title: Abriendo Puertas: baseline findings from an integrated intervention to promote prevention, treatment and care among FSW living with HIV in the Dominican Republic.
abstract: Female sex workers (FSW) are often the focus of primary HIV prevention efforts. However, little attention has been paid to the prevention, treatment, and care needs of FSW living with HIV. Based on formative research, we developed an integrated model to promote prevention and care for FSW living with HIV in Santo Domingo, Dominican Republic, including (1) individual counseling and education; (2) peer navigation; (3) clinical provider training; and (4) community mobilization. We enrolled 268 FSW living with HIV into the intervention and conducted socio-behavioral surveys, sexually transmitted infection (STI) testing, and viral load (VL) assessments. We used multivariate logistic regression to identify behavioral and socio-demographic factors associated with detectable VL (>50 copies/mL) and STI prevalence. Over half of all participants (51.9%) had a detectable VL, even though most received HIV-related care in the last 6 months (85.1%) and were currently on anti-retroviral treatment (ART) (72.4%). Factors positively associated with a detectable VL included being 18-35 years of age (Adjusted Odds Ratio [AOR] 2.46, 95% CI 1.31-4.60), having ever used drugs (AOR 2.34, 95% CI 1.14-4.79), and having ever interrupted ART (AOR 3.09, 95% CI 1.44-6.59). Factors protective against having a detectable VL included being single (AOR 0.45, 95% 0.20-0.98) and being currently on ART (AOR 0.17, 95% CI 0.07-0.41). Nearly one-quarter (23.1%) had an STI, which was associated with being single (AOR 3.21, 95% CI 1.27-8.11) and using drugs in the last 6 months (AOR 3.54, 95% CI 1.32-9.45). Being on ART was protective against STI (AOR 0.51, 95% CI 0.26-1.00). Baseline findings indicate significant barriers to VL suppression and STI prevention among FSW living with HIV and highlight gaps in the continuum of HIV care and treatment. These findings have important implications for both the individual health of FSW and population-level HIV transmission dynamics.
authors.affiliation: HIV Vaccine Research Unit, Instituto Dermatalógico y Cirugia de Piel Dr. Humberto Bogart Diaz, Santo Domingo, Rep. Dom.
authors.forename: Yeycy
authors.initials: Y
authors.lastname: Donastorg
authors.affiliation: Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America.
authors.forename: Clare
authors.initials: C
authors.lastname: Barrington
authors.affiliation: HIV Vaccine Research Unit, Instituto Dermatalógico y Cirugia de Piel Dr. Humberto Bogart Diaz, Santo Domingo, Rep. Dom.
authors.forename: Martha
authors.initials: M
authors.lastname: Perez
authors.affiliation: Department of Health, Behavior and Society, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America.
authors.forename: Deanna
authors.initials: D
authors.lastname: Kerrigan
mesh_terms: D000293:Adolescent; D000328:Adult; D003710:Demography; D004293:Dominican Republic / Q000453:epidemiology; D005260:Female; D015658:HIV Infections / Q000453:epidemiology / Q000517:prevention & control* / Q000628:therapy* / Q000821:virology; D006801:Humans; D008875:Middle Aged; D016017:Odds Ratio; D005791:Patient Care; D060386:Sex Workers / Q000706:statistics & numerical data; D012725:Sexual Behavior; D012749:Sexually Transmitted Diseases / Q000453:epidemiology; D019562:Viral Load; D055815:Young Adult