Amaya Gabriela Perez-Brumer

• MSc
• Professor (Assistant) at University of Toronto

Transgender youth face disproportionately high rates of homelessness, which can increase vulnerability to HIV. In Peru, the incidence of HIV among transgender women has increased 19% since 2010 and young transgender women are a priority population for HIV prevention. We sought to estimate the proportion of young transgender women experiencing homel...

Examining structural sexism and COVID-19 disparities involves considering how gendered norms of care shape prosocial health behaviors. We explored perceptions of gender norms and associated power imbalances amid COVID-19. From August-October 2021, we conducted 26 interviews with COVID-19 trial participants. Immersion crystallization guided analysis...

Objective To apply an intersectional lens to explore how the interconnected social identities of women across global settings impact access experiences for gender-based violence (GBV) supports. Design A scoping review. Data sources We systematically searched seven databases to identify studies published in English from the database inception to J...

Background Oral Pre-exposure prophylaxis (PrEP) is effective in preventing HIV transmission. However, despite high rates of HIV risk behaviors among people who inject drugs (PWID), this population remains underserved by current HIV prevention efforts in the United States. To address this challenge, we conducted an in-depth exploration of perspectiv...

Background: Transgender women are a key population in the HIV epidemic globally, including in Peru. This cross-sectional epidemiological study characterized the pre-exposure prophylaxis (PrEP) cascade in adolescent and young adult transgender women in Peru to inform roll-out of early HIV prevention efforts. Methods: Between February-July 2022, a...

Background Latin America—amidst its largest mass migration—has seen minimal progress in curbing new HIV infections. Transgender women (TW) in the region are disproportionately affected, but scant data examines HIV vulnerabilities alongside migration. Methods Between February-July 2022, 211 young TW ages 16-24 in Lima participated in a cross-sectio...

Introduction Pre-exposure prophylaxis (PrEP) stands as an effective tool in preventing HIV transmission among individuals at risk of HIV infection. However, the effectiveness of daily oral PrEP is contingent on the adherence of its users, which can pose a challenge for many individuals. Various studies have explored different interventions aimed at...

Background Ring-based studies are a novel research design commonly used for research involving infectious diseases: contacts of newly infected individuals form a ring that is targeted for interventions (e.g., vaccine, post-exposure prophylaxis). Given the novelty of the research design, it is critical to obtain feedback from participants on their e...

Globally, transgender women (TW) face a high burden of the HIV epidemic. In Peru, HIV prevalence among TW rises at age 25, indicating a need to understand HIV vulnerability as adolescents reach adulthood. The life course of TW is often marked by abuse, discrimination and poverty fueled by transphobic stigma. Approaches to the HIV epidemic among TW...

Introduction Oral pre-exposure prophylaxis (PrEP) for HIV-1 infection is over 99% effective in protecting against HIV acquisition when used consistently and appropriately. However, PrEP uptake and persistent use remains suboptimal, with a substantial gap in utilization among key populations who could most benefit from PrEP. In Latin America specifi...

Introduction Peruvian young transgender women (YTW) ages 16−24 years are a critical but understudied group for primary HIV prevention efforts, due to sharp increases in HIV prevalence among TW ages 25 years and older. Methods Between February and July 2022, a cross‐sectional quantitative study with YTW ages 16−24 years in Peru (N = 211) was conduc...

Legal gender affirmation - legal name and gender marker change - is an important health-promoting health determinant for transgender people. In Peru, the state's failure to universally recognize transgender people's legal identity limits standardized legal affirmation procedures, including the paucity of government officials trained in gender affir...

Gender-based stigma (GBS) occurs across the globe and harms health and well-being, particularly among women. Yet, there remains a need for synthesized literature to better understand the impact of GBS on health care-related outcomes. Addressing this gap, this scoping review summarizes what is known about GBS and health care-related outcomes among c...

Background HIV burden in the US among people who inject drugs (PWID) is driven by overlapping syndemic factors such as co-occurring health needs and environmental factors that synergize to produce worse health outcomes among PWID. This includes stigma, poverty, and limited healthcare access (e.g. medication to treat/prevent HIV and for opioid use d...

This study presents the first ever comparative regional portrait of racial inequality and incarceration across the Americas, using census data from Brazil, Cuba, Puerto Rico, and the United States mainland. While racism is known to pervade criminal justice across the US mainland, Latin American prisons remain understudied, with the entire region of...

Background Most forcibly displaced persons are hosted in low- and middle-income countries (LMIC). There is a growing urbanization of forcibly displaced persons, whereby most refugees and nearly half of internally displaced persons live in urban areas. This scoping review assesses the sexual and reproductive health (SRH) needs, outcomes, and priorit...

