康促进策略代表了 HIV 预防工作的关键框架。