Abriendo Puertas: Feasibility and Effectiveness a Multi-Level Intervention to Improve HIV Outcomes Among Female Sex Workers Living with HIV in the Dominican Republic
- 398 Downloads
Female sex workers (FSW) are disproportionately affected by HIV. Yet, few interventions address the needs of FSW living with HIV. We developed a multi-level intervention, Abriendo Puertas (Opening Doors), and assessed its feasibility and effectiveness among a cohort of 250 FSW living with HIV in the Dominican Republic. We conducted socio-behavioral surveys and sexually transmitted infection and viral load testing at baseline and 10-month follow-up. We assessed changes in protected sex and adherence to antiretroviral therapy (ART) with logistic regression using generalized estimating equations. Significant pre-post intervention changes were documented for adherence (72–89 %; p < 0.001) and protected sex (71–81 %; p < 0.002). Higher intervention exposure was significantly associated with changes in adherence (AOR 2.42; 95 % CI 1.23–4.51) and protected sex (AOR 1.76; 95 % CI 1.09–2.84). Illicit drug use was negatively associated with both ART adherence and protected sex. Abriendo Puertas is feasible and effective in improving behavioral HIV outcomes in FSW living with HIV.
KeywordsHIV Sex workers Multi-level intervention Multi-level intervention Viral suppression Protected sex STI
We would like to acknowledge the women who participated in the Abriendo Puertas cohort and intervention. Their time and dedication made this work possible. We would also like to thank all the research and intervention team members from IDCP, MODEMU and COIN for their commitment, skill and enthusiasm. This Research to Prevention (R2P) project was supported by USAID|Project SEARCH, Task Order No. 2, funded by the US Agency for International Development under Contract No. GHH-I-02-07-00032-00, beginning 30 September 2008, and supported by the President’s Emergency Plan for AIDS Relief. The Johns Hopkins University Center for AIDS Research, 1P30AI094189, provided additional support.
DK and CB conceptualized the overall study design and jointly led the manuscript writing, with DK taking the lead on first drafts of each section. YD and MP led all fieldwork for the study and contributed to analysis plan and write up of findings. NG led all statistical analyses and contributed to the writing of the methods and results.
Compliance with Ethical Standards
Conflicts of Interest
The authors have no conflicts of interest to declare.
- 3.Kerrigan D, Wirtz A, Baral S, et al. The Global HIV Epidemics among Sex Workers. Washington, DC: World Bank Publications; 2013.Google Scholar
- 6.Wirtz AL, Pretorius C, Beyrer C, Baral S, Decker MR, Sherman SG, Sweat M, Poteat T, Butler J, Oelrichs R, Semini I, Kerrigan D. Epidemic impacts of a community empowerment intervention for HIV prevention among female sex workers in generalized and concentrated epidemics. PLoS One. 2014;9(2):e88047.CrossRefPubMedPubMedCentralGoogle Scholar
- 11.Kennedy C, Barrington C, Donastory Y, et al. Exploring the positive health, dignity and prevention needs of female sex workers, men who have sex with men and transgender women in the Dominican Republic and Swaziland. Baltimore, MD: USAID - Project Search: Research to Prevention, 2013.Google Scholar
- 12.Kerrigan D, Donastorg Y, Perez M, et al. Abriendo Puertas: feasibility and initial effects of a multi-level intervention among female sex workers living with HIV in the Dominican Republic: USAID, 2014.Google Scholar
- 13.Kerrigan D, Moreno L, Rosario S, Gomez B, Jerez H, Weiss E, van Dam J, Roca E, Barrington C, Sweat M. Combining Community Approaches and Government Policy to Prevent HIV Infection in the Dominican Republic. Washington, D.C.: Horizons/Population Council/USAID; 2004.Google Scholar
- 14.CONAVIHSIDA. Segunda encuesta de vigilancia de comportamiento con vinculación serológica en poblaciones claves: Gais, Trans y Hombres que tienen Sexo con Hombres (GTH), Trabajadoras Sexuales (TRSX), Usuarios de Drogas (UD). Santo Domingo, 2012.Google Scholar
- 15.UNAIDS. Epidemiological Fact Sheet on HIV and AIDS: Dominican Republic. Geneva: Switzerland; 2013 2013.Google Scholar
- 17.Chesney MA, Ickovics JR, Chambers DB, Gifford AL, Neidig J, Zwickl B, Wu AW. Self-reported adherence to antiretroviral medications among participants in HIV clinical trials: the AACTG adherence instruments. Patient Care Committee & Adherence Working Group of the Outcomes Committee of the Adult AIDS Clinical Trials Group (AACTG). AIDS Care. 2000;12(3):255–66.CrossRefPubMedGoogle Scholar
- 19.StataCorp. Stata statistical software: release 13. College Station: StataCorp LP; 2013.Google Scholar
- 20.R Core Team. R: A language and environment for statistical computing. R Foundation for Statistical Computing. Vienna, Austria. http://www.R-project.org/. 2013.
- 23.Edlin BR, Irwin KL, Faruque S, McCoy CB, Word C, Serrano Y, Inciardi JA, Bowser BP, Schilling RF, Holmberg SD. Intersecting epidemics–crack cocaine use and HIV infection among inner-city young adults. Multicenter Crack Cocaine and HIV Infection Study Team. N Engl J Med. 1994;331(21):1422–7.CrossRefPubMedGoogle Scholar
- 26.Deschamps MM, Zorrilla CD, Morgan CA, Donastorg Y, Metch B, Madenwald T, Joseph P, Severe K, Garced S, Perez M, Escamilia G, Swann E, Pape JW, Team HP. Recruitment of Caribbean female commercial sex workers at high risk of HIV infection. Pan Am J Public Health. 2013;34(2):92–8.Google Scholar
- 31.Ulibarri MD, Roesch S, Rangel MG, Staines H, Amaro H, Strathdee SA. “Amar te Duele” (“love hurts”): sexual relationship power, intimate partner violence, depression symptoms and HIV risk among female sex workers who use drugs and their non-commercial, steady partners in Mexico. AIDS Behav. 2015;19(1):9–18.CrossRefPubMedPubMedCentralGoogle Scholar
- 32.Barrington C, Latkin C, Sweat MD, Moreno L, Ellen J, Kerrigan D. Talking the talk, walking the walk: social network norms, communication patterns, and condom use among the male partners of female sex workers in La Romana, Dominican Republic. Soc Sci Med. 2009;68(11):2037–44.CrossRefPubMedPubMedCentralGoogle Scholar
- 36.Myers JE, Taylor BS, Rojas Fermin RA, Reyes EV, Vaughan C, Jose L, Javier C, Franco Estevez R, Donastorg Cabral Y, Batista A, Lie Y, Coakley E, Hammer SM, Brudney K. Transmitted drug resistance among antiretroviral-naive patients with established HIV type 1 infection in Santo Domingo, Dominican Republic and review of the Latin American and Caribbean literature. AIDS Res Hum Retroviruses. 2012;28(7):667–74.CrossRefPubMedPubMedCentralGoogle Scholar