Background and aims Identifying effective opioid treatment options during pregnancy is a high priority due to the growing prevalence of opioid use disorder across North America. We assessed the temporal impact of three population‐level interventions on the use of opioid agonist treatment (OAT) during pregnancy in Ontario, Canada. Design This was a...

Limited attention has been paid to understanding how shifts in COVID-19 stigma are associated with sociohistorical changes, and how these dynamics impact perceived and enacted stigma among those affected by COVID-19. From drivers of fear and scapegoating at the beginning of the pandemic to subsequent health and social impacts on prevention efforts,...

Advancements in long-acting (LA) HIV treatment and cure research with analytical treatment interruptions (ATIs) have generated important scientific and implementation questions. There is an urgent need to examine challenges navigating the evolving HIV treatment and cure research landscape. From August to October 2022, we conducted 26 semistructured...

The Venezuelan refugee crisis has triggered Latin America’s largest mass migration, displacing over a fifth of the country’s population. A significant number of migrants have sought refuge in neighboring countries like Peru. Within this context, Venezuelan migrants confront an array of vulnerabilities, including xenophobia and economic hardship, wh...

Urban refugees may be disproportionately affected by socio-environmental stressors that shape alcohol use, and this may have been exacerbated by additional stressors in the COVID-19 pandemic. This multi-method study aimed to understand experiences of, and contextual factors associated with, alcohol use during the pandemic among urban refugee youth...

Long-acting injectable antiretroviral therapy (LAI ART) has the potential to address adherence obstacles associated with daily oral ART, leading to enhanced treatment uptake, adherence, and viral suppression among people living with HIV (PLWH). Yet, its potential may be limited due to ongoing disparities in availability and accessibility. We need a...

To explore the narrowing of the concept of ‘global’ in global health, this article traces how Latin America has held a place of both privilege and power as well as marginalisation in the field. We employ a modified extended case method to examine how Latin America has been ‘seen’ and ‘heard’ in understandings of global health, underscoring the regi...

El presente artículo tiene como objetivo describir y analizar las políticas públicas para el acceso a la vacunación contra el COVID-19 para migrantes con estatus migratorio irregular en seis países donde se concentra cerca del 80% de la población venezolana migrante: Argentina, Brasil, Chile, Colombia, Ecuador y Perú. Llevamos a cabo un análisis de...

Food insecurity (FI) and water insecurity (WI) are linked with HIV vulnerabilities, yet how these resource insecurities shape HIV prevention needs is understudied. We assessed associations between FI and WI and HIV vulnerabilities among urban refugee youth aged 16–24 in Kampala, Uganda through individual in-depth interviews (IDI) (n = 24), focus gr...

Introduction Social networks contribute to normative reinforcement of HIV prevention strategies, knowledge sharing, and social capital, but little research has characterized the social networks of transgender women (TW) in Latin America. We conducted a mixed methods analysis of three network clusters of TW in Lima, Peru, to evaluate network composi...

Transgender women's (TW) social networks may facilitate HIV prevention information dissemination and normative reinforcement. We conducted a qualitative study of social networks among 20 TW affiliated with 3 “casas trans” (houses shared among TW) in Lima, Peru, using diffusion of innovations theory to investigate community-level HIV prevention norm...

Background: Cisgender women represent over half of people living with HIV globally. However, current research efforts toward a cure for HIV focus predominantly on cisgender men. The under-representation of women in HIV cure clinical studies is particularly problematic given data suggesting that sex-dependent phenotypes limit scientific discovery....

Background: Globally transgender women (TW) are at heightened vulnerability for HIV infection. In Lima Peru, sharp increases in HIV prevalence are seen among TW ages 25 years and older highlighting the need for early HIV prevention efforts for young TW. This study conducted in-depth qualitative interviews to elucidate the social and developmental...

Objective Epidemics impact individuals unevenly across race, gender, and sexuality. In addition to being more vulnerable to COVID-19 infection, evidence suggests racialized gender and sexual minorities experienced disproportionate levels of discrimination and stigma during the COVID-19 epidemic. Drawing on Critical Race Theory (CRT), we examined th...

Background: Tailored coronavirus disease 2019 (COVID-19) prevention strategies are needed for urban refugee youth in resource-constrained contexts. We developed an 8-wk interactive informational mobile health intervention focused on COVID-19 prevention practices informed by the Risk, Attitude, Norms, Ability, Self-regulation-or RANAS-approach. Me...

