title: Environmental-structural interventions to reduce HIV/STI risk among female sex workers in the Dominican Republic.
abstract: OBJECTIVE
  We assessed the effectiveness of 2 environmental-structural interventions in reducing risks of HIV and sexually transmitted infections (STIs) among female sex workers in the Dominican Republic.
  
  
  METHODS
  Two intervention models were implemented over a 1-year period: community solidarity in Santo Domingo and solidarity combined with government policy in Puerto Plata. Both were evaluated via preintervention-postintervention cross-sectional behavioral surveys, STI testing and participant observations, and serial cross-sectional STI screenings.
  
  
  RESULTS
  Significant increases in condom use with new clients (75.3%-93.8%; odds ratio [OR]=4.21; 95% confidence interval [CI]=1.55, 11.43) were documented in Santo Domingo. In Puerto Plata, significant increases in condom use with regular partners (13.0%-28.8%; OR=2.97; 95% CI=1.33, 6.66) and reductions in STI prevalence (28.8%-16.3%; OR = 0.50; 95% CI = 0.32, 0.78) were documented, as were significant increases in sex workers' verbal rejections of unsafe sex (50.0%-79.4%; OR=3.86; 95% CI=1.96, 7.58) and participating sex establishments' ability to achieve the goal of no STIs in routine monthly screenings of sex workers (OR=1.17; 95% CI=1.12, 1.22).
  
  
  CONCLUSIONS
  Interventions that combine community solidarity and government policy show positive initial effects on HIV and STI risk reduction among female sex workers.
authors.affiliation: Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Room 5523A, Baltimore, MD 21205, USA. dkerriga@jhsph.edu
authors.forename: Deanna
authors.initials: D
authors.lastname: Kerrigan
authors.forename: Luis
authors.initials: L
authors.lastname: Moreno
authors.forename: Santo
authors.initials: S
authors.lastname: Rosario
authors.forename: Bayardo
authors.initials: B
authors.lastname: Gomez
authors.forename: Hector
authors.initials: H
authors.lastname: Jerez
authors.forename: Clare
authors.initials: C
authors.lastname: Barrington
authors.forename: Ellen
authors.initials: E
authors.lastname: Weiss
authors.forename: Michael
authors.initials: M
authors.lastname: Sweat
mesh_terms: D000293:Adolescent; D000328:Adult; D003256:Community Participation / Q000379:methods*; D017280:Condoms / Q000706:statistics & numerical data; D003430:Cross-Sectional Studies; D004293:Dominican Republic / Q000453:epidemiology; D005260:Female; D015658:HIV Infections / Q000517:prevention & control; D006266:Health Education / Q000458:organization & administration; D006291:Health Policy; D006801:Humans; D008403:Mass Screening / Q000458:organization & administration; D015995:Prevalence; D012307:Risk Factors; D011477:Sex Work; D012749:Sexually Transmitted Diseases / Q000453:epidemiology / Q000517:prevention & control*; D047568:Unsafe Sex