Factors Related to Pregnancy among Female Sex Workers Living with HIV in the Dominican Republic

Female sex workers (FSWs) living with HIV are a vulnerable population for multiple health concerns and have been vastly understudied in public health literature. This study analyzes factors related to pregnancy among 268 FSWs living with HIV in the Dominican Republic. 

Results indicate that 

• 34% of participants had been pregnant since HIV diagnosis. 

Multivariate analysis revealed significant associations between 

• pregnancy after HIV diagnosis and ART interruption, 
• knowledge of mother-to-child transmission, 
• serostatus disclosure to a sex partner, 
• older age 
• and a more negative perception of their health provider. 

Results indicate noteworthy associations between having been pregnant and the health provider experience and ART interruption, indicating a significant need for further research on this population to ensure both maternal and child health.

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By:  Cernigliaro D¹, Barrington C², Perez M³, Donastorg Y³, Kerrigan D⁴.

¹Department of Health, Behavior and Society, The Johns Hopkins Bloomberg School of Public Health, HH287, 624 N. Broadway St., Baltimore, MD, 21205, USA. danacern@gmail.com.

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

³HIV Vaccine Research Unit, Instituto Dermatalógico y Cirugia de Piel Dr. Humberto Bogart Diaz, Santo Domingo, Dominican Republic.

⁴Department of Health, Behavior and Society, The Johns Hopkins Bloomberg School of Public Health, HH287, 624 N. Broadway St., Baltimore, MD, 21205, USA.

AIDS Behav. 2016 May 4. [Epub ahead of print]

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HIV Testing, Care & Treatment Experiences among the Steady Male Partners of Female Sex Workers Living with HIV in The Dominican Republic

Male steady partners of female sex workers (FSW) living with human immunodeficiency virus (HIV) represent a key population for treatment as prevention and/or pre-exposure prophylaxis interventions. 

This study uses data collected from male steady partners who were referred by FSW living with HIV participating in a multi-level HIV prevention and care intervention in Santo Domingo, Dominican Republic. We conducted a socio-behavioral survey and HIV testing with all men (n = 64) and 16 in-depth interviews with a sub-sample to obtain more depth. Thirty-five of the 64 participants were living with HIV; 27 were previously diagnosed and 8 were diagnosed during our study. As a result, 45% of men were members of sero-discordant sexual partnerships. 

Of men with no previous HIV diagnosis (n = 37), 15 had never been tested for HIV and nine had not been tested in the past two years. Ninety-three percent of men previously diagnosed with HIV reported receiving HIV care in the past 6 months and 78% were taking anti-retrovirals. Low HIV testing was partly due to men not feeling at risk for HIV, despite having an HIV-infected partner. 

Additionally, a lack of tailored care inhibited engagement in anti-retroviral treatment for those infected. HIV testing was low, highlighting a need for test-and-treat strategies. Men not living with HIV would benefit from regular testing and would be good candidates for pre-exposure prophylaxis. 

While almost all men who had been diagnosed with HIV were engaged in care and adherent to anti-retroviral therapy, future research should assess whether they are achieving optimal HIV outcomes for their health and prevention of ongoing transmission.

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By:  Fleming PJ1, Barrington C2, Perez M3, Donastorg Y3, Kerrigan D4.

• 1 Division of Global Public Health , University of California , San Diego , CA , USA.
• 2 Department of Health Behavior , University of North Carolina , Chapel Hill , NC , USA.
• 3 HIV Vaccine Trials Unit , Instituto Dermatológico y Cirugía de Piel 'Dr. Huberto Bogaert Díaz' , Santo Domingo , Dominican Republic.
• 4 Department of Health, Behavior and Society , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA.
• AIDS Care. 2016 Mar 24:1-6 

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Feasibility of Identifying a Female Sex Worker Cohort at High Risk of HIV Infection in the Caribbean for HIV Vaccine Efficacy Trials

Background: Identifying cohorts of Caribbean women with HIV infection rates sufficient for inclusion in HIV vaccine efficacy trials has been challenging. HVTN 907 determined the feasibility of identifying and retaining a cohort of women at high risk for HIV acquisition by focusing recruitment on female sex workers (FSWs).

Methods: HIV uninfected FSWs, residing in Haiti, Dominican Republic, and Puerto Rico, who reported unprotected sex and met previously described more stringent site-specific eligibility criteria, were eligible. Behavioral risk assessment, HIV counseling and testing, and pregnancy testing were performed at baseline, 6, 12, and 18 months.

Results: Among 799 FSWs (264 from Dominican Republic, 334 from Haiti, and 201 from Puerto Rico), the median age was 26 years, with 54% having less than a high school education and 45% having a monthly household income of less than $US 100. Median number of male partners 6 months before screening was 200. Retention at 18 months was 93%. Twelve women became HIV infected, 9 from Haiti. The annualized HIV incidence was 1.07% (95% confidence interval: 0.55% to 1.87%). Pregnancy incidence was 22.5% (95% confidence interval: 21.9% to 29.5%). Statistically significant declines in risk behaviors occurred between screening and the 18-month visit assessment.

Discussion: The HVTN 907 study identified a high-risk cohort of women with excellent retention for all 3 sites, despite major challenges especially in Haiti. These results show that a bridging study of a vaccine shown to be efficacious in other clade settings would be possible among FSWs in the region, particularly in Haiti.

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By:   Deschamps, Marie M. MD^*; Metch, Barbara MA, MS^†; Morgan, Cecilia A. PhD^†; Zorilla, Carmen D. MD^‡; Donastorg, Yeycy MD^§; Swann, Edith PhD, MN^‖; Taina, Dadaille MD^*; Patrice, Joseph MD^*; Pape, William J. MD^*; on behalf of the HVTN 907 Study Team

doi: 10.1097/QAI.0000000000000796 

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Retention in HIV Care among Female Sex Workers in the Dominican Republic: Implications for Research, Policy and Programming

There are clear benefits of retention in HIV care, yet millions of people living with HIV are sub-optimally retained. This study described factors from Andersen's behavioral model that were associated with retention in HIV care among 268 female sex workers (FSWs) living with HIV in the Dominican Republic using two measures of retention: a 6-month measure of HIV clinic attendance and a measure that combined clinic attendance and missed visits. FSWs who ever attended HIV care reported high rates (92 %) of 6-month attendance, but 37 % reported missed visits. 

Using the combined retention measure, the odds of being retained in HIV care were higher among FSWs with more positive perceptions of HIV service providers and lower among women who reported recent alcohol consumption and self-stigmatizing beliefs related to sex work. 

These findings support the hypothesis that retention in HIV care may be best determined through a combined measure as missed visits are an important mechanism to identify in-care patients who require additional support.

Via:  http://goo.gl/K2zGVV Purchase full article at: http://goo.gl/I5KfI8

By: Zulliger R1, Maulsby C, Barrington C, Holtgrave D, Donastorg Y, Perez M, Kerrigan D.

1Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Room 904, Baltimore, MD, 21205, USA

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