This report sheds new light on adolescent drug experiences in Panama, the five Spanish-heritage countries of Central America, and the Dominican Republic, and presents the first estimates of school-level clustering of youthful drug involvement in these seven countries. Placed in relation to school survey findings from North America and Europe, these estimates indicate lower levels of drug involvement in these seven countries of the Americas. For example, in the United States of America 70% of surveyed youths had tried alcohol and 59% had smoked tobacco. By comparison, in these seven countries, only 51% have tried alcohol and only 29% have smoked tobacco. Future research will help to clarify explanations for the observed variations across different countries of the world. In the meantime, strengthening of school-based and other prevention efforts in the seven-country PACARDO area may help these countries slow the spread of youthful drug involvement, reduce school-level clustering, and avoid the periodic epidemics of illegal drug use that have been experienced in North America.

IntroductionNot only do transgender female sex workers have some of the highest rates of sexually transmitted infections (STI), human immunodeficiency virus (HIV), and experienced stigma, they also have higher likelihood of early sexual debut and some of the lowest levels of educational attainment compared to other stigmatized populations. Some of the most common interventions designed to reduce transmission of HIV and STIs seek to educate high-risk groups on sexual health and encourage condom use across all partner types; however, reaching stigmatized populations, particularly those in resource-limited settings, is particularly challenging. Considering the importance of condom use in stopping the spread of HIV, the aim of this study was two-fold; first to characterize this hard-to-reach population of transgender female sex workers in the Dominican Republic, and second, to assess associations between their HIV knowledge, experienced stigma, and condom use across three partner types.MethodsWe analyzed self-reported data from the Questionnaire for Transgender Sex Workers (N = 78). Respondents were interviewed at their workplaces. Univariate and bivariate analyses were employed. Fisher Chi-square tests assessed differences in HIV knowledge and experienced stigma by condom use across partner types.ResultsHIV knowledge was alarmingly low, condom use varied across partner type, and the respondents in our sample had high levels of experienced stigma. Average age of first sexual experience was 13.12 years with a youngest age reported of 7. Dominican Republic statutory rape laws indicate 18 years is the age of consent; thus, many of these transgender women’s first sexual encounters would be considered forcible (rape) and constitute a prosecutable crime. On average, respondents reported 8.45 sexual partners in the prior month, with a maximum of 49 partners. Approximately two thirds of respondents used a condom the last time they had sex with a regular partner. This was considerably lower than condom use reported with coercive partners (92.96%) and clients (91.78%). Bivariate analyses revealed two trends: experienced stigma was associated with lower rates of condom use, and lower HIV knowledge was associated with lower rates of condom use. The former provides additional evidence that experienced stigma may become internalized, affecting individual-level behaviors—lowering self-confidence and resilience—making it more difficult to negotiate condom use due to lack of self-efficacy and desire to show trust in one’s partner. The latter supports public health research that suggests gaps in HIV knowledge persist and are pronounced in highly stigmatized populations.DiscussionThe vulnerabilities experienced by transgender persons, particularly in environments that vehemently adhere to conservative ideologies related to sex and gender, are significant and harm this population. These vulnerabilities could potentially be addressed through critically examining of impact of policies that indirectly promote or allow victimization of tran...

This study summarizes results from six data collection instruments administered to tourists, hotel workers, and commercial sex workers (CSWs) in the Dominican Republic (D.R.). The objective of this study was to assess: 1. how HIV/AIDS may affect tourism; 2. how tourists are likely to react to prevention campaigns; and 3. how tourism may affect the spread of HIV/AIDS. It was found that an overwhelming proportion of tourists did not consider the prevalence of HIV to be a factor when making their travel plans, and that most did not consider themselves at greater risk of becoming infected while on holiday than when they were at home. This study determined that the spread of HIV/AIDS was unlikely to affect the demand for tourism services in the D.R. The study also found that most tourists would respond positively to an HIV/AIDS prevention campaign and would not be discouraged from visiting the D.R. because of such campaigns. Those most receptive to prevention efforts were also those who felt they were at highest risk, according to study data. Finally, it was determined that while most tourists probably do not engage in high risk activities, there were some male and female tourists who do engage in sexual encounters with multiple Dominican CSWs and hotel employees. These encounters represent a risk to the health and economic development of the D.R., as well as to tourists and their other sexual partners. Based on these findings, it is recommended that in order to minimize the potential social and economic impact of HIV/AIDS in the D.R., prevention messages need to reach a number of groups which have not yet been adequately targeted. These groups include tourists, with a special emphasis on 'sex tourists', and hotel employees, with a special emphasis on entertainment staff.

Transgender women are a high-risk population, and transgender female sex workers are one of the most vulnerable populations globally. Transgender female sex workers have high rates of sexually transmitted infections, HIV, and exposure to violence compared to cisgender sex workers; these negative exposures are associated with an increase in HIV risk behaviors. Thus, the aim of this study is to examine the relationship between exposure to violence and condom non-use in transgender female sex workers residing in the Dominican Republic. We hypothesize that mediation exists wherein the effects of violence on condom non-use are mediated by distrust. Facilitated interview data ( N = 78) were used. Primary outcome was condom non-use with coercive partner. Four logistic regression models and a mediation analysis were employed. Respondents' mean age was 23.0 years (SD = 4.8) with an average level education attainment of 10.1 years (SD = 2.6); 35% reported experiencing violence; 17% believed that a person who asks a partner to use a condom does not trust that partner. Exploratory mediation analyses yielded a significant indirect effect of experience with violence on condom non-use through distrust (b = 0.64, SE = 0.33, p = .05). Results suggest that distrust mediates the association between experienced violence and condom use with coercive partners. It was concluded that developing interventions on increasing resilience and perceived self-worth, plus provision of screening for violence and referral services may reduce maladaptive attributions and cognitions about condom use. Furthermore, by implementing policies that protect vulnerable populations, and subsequently enforcing them, the Dominican Republic has the opportunity to improve overall population health and protect their most disadvantaged citizens.

HSV caused 43% of genital ulcers in these populations. The modified algorithm had lower sensitivity but a reduced overtreatment rate. M-PCR testing was more sensitive than standard tests and more specific and sensitive than clinical diagnosis.