Skip to main content

Advertisement

SpringerLink
Log in

Abriendo Puertas: Feasibility and Effectiveness a Multi-Level Intervention to Improve HIV Outcomes Among Female Sex Workers Living with HIV in the Dominican Republic

  • Original Paper
  • Published:
AIDS and Behavior Aims and scope Submit manuscript

Abstract

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Cohen MS, Chen YQ, McCauley M, et al. Prevention of HIV-1 infection with early antiretroviral therapy. N Engl J Med. 2011;365(6):493–505.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Ogbuagu O, Bruce RD. Reaching the unreached: treatment as prevention as a workable strategy to mitigate HIV and its consequences in high-risk groups. Curr HIV/AIDS Rep. 2014;11(4):505–12.

    Article  PubMed  Google Scholar 

  3. Kerrigan D, Wirtz A, Baral S, et al. The Global HIV Epidemics among Sex Workers. Washington, DC: World Bank Publications; 2013.

    Google Scholar 

  4. Baral S, Beyrer C, Muessig K, Poteat T, Wirtz AL, Decker MR, Sherman SG, Kerrigan D. 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 

  5. Shannon K, Strathdee SA, Goldenberg SM, Duff P, Mwangi P, Rusakova M, Reza-Paul S, Lau J, Deering K, Pickles, Boily MC. Global epidemiology of HIV among female sex workers: influence of structural determinants. Lancet. 2015;385(9962):55–71.

    Article  PubMed  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.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Mountain E, Mishra S, Vickerman P, Pickles M, Gilks C, Boily MC. Antiretroviral therapy uptake, attrition, adherence and outcomes among HIV-infected female sex workers: a systematic review and meta-analysis. Expert Rev Anti Infect Ther. 2014;12(10):1203–19.

    Article  CAS  PubMed  Google Scholar 

  8. Kerrigan D, Kennedy CE, Morgan-Thomas R, et al. A community empowerment approach to the HIV response among sex workers: effectiveness, challenges, and considerations for implementation and scale-up. Lancet. 2015;385(9963):172–85.

    Article  PubMed  Google Scholar 

  9. Decker MR, Crago AL, Chu SK, Sherman SG, Seshu MS, Buthelezi K, Dhaliwal M, Beyrer C. Human rights violations against sex workers: burden and effect on HIV. Lancet. 2015;385(9963):186–99.

    Article  PubMed  Google Scholar 

  10. Donastorg Y, Barrington C, Perez M, Kerrigan D. Abriendo Puertas: baseline findings from an integrated intervention to promote prevention, treatment and care among FSW living with HIV in the Dominican Republic. PLoS ONE. 2014;9(2):e88157.

    Article  PubMed  PubMed Central  Google 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.

  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.

  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.

  15. UNAIDS. Epidemiological Fact Sheet on HIV and AIDS: Dominican Republic. Geneva: Switzerland; 2013 2013.

    Google Scholar 

  16. Kerrigan D, Moreno L, Rosario S, et al. Environmental-structural interventions to reduce HIV/STI risk among female sex workers in the Dominican Republic. Am J Public Health. 2006;96(1):120–5.

    Article  PubMed  PubMed Central  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.

    Article  CAS  PubMed  Google Scholar 

  18. Liang KY, Zeger SL. Longitudinal data analysis using generalized linear models. Biometrika. 1986;73(1):13–22.

    Article  Google 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.

  21. Shannon K, Bright V, Gibson K, Tyndall MW, Maka Project P. Sexual and drug-related vulnerabilities for HIV infection among women engaged in survival sex work in Vancouver, Canada. Canadian journal of public health. 2007;98(6):465–9.

    PubMed  Google Scholar 

  22. Samet JH, Pace CA, Cheng DM, Coleman S, Bridden C, Pardesi M, Saggurti N, Raj A. Alcohol use and sex risk behaviors among HIV-infected female sex workers (FSWs) and HIV-infected male clients of FSWs in India. AIDS Behav. 2010;14(Suppl 1):S74–83.

