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Cultivating PEARL (Promoting Empowerment and Risk Reduction): Formative Research for a PrEP Intervention Among Female Sex Workers in Baltimore, Maryland

AIDS and Behavior volume 26, pages 2664–2675 (2022)Cite this article

Abstract

Pre-exposure prophylaxis (PrEP) is a vital component of comprehensive HIV prevention among female sex workers (FSW). There are limited PrEP interventions targeting FSW in the U.S., who have high HIV risk. Formative research was conducted to inform PEARL (Promoting Empowerment And Risk Reduction), a PrEP intervention for FSW in Baltimore, MD, including a community forum, key informant interviews with providers, and focus group discussions with FSW. FSW and providers acknowledged challenges to building rapport and establishing continuity in care settings. FSW reported low PrEP awareness, with high interest once aware. FSW and providers reported uptake barriers including perceived financial issues, lack of PrEP awareness, and mistrust of the pharmaceutical industry. Concerns were raised about substance use and daily PrEP adherence. Developing a tailored PrEP intervention for FSW necessitates multiple perspectives (e.g. FSW, service providers). Resumen La profilaxis preexposición (PrEP) es un componente vital de la prevención integral del VIH para las trabajadoras sexuales (TSF). En los Estados Unidos, hay pocas intervenciones de PrEP dirigidas a las TSF, quienes experiencian un riesgo elevado de contraer el VIH. Se realizó una investigación formativa para informar a PEARL (Promoción del empoderamiento y la reducción de riesgos), una intervención de PrEP para TSF en Baltimore, MD—la cual incluyó un foro comunitario, entrevistas con proveedores de servicios a las TSF y discusiones entre grupos focales de TSF. TSF y proveedores de servicio reconocieron los retos de mantener buenas relaciones y establecer continuidad en los servicios de salud. TSF exhibieron conocimiento limitado sobre la PrEP, pero expresaron gran interés en la PrEP después de estar informadas. TSF y los proveedores de servicios hablaron de barreras aceptando a la PrEP, incluyendo problemas financieros percibidos, falta de conocimiento sobre la PrEP y desconfianza en la industria farmacéutica. Se expresaron preocupaciones sobre el uso de sustancias y la adherencia diaria a la PrEP. El desarrollo de una intervención de PrEP personalizada para TSF requiere varias perspectivas (por ejemplo, TSF, proveedores de servicios).

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Abbreviations

ART:

Antiretroviral therapy

CF:

Community forum

FSW:

Female sex workers

FGD:

Focus group discussion

HIV:

Human Immunodeficiency Virus

KII:

Key informant interview

PEARL:

Promoting Empowerment and Risk Reduction

PrEP:

Pre-exposure prophylaxis

U.S.:

United States

WHO:

World Health Organization

WWUD:

Women who use drugs

References

  1. Beyrer C, Crago A-L, Bekker L-G, Butler J, Shannon K, Kerrigan D, et al. An action agenda for HIV and sex workers. Lancet. 2015;385(9964):287–301.

    Article  PubMed  Google Scholar 

  2. Shannon K, Strathdee SA, Goldenberg SM, Duff P, Mwangi P, Rusakova M, et al. Global epidemiology of HIV among female sex workers: influence of structural determinants. Lancet. 2015;385(9962):55–71.

    Article  PubMed  Google Scholar 

  3. Baral S, Beyrer C, Muessig K, Poteat T, Wirtz AL, Decker MR, et al. Burden of HIV among female sex workers in low-income and middle-income countries: a systematic review and meta-analysis. Lancet Infect Dis. 2012;12(7):538–49.

    Article  PubMed  Google Scholar 

  4. Paz-Bailey G, Noble M, Salo K, Tregear SJ. Prevalence of HIV among US female sex workers: systematic review and meta-analysis. AIDS Behav. 2016;20(10):2318–31.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Sherman SG, Park JN, Galai N, Allen ST, Huettner SS, Silberzahn BE, et al. Drivers of HIV infection among Cisgender and transgender female sex worker populations in Baltimore City: results from the SAPPHIRE study. JAIDS J Acquir Immune Defic Syndr. 2019;80(5):513–21.

