HIV Prevalence among MSM and TGW in Jamaica Remains High

Introduction The study aim was to estimate HIV and syphilis prevalence among men who have sex with a man (MSM) and transgender women (TGW) in Jamaica and assess progress in prevention and treatment. Methods Participants were recruited sequentially from on-site prevention services, from NGO and government outreach activities, and by peers. Participants were men and TGW aged 16+ who reported sex with a man in the past year and consented to the survey and testing (HIV rapid test, HIV viral load, Bioline syphilis antibody test with TPPA confirmation). Results Among MSM (n=461), HIV prevalence was 27.1% (95% CI 22.5% - 31.7%), with 81% achieving viral suppression. 29.1% (95% CI 21.9% - 36.2%) were syphilis antibody positive. Within the past 12 months, 22% reported having a sexually transmitted infection (STI) and 60% reported 3+ sex partners. Within the past 6 months 22% received money for sex and 22% were taking pre-exposure prophylaxis (PrEP). 31% used a condom at last sex with their main male partner. 30% were uncomfortable telling anyone they have sex with men. 18% avoided seeking care due to concern they may be treated badly. Factors associated with HIV infection included syphilis (prevalence ratio 3.2 95% CI 2.3-4.6), ever had STI, not completing high school, receiving money for sex, being raped, homeless, jailed/imprisoned. Taking PrEP was protective (prevalence ratio 0.4 95% CI 0.2-0.8). Among TGW (n=41), HIV prevalence was 53.7% (95% CI 37.3% - 70.0%), with 68% achieving viral suppression. 51.2% (95% CI 37.0% - 65.4%.) were syphilis antibody positive. Within the past 12 months,71% reported 3 or more sex partners. Within the past 6 months 54% received money for sex and 5% were taking PrEP. 32% used a condom at last sex with their main partner. 24% avoided seeking healthcare due to concern they may be treated badly. Conclusion HIV and syphilis prevalence among MSM and TGW remain high in Jamaica. Adverse life events, syphilis, STI were associated with HIV infection. Increased access to PrEP and syphilis treatment, and structural changes to affirm the rights of MSM and TGW, including changes in social and cultural norms, are needed.