Introduction Social networks contribute to normative reinforcement of HIV prevention strategies, knowledge sharing, and social capital, but little research has characterized the social networks of transgender women (TW) in Latin America. We conducted a mixed methods analysis of three network clusters of TW in Lima, Peru, to evaluate network composi...

Use of the word "Latinx" has risen in popularity among both academics and non-academics to promote a gender-inclusive alternative to otherwise linguistically gendered terms of "Latino/a." While critics claim the term is inappropriate for populations without gender-expansive individuals, or those of unknown demographic composition, increasing usage...

Objectives Gender‐affirming hormonal therapies (GAHT) and HIV increase cardiovascular risk for transgender women (TW), yet there is a paucity of data quantifying cardiometabolic changes following GAHT initiation, particularly among TW with HIV. Methods The Féminas study enrolled TW from October 2016 to March 2017 in Lima, Peru. Participants report...

Background Migration is recognized as a key determinant of health. Yet, limited research addresses the arc of intranational migration and, even less, the experiences of transgender (trans) adolescents and women migrants and the associated health vulnerabilities. Using intersectional stigma as a theoretical frame, this study seeks to better understa...

The COVID-19 pandemic led to the widespread adoption of virtual care-the use of communication technologies to receive health care at home. We explored the differential impacts of the rapid transition to virtual care during the COVID-19 pandemic on health-care access and delivery for gay, bisexual and queer men (GBQM), a population that disproportio...

Background Pre-exposure prophylaxis (PrEP) is an important tool for HIV prevention in Latin America and the Caribbean (LAC). Yet, little is known about the PrEP policies landscape in the region. Addressing this gap, this scoping review assessed current PrEP policies throughout LAC to better understand existing PrEP implementation gaps and identify...

Given the magnitude of Venezuelan displacement in Latin America, there is a need to assess how migrants were, and will continue to be, addressed in COVID-19 vaccination policies. To explore migration status as a dimension of vaccine equity in Latin America and in relation to international human rights, we assessed national vaccination plans, peer-r...

Introduction: Increasing disparities within and between racial/ethnic groups in overdose deaths underscore the need to identify drivers and patterns to optimize overdose prevention strategies. We assess age-specific mortality rates (ASMR) in drug overdose deaths by race/ethnicity in 2015-2019 and 2020. Methods: Data were from the CDC Wonder, and...

Introduction: Intergenerational substance use and trauma disproportionately impact racialized women. Yet, how these factors impact outcomes in women involved in the criminal justice system is understudied. Methods: Using data from 443 participants in the Black Women in a Study of Epidemics, we assessed the impact of intergenerational substance u...

Scant studies have explored COVID-19 vaccine acceptability among refugees. However, contexts of forced migration may elevate COVID-19 vulnerabilities, and suboptimal refugee immunisation rates are reported for other vaccine-preventable diseases. We conducted a multi-methods study to describe COVID-19 vaccine acceptability among urban refugee youth...

In efforts to prevent the spread of COVID-19, jurisdictions across the globe, including Canada, enacted containment measures that affected intimacy and sexual relations. This article examines how public health measures during COVID-19 impacted the sexual practices of sexual minority men- gay, bisexual, queer and other men who have sex with men-and...

Given the magnitude of Venezuelan displacement in Latin America, there is a need to assess how migrants were, and will continue to be, addressed in COVID-19 vaccination policies. To explore migration status as a dimension of vaccine equity in Latin America and in relation to international human rights, we assessed national vaccination plans, peer-r...

Objective: The objective of this review is to characterize the state of literature regarding forcibly displaced persons' sexual and reproductive health in urban areas in low- and middle-income countries. Specific objectives include describing the sexual and reproductive health outcomes among forcibly displaced persons relocating in urban environme...

While effective for slowing the transmission of SARS-CoV-2, public health measures, such as physical distancing and stay-at-home orders, have significantly shifted the way people interact and maintain social connections. To better understand how people sought social and psychological support amid the pandemic, we conducted a longitudinal qualitativ...

Sexual and gender politics inform relational expectations surrounding sexual experiences of Peruvian transgender women (TW) and men who have sex with men (MSM). We used the framework of sexual role strain, or incongruence between preferred sexual role and actual sexual practices, to explore potential conflicts between personally articulated identit...

Venezuelan migration is the second largest international displacement in contemporary history. Yet, amid global calls for the inclusion of migrants and refugees in COVID-19 vaccination priority groups, little is known about how Latin American countries are prioritising COVID-19 vaccination for Venezuelans. This rapid scoping addresses this gap, tak...

The Seasonal Agricultural Worker Program (SAWP) is a managed migration programme that aims to fill labour shortages in Canada's agricultural industry with Black and Brown workers from the global South. For decades, migrant workers, scholars, and advocate groups have called for fundamental changes to address power imbalances produced by the design o...