    Article  PubMed  Google Scholar 

  6. Cleland CM, Des Jarlais DC, Perlis TE, Stimson G, Poznyak V. HIV risk behaviors among female IDUs in developing and transitional countries. BMC Public Health. 2007;7(1):271.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Astemborski J, Vlahov D, Warren D, Solomon L, Nelson KE. The trading of sex for drugs or money and HIV seropositivity among female intravenous drug users. Am J Public Health. 1994;84(3):382–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Baral S, Todd CS, Aumakhan B, Lloyd J, Delegchoimbol A, Sabin K. HIV among female sex workers in the Central Asian Republics, Afghanistan, and Mongolia: contexts and convergence with drug use. Drug Alcohol Depend. 2013;132:S13–6.

    Article  PubMed  Google Scholar 

  9. Roberts A, Mathers B, Degenhardt L. Women who inject drugs: A review of their risks, experiences and needs. A report prepared on behalf of the Reference Group to the United Nations on HIV and Injecting Drug Use Australia Sydney: National Drug and Alcohol Research Centre (NDARC), University of New South Wales. 2010.

  10. Abad N, Baack BN, O’Leary A, Mizuno Y, Herbst JH, Lyles CM. A systematic review of HIV and STI behavior change interventions for female sex workers in the United States. AIDS Behav. 2015;19(9):1701–19.

    Article  PubMed  Google Scholar 

  11. Surratt HL, Kurtz SP, Chen M, Mooss A. HIV risk among female sex workers in Miami: the impact of violent victimization and untreated mental illness. AIDS Care. 2012;24(5):553–61.

    Article  PubMed  Google Scholar 

  12. Buttram ME, Surratt HL, Kurtz SP. Resilience and syndemic risk factors among African-American female sex workers. Psychol Health Med. 2014;19(4):442–52.

    Article  PubMed  Google Scholar 

  13. Shannon K, Kerr T, Allinott S, Chettiar J, Shoveller J, Tyndall MW. Social and structural violence and power relations in mitigating HIV risk of drug-using women in survival sex work. Soc Sci Med. 2008;66(4):911–21.

    Article  PubMed  Google Scholar 

  14. Shannon K, Kerr T, Strathdee SA, Shoveller J, Montaner JS, Tyndall MWJB. Prevalence and structural correlates of gender based violence among a prospective cohort of female sex workers. BMJ. 2009;339:2939.

    Article  Google Scholar 

  15. Footer KH, Silberzahn BE, Tormohlen KN, Sherman SG. Policing practices as a structural determinant for HIV among sex workers: a systematic review of empirical findings. J Int AIDS Soc. 2016;19:20883.

    Article  PubMed  PubMed Central  Google Scholar 

  16. El-Bassel N, Shaw SA, Dasgupta A, Strathdee SA. Drug use as a driver of HIV risks: re-emerging and emerging issues. Curr Opin HIV AIDS. 2014;9(2):150.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Risher K, Mayer K, MBeyrer C. The HIV treatment cascade in men who have sex with men, people who inject drugs and sex workers. JCOiH, AIDS. 2015;10(6):420.

    CAS  Google Scholar 

  18. Des Jarlais DC, Feelemyer JP, Modi SN, Arasteh K, Hagan H. Are females who inject drugs at higher risk for HIV infection than males who inject drugs: an international systematic review of high seroprevalence areas. Drug Alcohol Depend. 2012;124(1):95–107.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Goldenberg SM, Duff P, Krusi A. Work environments and HIV prevention: a qualitative review and meta-synthesis of sex worker narratives. BMC Public Health. 2015;15(1):1241.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Campbell R, Kinnell H. “We Shouldn't Have to Put Up with This”: street sex work and violence. 2000.

