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.

Barriers to Viral Suppression Among Female Sex Workers: Role of Structural and Intimate Partner Dynamics

“…5 With a growing focus on the HIV cascade of care among other key populations, only a handful of studies have examined the treatment experiences and outcomes among SWs, with most focused on clinical and behavioural measures and little research on broader social and structural factors. 6,7 At an individual and population level, suboptimal access and retention in care and poor HIV clinical outcomes (e.g., unsuppressed viral load) may impact women’s morbidity, mortality and overall quality of life, including emotional and psychological health, sexual and reproductive health and economic productivity. 8 …”

“…15 Two were a prospective cohort design, 16–18 two were cross-sectional, 6,19 and one was a peer-driven intervention. 20 Most of these studies focused on individual-correlates of undetectable pVL, including adherence, 6,7,20 drug use 17 and younger age. 6 Additionally, Donastorg and colleagues reported a higher prevalence of undetectable pVL among single SWs in the Dominican Republic, underscoring the need for further research into how interpersonal factors, including relationship dynamics, affect ART treatment success.…”

“…6 Additionally, Donastorg and colleagues reported a higher prevalence of undetectable pVL among single SWs in the Dominican Republic, underscoring the need for further research into how interpersonal factors, including relationship dynamics, affect ART treatment success. 6 …”

Advancing the strategic use of HIV operations research to strengthen local policies and programmes: the Research to Prevention Project

“…After 10 months, women in the Abriendo Puertas intervention showed statistically significant improvements in consistent condom use with all sexual partners in the last month [35]. Engagement in HIV care services, treatment continuity and adherence to anti-retroviral therapy also improved significantly among participants.…”

Perceptions of Sex Work-Related Stigma in Female Sex Workers from the Dominican Republic: Implications for HIV Interventions

“…This duality may serve to stigmatize, blame, and isolate FSW from receiving healthcare services needed to prevent and treat HIV/AIDS (Donastorg et al 2014;Scambler and Paoli 2008). Stigma related to sex work is conceptually distinct from stigma related to HIV/AIDS and may play an amplifying role in sex workers' negative health behaviors and outcomes.…”