HIV prevalence among this group is thought to be 49 times higher than the general population.17 In countries where data are collected on this key population, transgender women have some of the highest HIV prevalence rates.Country level data collected between 20 also show much higher HIV prevalence among transgender women sex workers compared to male and female sex workers.18 For example, HIV prevalence among transgender women who participate in sex work is 32% in Ecuador and Panama,19 and between 20-30% in Argentina, Bolivia, El Salvador, Honduras, Paraguay, Peru and Uruguay.20 Research has shown that 44-70% of transgender women have felt the need to leave, or were thrown out of their homes.21 One study from Mexico indicated that 11.4% of transgender women living with HIV were excluded from family activities.22 Moreover, transgender people have fewer educational and social opportunities, often resorting to sex work for an income.23 Transgender people also face high rates of violence.Higher levels of inconsistent condom use were also reported among those who experienced sexual abuse, rejection and police detention.28 There are an estimated 721,000 people who inject drugs (sometimes referred to as PWID) in Latin America and the Caribbean.

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In nine of 17 countries, minors require parental or guardian consent to take an HIV test and find out the results.

A few countries in the Caribbean have developed policies allowing minors to access HIV testing without parental consent, either allowing it at any age (such as in Guyana) or above the age of 14 (as in Trinidad and Tobago).38 In Mexico and Panama, adolescents have to be accompanied by a parent, a legal guardian or other state-recognized individuals responsible for the well-being of adolescents in order to receive their test results.

In 2014, men who have sex with men accounted for nearly a third of new HIV infections in the region.9 However, HIV prevalence among this group varies greatly between countries.

For example, it is as high as 25.4% in Bolivia, falling to 1.8% in Cuba.1011 There are many reasons for high levels of HIV transmission among this group.

In 2014, only 51% of men who have sex with men were reported to have access to HIV services, a level which had remained largely unchanged for several years.12 Moreover, HIV testing in the last 12 months among men who have sex with men varied enormously from country to country, ranging from 5% to 70%.

This suggests large differences in access to testing services between countries in the region.13 Homophobia and the ‘machismo’ (strong/aggressive masculinity) culture are common throughout the region and sex between men is highly stigmatised.

Sex workers are also frequently marginalised by social and religious institutions and subject to discrimination.

For these reasons, many people who engage in sex work do so covertly.

In 2013, 6.1% of female sex workers in Latin America were thought to be living with HIV.

Male sex workers tend to be much more affected by HIV than female sex workers.

For example, in the same year, 69% of male sex workers in Suriname were estimated to be living with HIV, compared to just 4% of female sex workers.25 Testing coverage among sex workers was higher among female sex workers (ranging from 39% to 98%) than among male sex workers (ranging from 17% to 70%).