  21. Administration FD. Truvada for PrEP fact sheet: ensuring safe and proper use. 2012. 2015.

  22. Choopanya K, Martin M, Suntharasamai P, Sangkum U, Mock PA, Leethochawalit M, et al. Antiretroviral prophylaxis for HIV infection in injecting drug users in Bangkok, Thailand (the Bangkok Tenofovir Study): a randomised, double-blind, placebo-controlled phase 3 trial. Lancet. 2013;381(9883):2083–90.

    Article  PubMed  Google Scholar 

  23. Baeten JM, Donnell D, Ndase P, Mugo NR, Campbell JD, Wangisi J, et al. Antiretroviral prophylaxis for HIV prevention in heterosexual men and women. N Engl J Med. 2012;367(5):399–410.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Thigpen MC, Kebaabetswe PM, Paxton LA, Smith DK, Rose CE, Segolodi TM, et al. Antiretroviral preexposure prophylaxis for heterosexual HIV transmission in Botswana. N Engl J Med. 2012;367(5):423–34.

    Article  CAS  PubMed  Google Scholar 

  25. Van Der Straten A, Brown ER, Marrazzo JM, Chirenje MZ, Liu K, Gomez K, et al. Divergent adherence estimates with pharmacokinetic and behavioural measures in the MTN-003 (VOICE) study. J Int AIDS Soc. 2016;19(1):20642.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Van Damme L, Corneli A, Ahmed K, Agot K, Lombaard J, Kapiga S, et al. Preexposure prophylaxis for HIV infection among African women. N Engl J Med. 2012;367(5):411–22.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  27. Organization WH. Policy brief: pre-exposure prophylaxis (PrEP): WHO expands recommendation on oral pre-exposure prophylaxis of HIV infection (PrEP). 2015.

  28. Eakle R, Gomez GB, Naicker N, Bothma R, Mbogua J, Cabrera Escobar MA, et al. HIV pre-exposure prophylaxis and early antiretroviral treatment among female sex workers in South Africa: results from a prospective observational demonstration project. PLoS Med. 2017;14(11):1002444.

    Article  Google Scholar 

  29. Cowan FM, Davey C, Fearon E, Mushati P, Dirawo J, Chabata S, et al. Targeted combination prevention to support female sex workers in Zimbabwe accessing and adhering to antiretrovirals for treatment and prevention of HIV (SAPPH-IRe): a cluster-randomised trial. Lancet HIV. 2018;5(8):e417–26.

    Article  PubMed  Google Scholar 

  30. Ya-lin AH, Zhu W, Smith DK, Harris N, Hoover KWJM. HIV preexposure prophylaxis, by race and ethnicity-United States. Morb Mortal Week Rep. 2018;67(41):1147.

    Article  Google Scholar 

  31. Control CfD, Prevention %J Atlanta GARfhwcghprpc-h-p-g-p. Preexposure prophylaxis for the prevention of HIV infection in the United States–2017 update. 2017.

  32. Raifman J. US guidelines that empower women to prevent HIV with preexposure prophylaxis. Sex Trans Dis. 2018;45(6):e38–9.

    Article  Google Scholar 

  33. Tomko C, Park JN, Allen ST, Glick J, Galai N, Decker MR, et al. Awareness and interest in HIV pre-exposure prophylaxis among street-based female sex workers: results from a US context. AIDS Patient Care STDs. 2019;33:49–57.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Garfinkel DB, Alexander KA, McDonald-Mosley R, Willie TC, Decker MR. Predictors of HIV-related risk perception and PrEP acceptability among young adult female family planning patients. AIDS Care. 2017;29(6):751–8.

    Article  PubMed  Google Scholar 

  35. Peitzmeier SM, Tomko C, Wingo E, Sawyer A, Sherman SG, Glass N, et al. Acceptability of microbicidal vaginal rings and oral pre-exposure prophylaxis for HIV prevention among female sex workers in a high-prevalence US city. AIDS Care. 2017;29(11):1453–7.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Control CfD. Project PrIDE 2019: https://www.cdc.gov/hiv/research/demonstration/projectpride.html.

