Introduction Transgender women experience high sexually transmitted infection (STI) rates, yet there is a lack of information about STI testing uptake among transgender women in low and middle-income countries. We conducted a tablet-based survey to assess syphilis testing uptake and prevalence among transgender women in Jamaica.
Methods We conducted a cross-sectional survey with a peer-driven recruitment sample of transgender women in Kingston and Ocho Rios, Jamaica. Participants were provided with a coupon with their survey identification (ID) code for voluntary, free, rapid serological syphilis testing. Coupon ID codes for testing uptake/results were linked with survey results. We conducted backwards stepwise logistic regression to determine factors associated with opting in for syphilis testing.
Results Among 137 participants (mean age: 24.0 [SD: 4.5]), 60.6% opted in for syphilis testing and 10.6% tested positive. One-quarter (25.2%) self-reported being HIV-positive; all participants with syphilis infection were HIV-positive. In univariable analyses having multiple partners was associated with reduced odds of opting in for testing (OR: 0.19; 95% CI: 0.06–0.60). In multivariable analyses controlling for relationship status, HIV-positive participants were four-fold more likely to opt-in for syphilis testing (Adjusted Odds Ratio [AOR: 4.33]; 95% CI: 1.31–14.26) than HIV-negative participants. Perceived STI risk (AOR: 1.58; 95% CI: 1.04–2.40) and childhood sexual abuse history (AOR: 2.80; 95% CI: 1.03–7.62) were associated with increased odds of opting in for testing. Incarceration history (AOR: 0.27; 95% CI: 0.11–0.71) was associated with reduced odds of opting in for syphilis testing.
Conclusion Transgender women in Jamaica experience high HIV and syphilis prevalence, and syphilis and HIV co-infection. Findings suggest opt-in clinic based syphilis testing may miss the opportunity to provide testing for some transgender women at elevated STI risk. Future research should assess whether point-of-care syphilis testing may increase testing uptake.