(P410) Barriers to syphilis treatment among transwomen in Brazil

Background: Epidemiological data indicate syphilis prevalence is high and infection is not controlled in Brazil. As in much of the world, syphilis in Brazil disproportionately affects sexual and gender minorities. Given the violence experienced by transwomen, there may be barriers to testing and treatment services. However, data are scarce on the barriers to syphilis testing and treatment faced by Brazilian transwomen.

Methods: Data are from cross-sectional surveys among transwomen in 5 major socio-economic-geographic zones in Brazil, including Campo Grande, Manaus, Porto Alegre, Salvador, and São Paulo. Respondent-driven sampling was used to recruit transwomen who answered a structured questionnaire about demographics, social-economic situation, experiences with stigma and discrimination, and previous syphilis testing and treatment. Comparisons of proportions were done using the chi-square test with p< 0.05.

Results: A total of 1317 transwomen participated. The average age was 33 years, 43.7% self-identified as pardo (approx. mixed race), 79.2% had high school education or lower, 24.7% engaged in sex work, and 22.3% were unemployed. In the last 12 months, 85.2% experienced discrimination, 47.4% experienced verbal abuse; and 30.4% reported being poorly treated by a healthcare provider. Syphilis testing in the last year was reported by 55.7%, of whom 28.7% reported a positive result. No or incomplete treatment for syphilis was reported by 38.9%. A significant regional disparity in syphilis treatment was found, with 57.3% of transwomen in São Paulo reporting no or incomplete treatment, followed by Salvador (32.1%), Campo Grande (29.4%), Porto Alegre (20.0%), and Manaus (17.8%). Trans women who reported verbal abuse in the last year were more likely to have no or incomplete syphilis treatment (46.4%). No disparities in syphilis treatment were noted by race/ethnicity, age, or socio-economic status.

Conclusions: Trans women in Brazil have a high prevalence of syphilis, yet more than one-third received no or incomplete treatment, especially in big cities as São Paulo and Salvador. Healthcare providers in Brazil need to be sensitized to transgender health concerns and the barriers they encounter with the healthcare system. Routine syphilis screening and treatment need to be integrated into trans-friendly healthcare programs nationwide.