  37. Decker MR, Beyrer C, Sherman SG. Ending the invisibility of sex workers in the US HIV/AIDS surveillance and prevention strategy. AIDS (Lond, Engl). 2014;28(15):2325.

    Article  Google Scholar 

  38. Forbes A. Speaking of sex workers: How suppression of research has distorted the United States’ domestic HIV response. Reprod Health Matters. 2015;23(45):21–9.

    Article  PubMed  Google Scholar 

  39. Pelaez D, Weicker N, Glick J, Mesenburg J, Wilson A, Kirkpatrick H, et al. The PEARL study: a prospective two-group pilot PrEP promotion intervention for cisgender female sex workers living in Baltimore, MD US. AIDS Care. 2021;33(1):1–10.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  40. Cooper V, Clatworthy J, Whetham J. mHealth Interventions to support self-management In HIV: a systematic review. The Open AIDS. 2017;11:119.

    Article  Google Scholar 

  41. Michie S, Richardson M, Johnston M, Abraham C, Francis J, Hardeman W, et al. The behavior change technique taxonomy (v1) of 93 hierarchically clustered techniques: building an international consensus for the reporting of behavior change interventions. Ann Behav Med. 2013;46(1):81–95.

    Article  PubMed  Google Scholar 

  42. Catalani C, Philbrick W, Fraser H, Mechael P, Israelski DM. mHealth for HIV treatment & prevention: a systematic review of the literature. AIDS J. 2013;7:17.

    Article  Google Scholar 

  43. Fuchs JD, Stojanovski K, Vittinghoff E, McMahan VM, Hosek SG, Amico KR, et al. A mobile health strategy to support adherence to antiretroviral preexposure prophylaxis. AIDS Patient Care STDS. 2018;32(3):104–11.

    Article  PubMed  PubMed Central  Google Scholar 

  44. Liu AY, Vittinghoff E, von Felten P, Rivet Amico K, Anderson PL, Lester R, et al. Randomized controlled trial of a mobile health intervention to promote retention and adherence to preexposure prophylaxis among young people at risk for human immunodeficiency virus: The EPIC Study. Clin Infect Dis. 2019;68(12):2010–7.

    Article  CAS  PubMed  Google Scholar 

  45. Jongbloed K, Parmar S, van der Kop M, Spittal PM, Lester RT. Recent evidence for emerging digital technologies to support global HIV engagement in care. Curr HIV/AIDS Rep. 2015;12(4):451–61.

    Article  PubMed  PubMed Central  Google Scholar 

  46. Cunningham S, Sanders T, Scoular J, Campbell R, Pitcher J, Hill K, et al. Behind the screen: Commercial sex, digital spaces and working online. Technol Soc. 2018;53:47–54.

    Article  Google Scholar 

  47. Benoit C, Belle-Isle L, Smith M, Phillips R, Shumka L, Atchison C, et al. Sex workers as peer health advocates: community empowerment and transformative learning through a Canadian pilot program. Int J Equity Health. 2017;16(1):160.

    Article  PubMed  PubMed Central  Google Scholar 

  48. Hallum-Montes R, Morgan S, Rovito HM, Wrisby C, Anastario MP. Linking peers, patients, and providers: a qualitative study of a peer integration program for hard-to-reach patients living with HIV/AIDS. AIDS Care. 2013;25(8):968–72.

    Article  PubMed  Google Scholar 

  49. Tobin KE, Kuramoto SJ, Davey-Rothwell MA, Latkin CA. The STEP into Action study: a peer-based, personal risk network-focused HIV prevention intervention with injection drug users in Baltimore Maryland. Addiction. 2011;106(2):366–75.

