Abriendo Puertas: A Multi-level Intervention to Improve HIV Outcomes by Addressing Stigma and Discrimination Among Female Sex Workers in the Dominican Republic

Part of the Social Aspects of HIV book series (SHIV, volume 4)


The Dominican Republic has a long history of community-led, structural responses to HIV among female sex workers. Until recently, however, this work did not explicitly address the needs and realities of female sex workers living with HIV. In 2013, the Abriendo Puertas (Opening Doors) multi-level intervention, based on findings from formative research, was developed and implemented among 250 female sex workers living with HIV in Santo Domingo. The model proved both feasible and acceptable to the community and other key stakeholders and showed initial effectiveness in improving HIV behavioral outcomes such as protected sex and adherence to antiretroviral therapy. This chapter looks at the interplay between two key types of structural factors impacting the health and HIV outcomes of female sex workers living with HIV: HIV and sex work-related stigma and discrimination. It examines how the intervention began to enable participants to resist and redefine these intersecting stigmatized identities surrounding their HIV status and occupation as sex workers, among others, by creating a safe space for them to work together as a group and problem solve around their needs and priorities. Findings suggest the importance of both interpersonal support and community-led collective action to address the intersecting forms of stigma facing sex workers and to improve HIV outcomes and human rights.


Female sex workers HIV Multi-level intervention Stigma Social cohesion Structural factors Dominican Republic 


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Copyright information

© Springer International Publishing AG 2018

Authors and Affiliations

  1. 1.Johns Hopkins Bloomberg School of Public HealthBaltimoreUSA
  2. 2.University of North Carolina (UNC) Gillings School of Global Public HealthChapel HillUSA
  3. 3.United States Agency for International DevelopmentWashington, DCUSA
  4. 4.Instituto Dermatológico y Cirugía de Piel Dr. Huberto Bogaert Díaz, HIV Vaccince Research UnitSanto DomingoDominican Republic

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