Factors Influencing Voluntary Counseling and Testing Compliance Among Transgender Women

Voluntary counseling and testing (VCT) play an important role in reducing HIV/AIDS transmission. Indonesia ranks 14th globally in terms of the number of people living with HIV (PLHIV), with an estimated 564,000 cases in 2025, but only 63% are aware of their status. The use of VCT among high-risk groups, particularly transgender women, is still not optimal. This study aims to analyze the relationship between knowledge, attitudes, family support, peer support, organizational participation, and the use of alternative treatments with VCT adherence among transgender women in Madiun Regency. An analytical observational study with a cross-sectional design was conducted on 60 transgender women in Madiun, East Java, using simple random sampling. Inclusion criteria were transgender women registered with the AIDS Commission and residing in Madiun District. VCT adherence data were obtained from the Regional AIDS Commission, while knowledge, attitude, and social support data were collected through a validated questionnaire. Analysis used chi-square tests and logistic regression. Results showed that 51.7% of respondents were non-adherent. Non-adherence was significantly associated with poor knowledge (OR = 5.71; p = 0.0002), unfavorable attitudes (OR = 7.68; p = 0.000), a lack of family support (OR = 3.19; p = 0.032), and a lack of organizational participation (OR = 15.7; p = 0.002). Knowledge, attitude, family support, and peer support are key determinants of VCT adherence, while alternative treatment is not a significant factor. Community-based interventions that focus on these factors are crucial in enhancing VCT adherence.