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 contex...

Purpose of review: This paper provides a critical review of recent therapeutic advances in long-acting (LA) modalities for human immunodeficiency virus (HIV) treatment and prevention. Recent findings: LA injectable antiretroviral therapy (ART) has been approved in the United States, Canada and Europe; the United States also has approved LA injec...

In February 2021, the Peruvian ‘vaccinegate’ scandal broke when the media reported that nearly 500 experimental doses of an ongoing COVID-19 trial were given to key individuals not enrolled in the trial. Indeed, vaccine doses were administered to leading politicians, such as the former President and his wife, and other high-level health officials a...

Introduction The entangled health and economic crises fueled by COVID-19 have exacerbated the challenges facing Venezuelan migrants. There are more than 5.6 million Venezuelan migrants globally and almost 80% reside throughout Latin America. Given the growing number of Venezuelan migrants and COVID-19 vulnerability, this rapid scoping review examin...

Introduction With over 82.4 million forcibly displaced persons worldwide, there remains an urgent need to better describe culturally, contextually and age-tailored strategies for preventing COVID-19 in humanitarian contexts. Knowledge gaps are particularly pronounced for urban refugees who experience poverty, overcrowded living conditions and poor...

Introduction Although pre-exposure prophylaxis (PrEP) is a remarkable biomedical advance to prevent HIV, ongoing research on PrEP contributes to and interacts with a legacy of HIV experimentation on marginalized communities in resource-limited settings. This paper explores the complexity of PrEP research mistrust among Peruvian transgender (trans)...

Menstruation research has largely focused on addressing menstrual management barriers facing cisgender women and girls in low and middle-income countries. Scant literature has assessed the menstrual management needs of trans and non-binary people assigned female at birth. To better understand these frequently invisibilised menstruation-related need...

Background The health of transgender men (trans men)–individuals who identify as men and were assigned a female sex assigned at birth–is overlooked globally. This mixed-methods exploratory study sought to understand the lived experiences, health, and social needs of trans men in Lima, Peru to bring visibility to specific health needs and inform res...

Sexual communication with partners informs risk assessment and sexual practices. We evaluated participant, partner, and network factors associated with communication about condom use and HIV serostatus and explored their relationships with condomless anal intercourse (CAI) among 446 men who have sex with men (MSM) and 122 transgender women (TW) in...

Background Social networks, norms, and discussions about sexual health may inform sexual practices, influencing risk of human immunodeficiency virus (HIV) or sexually transmitted infection (STI) acquisition. To better understand social networks of Peruvian men who have sex with men (MSM) and transgender women (trans women), we examined key social n...

We conducted a pilot randomized controlled trial of a social network-based intervention to promote PrEP adherence among transgender women (TW) in Lima, Peru. We enrolled 89 TW from six social networks and cluster-randomized them 1:1 to standard of care (n = 44) or the TransPrEP intervention (n = 45). Core workshops discussed strategies to support P...

This special issue of Global Public Health brings together papers examining how sexuality, gender, health and human rights have become increasing visible and highly contested within global health. The papers included here question and explore the often contradictory processes through which global equity-seeking populations negotiate pleasure and da...

To improve understanding of factors associated with intimate partner violence (IPV) and explore its role in sexually transmitted infection (STI) acquisition, we analyzed partnership-level correlates of IPV among men who have sex with men (MSM) and transgender women (TW) in Peru. In a 2017 cross-sectional study of rectal STI screening and HIV preven...

Limited data exists on intimate partner violence (IPV) among transgender women (TW), though global trends suggest IPV is associated with HIV risk in this population. We describe the prevalence of verbal, physical, and/or sexual violence as well as participant- and partner-level correlates of IPV among TW in Lima, Peru. Among 389 respondents, 15.2%...

Social marginalization harms lesbian, gay, bisexual, and transgender (LGBT) persons’ wellbeing in Lesotho. Socio-cultural mechanisms linking LGBT stigma, depression, substance use, and HIV among LGBT persons in Lesotho are understudied. We explore associations between LGBT stigma, mental health stressors, and HIV vulnerabilities among LGBT persons...

Background Transgender (trans) people experience profound mental health disparities compared with the general population, attributable in part to the psychological effects of gender non-affirmation. Despite the barriers to legal gender affirmation for trans people, little is known about its association with mental health. We therefore sought to det...

Understanding social network structures can contribute to the introduction of new HIV prevention strategies with socially marginalized populations like transgender women (TW). We conducted 20 semi-structured interviews and four focus groups (n = 32) with TW from selected social networks in Lima, Peru between May and July, 2015. Participants describ...

