title: Violence From a Sexual Partner is Significantly Associated With Poor HIV Care and Treatment Outcomes Among Female Sex Workers in the Dominican Republic.
abstract: BACKGROUND
  Female sex workers (FSWs) experience high rates of violence from their sexual partners. Although violence is associated with HIV risk behaviors among FSWs, there is limited evidence on the association between violence and HIV treatment outcomes.
  
  
  METHODS
  We analyzed data from a socio-behavioral survey with a cohort of FSWs living with HIV in the Dominican Republic (n = 268) to describe the burden of violence from a sexual partner in the last 6 months. We assessed the relationship between violence and HIV treatment outcomes, comparing findings across 2 types of sexual partners: intimate partners and clients.
  
  
  RESULTS
  Nearly one-fifth of women (18.3%) experienced violence in the last 6 months. More women experienced violence from an intimate partner (12.3%) than a client (8.3%), with some (2.6%) reporting both. Although violence from an intimate partner was significantly associated with not currently being on antiretroviral treatment [ART; adjusted odds ratio (AOR): 4.05, 95% confidence interval (CI): 1.00 to 16.36] and missing an ART dose in the last 4 days (AOR: 5.26, 95% CI: 1.91 to 14.53), violence from a client was associated with never having received HIV care (AOR: 2.85, 95% CI: 1.03 to 7.92) and ever interrupting ART (AOR: 5.45, 95% CI: 1.50 to 19.75).
  
  
  CONCLUSIONS
  Violence from a sexual partner is associated with poor HIV treatment outcomes among FSWs. Different patterns by type of partner reflect how relationship dynamics may influence these associations. Violence prevention and support services should be tailored based on type of partner. Violence screening and referrals should be integrated into HIV care services for FSWs to improve their health and reduce ongoing transmission.
authors.affiliation: *Duke University School of Medicine, Durham, NC; †Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC; ‡Instituto Dermatologico y Cirugia de la Piel; §University of Michigan School of Public Health, Ann Arbor, MI; and ‖Department of Health, Behavior and Society, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
authors.forename: Carlisdania
authors.initials: C
authors.lastname: Mendoza
authors.forename: Clare
authors.initials: C
authors.lastname: Barrington
authors.forename: Yeycy
authors.initials: Y
authors.lastname: Donastorg
authors.forename: Martha
authors.initials: M
authors.lastname: Perez
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Fleming
authors.forename: Michele R
authors.initials: MR
authors.lastname: Decker
authors.forename: Deanna
authors.initials: D
authors.lastname: Kerrigan
mesh_terms: D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D004293:Dominican Republic; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000523:psychology*; D006801:Humans; D055118:Medication Adherence / Q000523:psychology*; D008875:Middle Aged; D060386:Sex Workers; D012747:Sexual Partners; D016896:Treatment Outcome; D014754:Violence; D055815:Young Adult