    Article  PubMed  Google Scholar 

  50. Broadhead RS, Heckathorn DD, Altice FL, Van Hulst Y, Carbone M, Friedland GH, et al. Increasing drug users’ adherence to HIV treatment: results of a peer-driven intervention feasibility study. Soc Sci Med. 2002;55(2):235–46.

    Article  PubMed  Google Scholar 

  51. Yang X, Xia G. Effectiveness of a peer-assisted multicomponent behavioral intervention in HIV risk reduction among female entertainment workers in China. AIDS Educ Prev. 2015;27(5):446–64.

    Article  PubMed  Google Scholar 

  52. Sherman SG, German D, Cheng Y, Marks M, Bailey-Kloche M. The evaluation of the JEWEL project: an innovative economic enhancement and HIV prevention intervention study targeting drug using women involved in prostitution. AIDS Care. 2006;18(1):1–11.

    Article  CAS  PubMed  Google Scholar 

  53. Lippman SA, Chinaglia M, Donini AA, Diaz J, Reingold A, Kerrigan DL. Findings from Encontros: a multilevel STI/HIV intervention to increase condom use, reduce STI, and change the social environment among sex workers in Brazil. Sex Transm Dis. 2012;39(3):209–16.

    Article  PubMed  PubMed Central  Google Scholar 

  54. Project HAPRS. Compendium of evidence-based interventions and best practices for HIV prevention. In: Prevention CfDCa, editor.

  55. Kelley CF, Kahle E, Siegler A, Sanchez T, Del Rio C, Sullivan PS, et al. Applying a PrEP continuum of care for men who have sex with men in Atlanta Georgia. Clin Infect Dis. 2015;61(10):1590–7.

    Article  PubMed  PubMed Central  Google Scholar 

  56. Nunn AS, Brinkley-Rubinstein L, Oldenburg CE, Mayer KH, Mimiaga M, Patel R, et al. Defining the HIV pre-exposure prophylaxis care continuum. AIDS. 2017;31(5):731.

    Article  PubMed  Google Scholar 

  57. Halcomb EJ, Davidson PM. Is verbatim transcription of interview data always necessary? Appl Nurs Res. 2006;19(1):38–42.

    Article  PubMed  Google Scholar 

  58. Nevedal AL, Reardon CM, Widerquist MAO, Jackson GL, Cutrona SL, White BS, et al. Rapid versus traditional qualitative analysis using the Consolidated Framework for Implementation Research (CFIR). Implement Sci. 2021;16(1):1–12.

    Article  Google Scholar 

  59. Fereday J, Muir-Cochrane E. Demonstrating rigor using thematic analysis: A hybrid approach of inductive and deductive coding and theme development. Int J Qual Methods. 2006;5(1):80–92.

    Article  Google Scholar 

  60. Peng B, Yang X, Zhang Y, Dai J, Liang H, Zou Y, et al. Willingness to use pre-exposure prophylaxis for HIV prevention among female sex workers: a cross-sectional study in China. HIV/AIDS. 2012;4:149–58.

    Google Scholar 

  61. Ye L, Wei S, Zou Y, Yang X, Abdullah AS, Zhong X, et al. HIV pre-exposure prophylaxis interest among female sex workers in Guangxi, China. PLoS ONE. 2014;9(1):e86200.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  62. NSWP. Global consultation: PrEP and early treatment as HIV prevention strategies. Global network of sex work projects; 2014.

  63. Walters SM, Reilly KH, Neaigus A, Braunstein S. Awareness of pre-exposure prophylaxis (PrEP) among women who inject drugs in NYC: the importance of networks and syringe exchange programs for HIV prevention. Harm Reduct J. 2017;14(1):40.