As part of a planned series from Global Public Health aimed at exploring both the epistemological and political differences in diverse public health approaches across different geographic and cultural regions, this special issue assembles papers that consider the legacy of the Latin American Social Medicine and Collective Health (LASM-CH) movements...

Background Although syphilis remains a central public health problem, disease estimates for men who have sex with men (MSM) and transwomen (TW) in the Americas are incomplete. The purpose of this study was to compare the syphilis epidemics of North America (NA) and Latin America/Caribbean (LAC). Methods We conducted a systematic review of ten data...

Background: Stigma differentially influences HIV and STI care among MSM, especially regarding partner notification practices. Recognizing the heterogeneous behaviors/identities within the category "MSM," we used mixed-methods to assess sexual risk behaviors among men who have sex with men only (MSMO) and behaviorally bisexual MSM (MSMW) with HIV a...

Objective While men who have sex with men (MSM) are disproportionately affected by Peru’s overlapping HIV and STI epidemics, there are few data on how partnership-level and network-level factors affect STI transmission in Peru. We explored partnership-level and network-level factors associated with gonorrhoea/chlamydia ( Neisseria gonorrhoeae and/o...

BACKGROUND Public health strategies are urgently needed to improve HIV disparities among transgender women, including holistic intervention approaches that address those health needs prioritized by the community. Hormone therapy is the primary way many transgender women medically achieve gender identity affirmation. Peer navigation has shown to be...

Background: Public health strategies are urgently needed to improve HIV disparities among transgender women, including holistic intervention approaches that address those health needs prioritized by the community. Hormone therapy is the primary method by which many transgender women medically achieve gender affirmation. Peer navigation has been sh...

Cisgender men (CM) who report transgender women (TW) as sexual partners are an understudied population in the HIV epidemic in Latin America. The current study sought to characterize this group in a 2012 cross-sectional online survey of Latin American CM who were members of a sexual networking website for men who have sex with men (N = 11,847). Mult...

HIV disproportionately impacts transgender communities and the majority of new infections occur in the Southern United States. Yet, limited data exists on contextual realities of HIV vulnerability and healthcare needs among transgender individuals in the Deep South. Addressing this gap in the literature, we assess the health needs, including barrie...

In-depth qualitative interview guide included as supporting information. (DOCX)

HIV and other sexually transmitted infections (STIs) continue to affect men who have sex with men (MSM) and transgender women (TW) in Peru at disproportionately high rates. The ineffectiveness of traditional prevention strategies may be due to the disconnect between health promotion messages and community-level understandings of sexual cultures. We...

The magnitude of gender identity-related disparities in school-based outcomes is unknown because of a lack of representative studies that include measures of gender identity. By utilizing a representative sample generalizable to a broader population, this study elucidates the size of gender identity-related disparities, independent of sexual orient...

BACKGROUND: While men who have sex with men (MSM) and transgender women (TW) have been the focus of numerous combined HIV prevention strategies, these groups still account for more than 60% of new HIV infections in Peru. To improve understanding of factors influencing PrEP knowledge and uptake, we studied PrEP awareness and motivations/barriers to...

Background: Patient-initiated partner notification (PN) following the diagnosis of a sexually transmitted infection is a critical component of disease control in men who have sex with men (MSM) sexual networks. Both printed and internet-based technologies offer potential tools to enhance traditional partner notification approaches among MSM in res...

Swaziland has among the highest national adult HIV prevalence globally. There is limited knowledge of HIV vulnerabilities and prevention engagement among lesbian, gay, bisexual and transgender (LGBT) persons in the context of Swaziland’s criminalization of consensual same-sex practices. This study explored social processes of marginalization to ass...

Background: Gonorrhea (GC) and chlamydia (CT) disproportionately affect men who have sex with men (MSM), and public health implications vary by anatomic site and bacterial agent. Urethral and rectal GC and CT can increase risk of HIV transmission, while pharyngeal GC may be a reservoir for antimicrobial resistance. To define screening priorities in...

Social, cultural, and institutional processes which see heterosexuality as natural and universal discriminate against individuals who differ from this norm. This article draws on interviews with lesbian, gay, bisexual, and transgender (LGBT) people in Swaziland to provide an enhanced understanding of the ways in which heterosexism operates in pract...

Transgender women (TW) represent a vulnerable population at increased risk for HIV infection in Peru. A mixed-methods study with 48 TW and 19 healthcare professionals was conducted between January and February 2015 to explore barriers and facilitators to implementing a model of care that integrates HIV services with gender-affirmative medical care...