    Article  PubMed  PubMed Central  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  24. Ward H, Pallecaros A, Green A, Day S. Health issues associated with increasing use of “crack” cocaine among female sex workers in London. Sex Transm Infect. 2000;76(4):292–3.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Hoffman JA, Klein H, Eber M, Crosby H. Frequency and intensity of crack use as predictors of women’s involvement in HIV-related sexual risk behaviors. Drug Alcohol Depend. 2000;58(3):227–36.

    Article  CAS  PubMed  Google 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 

  27. Shannon K, Bright V, Duddy J, Tyndall MW. Access and utilization of HIV treatment and services among women sex workers in Vancouver’s Downtown Eastside. J Urban Health. 2005;82(3):488–97.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Ti L, Milloy M, Shannon K, Kerr T, Simo A, Montaner J, Wood E. Sex work involvement predicts poor viral load suppression among people who inject drugs in a Canadian setting. Sex Transm Infect. 2013;89(Suppl 1):A276.

    Article  Google Scholar 

  29. Syvertsen JL, Bazzi AR, Martinez G, Rangel MG, Ulibarri MD, Fergus KB, Amaro H, Strathdee SA. Love, trust, and HIV risk among female sex workers and their intimate male partners. Am J Public Health. 2015;105(8):1667–74.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Stoebenau K, Hindin MJ, Nathanson CA, Rakotoarison PG, Razafintsalama V. But then he became my sipa: the implications of relationship fluidity for condom use among women sex workers in Antananarivo, Madagascar. Am J Public Health. 2009;99(5):811–9.

    Article  PubMed  PubMed Central  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.

    Article  PubMed  PubMed Central  Google 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.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Murray L, Moreno L, Rosario S, Ellen J, Sweat M, Kerrigan D. The role of relationship intimacy in consistent condom use among female sex workers and their regular paying partners in the Dominican Republic. AIDS Behav. 2007;11(3):463–70.

    Article  PubMed  Google Scholar 

  34. Harris J, Pillinger M, Fromstein D, Gomez B, Garris I, Kanetsky PA, Tebas P, Gross R. Risk factors for medication non-adherence in an HIV infected population in the Dominican Republic. AIDS Behav. 2011;15(7):1410–5.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Brooks K, Law MB, Wilson I. Allocating HIV treatment to the adherent: a qualitative study of patient perceptions of their HIV care in the Dominican Republic. J Healthc Poor Underserved. 2014;25(4):1748–62.

    Article  Google 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.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  37. Reay G, Rankin JA, Then KL. Momentary fitting in a fluid environment: a grounded theory of triage nurse decision making. Int Emerg Nurs. 2015;. doi:10.1016/j.ienj.2015.09.006.

    PubMed  Google Scholar 

  38. Broaddus MR, Hanna CR, Schumann C, Meier A. “She makes me feel that I’m not alone”: linkage to Care Specialists provide social support to people living with HIV. AIDS Care. 2015;27(9):1104–7.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

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.

Author Contributions

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.

Author information

Authors and Affiliations

  1. The Johns Hopkins Bloomberg School of Public Health, 624 N Broadway HH 257, Baltimore, MD, 21205, USA

    Deanna Kerrigan & Noya Galai

  2. The University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA

    Clare Barrington

  3. Instituto Dermatologico y Cirugia de la Piel, Santo Domingo, Dominican Republic

    Yeycy Donastorg & Martha Perez

  4. Department of Statistics, The University of Haifa, Mt Carmel, Israel

    Noya Galai

Authors
  1. Deanna Kerrigan
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Clare Barrington
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yeycy Donastorg
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Martha Perez
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Noya Galai
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Deanna Kerrigan.

Ethics declarations

Conflicts of Interest

The authors have no conflicts of interest to declare.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kerrigan, D., Barrington, C., Donastorg, Y. et al. Abriendo Puertas: Feasibility and Effectiveness a Multi-Level Intervention to Improve HIV Outcomes Among Female Sex Workers Living with HIV in the Dominican Republic. AIDS Behav 20, 1919–1927 (2016). https://doi.org/10.1007/s10461-016-1376-z

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10461-016-1376-z

Keywords

Search

Navigation