    Article  PubMed  PubMed Central  Google Scholar 

  64. Reza-Paul S, Lazarus L, Doshi M, Hafeez RS, Ramaiah M, Maiya R, et al. Prioritizing risk in preparation for a demonstration project: a mixed methods feasibility study of oral pre-exposure prophylaxis (PREP) among female sex workers in South India. PLoS ONE. 2016;11(11):e0166889.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  65. Glick JL, Russo R, Jivapong B, Rosman L, Pelaez D, Footer KH, et al. The PrEP care continuum among cisgender women who sell sex and/or use drugs globally: a systematic review. AIDS Behav. 2019;24:1–22.

    Google Scholar 

  66. Merrill JO, Rhodes LA, Deyo RA, Marlatt GA, Bradley KA. Mutual mistrust in the medical care of drug users. J General Internal Med. 2002;17(5):327–33.

    Google Scholar 

  67. Olansky E, Mansergh G, Pitts N, Mimiaga MJ, Denson DJ, Landers S, et al. PrEP awareness in the context of HIV/AIDS conspiracy beliefs among Black/African American and Hispanic/Latino MSM in three urban US cities. J Homosex. 2020;67(6):833–43.

    Article  PubMed  Google Scholar 

  68. Eaton LA, Kalichman SC, Price D, Finneran S, Allen A, Maksut JJA, et al. Stigma and conspiracy beliefs related to pre-exposure prophylaxis (PrEP) and interest in using PrEP among black and white men and transgender women who have sex with men. AIDS Behav. 2017;21(5):1236–46.

    Article  PubMed  PubMed Central  Google Scholar 

  69. Eakle R, Bourne A, Mbogua J, Mutanha N, Rees H. Exploring acceptability of oral PrEP prior to implementation among female sex workers in South Africa. J Int AIDS Soc. 2018;21(2):25081.

    Article  Google Scholar 

  70. Qiao S, Li X, Stanton BJA. Behavior Social support and HIV-related risk behaviors: a systematic review of the global literature. AIDS Behav. 2014;18(2):419–41.

    Article  PubMed  PubMed Central  Google Scholar 

  71. Shushtari ZJ, Hosseini SA, Sajjadi H, Salimi Y, Latkin C, Snijders TA. Social network and HIV risk behaviors in female sex workers: a systematic review. BMC Public Health. 2018;18(1):1020.

    Article  PubMed  PubMed Central  Google Scholar 

  72. HIV/AIDS JUNPo. UNAIDS guidance note on HIV and sex work. 2012.

  73. Gynecologists ACoOa. Improving awareness of and screening for health risks among sex workers. Committee Opinion. 2017;No. 708.

  74. Beach MC, Keruly J, Moore RDJ. Is the quality of the patient-provider relationship associated with better adherence and health outcomes for patients with HIV? J General Intern Med. 2006;21(6):661.

    Article  Google Scholar 

  75. Haberer JE, Musiimenta A, Atukunda EC, Musinguzi N, Wyatt MA, Ware NC, et al. Short message service (SMS) reminders and real-time adherence monitoring improve antiretroviral therapy adherence in rural Uganda. AIDS (Lond Engl). 2016;30(8):1295.

    Article  CAS  Google Scholar 

  76. Pop-Eleches C, Thirumurthy H, Habyarimana JP, Zivin JG, Goldstein MP, De Walque D, et al. Mobile phone technologies improve adherence to antiretroviral treatment in a resource-limited setting: a randomized controlled trial of text message reminders. AIDS (Lond Engl). 2011;25(6):825.

    Article  Google Scholar 

  77. Anglada-Martinez H, Riu-Viladoms G, Martin-Conde M, Rovira-Illamola M, Sotoca-Momblona J, Codina-Jane C. Does mHealth increase adherence to medication? Results of a systematic review. Int J Clin Pract. 2015;69(1):9–32.

    Article  CAS  PubMed  Google Scholar 

  78. Fjeldsoe BS, Marshall AL, Miller YD. Behavior change interventions delivered by mobile telephone short-message service. Am J Prevent Med. 2009;36(2):165–73.

    Article  Google Scholar 

  79. Baranoski AS, Meuser E, Hardy H, Closson EF, Mimiaga MJ, Safren SA, et al. Patient and provider perspectives on cellular phone-based technology to improve HIV treatment adherence. AIDS Care. 2014;26(1):26–32.

    Article  PubMed  Google Scholar 

  80. Genberg BL, Shangani S, Sabatino K, Rachlis B, Wachira J, Braitstein P, et al. Improving engagement in the HIV care cascade: a systematic review of interventions involving people living with HIV/AIDS as peers. AIDS Behav. 2016;20(10):2452–63.

    Article  PubMed  PubMed Central  Google Scholar 

  81. Bradford JB, Coleman S, Cunningham W. HIV system navigation: an emerging model to improve HIV care access. AIDS Patient Care STDs. 2007;21(S1):S49–58.

    Article  PubMed  Google Scholar 

  82. (CDC) CfDCaP. Peer Support [Available from: https://www.cdc.gov/hiv/effective-interventions/treat/peer-support?Sort=Title%3A%3Aasc.

  83. 360/LINKAGES F. Peer Navigation for Key Populations: Implementation Guide. Washington, DC; 2017.

  84. Sherman SG, Srikrishnan AK, Rivett KA, Liu SH, Solomon S, Celentano DD. Acceptability of a microenterprise intervention among female sex workers in Chennai India. AIDS Behav. 2010;14(3):649–57.

    Article  PubMed  Google Scholar 

  85. Sakha MA, Kazerooni PA, Lari MA, Sayadi M, Azar FE, Motazedian N. Effect of an educational intervention on knowledge, attitudes and preventive behaviours related to HIV and sexually transmitted infections in female sex workers in southern Iran: a quasi-experimental study. Int J STD AIDS. 2013;24(9):727–35.

    Article  PubMed  Google Scholar 

  86. WHO UNFPA UG. Implementing comprehensive HIV/STI programmes with sex workers: practical approaches from collaborative interventions. Network of Sex Work Projects Geneva: The World Bank. 2013.

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Acknowledgements

We dedicate this paper to the memory of Emmi Williams, who helped facilitate the community forum and inspires our work. The authors would like to thank Heather Kirkpatrick for her help with the community forum and focus groups, Lori Rosman for her help with our many literature reviews, and all of the employees and clients of the SPARC center.

Funding

This work was supported by the NIH/NIDA (R34DA045619-02), the Drug Dependence Epidemiology Training Program, NIH/NIDA (T32DA007292), and the Johns Hopkins Center for AIDS Research (1P30AI094189). The funders had no role in the study design, data collection, or in the analysis and interpretation of the results, and this paper does not necessarily reflect the views or opinions of the funders.

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Authors and Affiliations

  1. Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

    Jennifer L. Glick

  2. Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

    Belinda Jivapong

  3. Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

    Rienna Russo

  4. Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA

    Jennifer L. Glick, Danielle Pelaez, Rebecca Piser, Katherine Footer & Susan G. Sherman

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  1. Jennifer L. Glick
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Contributions

JLG, BJ, and SGS conceptualized the manuscript. JLG led the manuscript writing with significant contribution from BJ; all authors contributed important intellectual content. JLG and BJ conducted the analysis. SGS is the study principal investigator and led the study design. All authors critically revised the manuscript and approved the final version.

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Correspondence to Jennifer L. Glick.

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Susan Sherman is an expert witness in opioid legislation on the plaintiff’s side. No other conflicts to declare.

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This study received approval from the Johns Hopkins Bloomberg School of Public Health Institutional Review Board.

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Glick, J.L., Jivapong, B., Russo, R. et al. Cultivating PEARL (Promoting Empowerment and Risk Reduction): Formative Research for a PrEP Intervention Among Female Sex Workers in Baltimore, Maryland. AIDS Behav 26, 2664–2675 (2022). https://doi.org/10.1007/s10461-022-03600-0

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Keywords

  • PrEP
  • Female sex workers
  • HIV prevention
  • Formative research