Detailed Mechanism Funding and Narrative

Details for Mechanism ID: 14705
Country/Region: Dominican Republic
Year: 2012
Main Partner: Johns Hopkins University
Main Partner Program: Bloomberg School of Public Health
Organizational Type: University
Funding Agency: USAID
Total Funding: $225,000

In support of Goal Areas 2, 3, and 4 (Broad Civil Society Participation; Promotion and Prevention; Universal Access to Integrated Care and Treatment) Research 2 Prevention will pilot a study to assess the efficacy of an integrated prevention and care model for Female Sex Workers (FSW) living with HIV and the feasibility of engaging the male regular partners of FSW living with HIV in HIV prevention and care services. This model will also help operationalize current Positive, Health, Dignity and Prevention guidelines and programming and tailor its multi-level intervention elements to the needs of sex workers globally. These efforts will provide the foundation for future interventions to improve the health of FSW and their regular partners who live with HIV and reduce further transmission of HIV through timely access and adherence to HIV treatment, care and prevention. The pilot will be targeted at FSW and their partners living in and around Santo Domingo. The study will employ a robust scientific design combining quantitative and qualitative tools to monitor and evaluate the intervention. In order to maximize efficiencies, the study is being designed to encourage local partners to integrate the interventions into their existing package of services. The activity also provides an opportunity to build on the existing capacity of local institutions to conduct qualitative research.

Funding for Sexual Prevention: Other Sexual Prevention (HVOP): $225,000

Despite its relatively small overall population size, the DR has a large female sex industry, with tens of thousands of Dominican FSW working within the DR and abroad. In Santo Domingo, the capital city, there are approximately 20,000 FSW, with national estimates ranging between 60,000 and 100,000. The most recent estimates of HIV prevalence among FSW in the DR indicate that prevalence is 3.3% in Santo Domingo. Even less attention has been paid to the experiences of women who engaged in sex work after being diagnosed with HIV. Preliminary results from formative research with FSW living with HIV in the DR, however, suggest that these women experience substantial barriers to accessing services and sustaining prescribed treatment regimens, something that highlights the need for research and action. Female sex workers in the DR have articulated a strong sense of HIV-related vulnerability with their regular partners given they are less likely to use condoms with their cohabitating partners or spouses. Since FSWs show lower rates of condom use with their regular partners and high levels of sexual partner concurrency occurs among FSW and their partners, such efforts will also make an important contribution to curbing ongoing HIV transmission by: decreasing biological transmission; creating access and improving adherence to anti-retroviral therapy (ART); and decreasing behavioral susceptibility by increasing consistent condom use. The basic tenets of Positive Health Dignity and Prevention are that a holistic set of structural, behavioral and biomedical interventions is needed to promote the health and well-being of PLWH. While this framework has been widely recognized by international organizations working to promote the well-being of PLWH, careful implementation and evaluation of the framework and its components, including efforts to reduce HIV-related stigma and discrimination, have been limited, especially among FSW and their regular partners.

The primary intervention will include four main components including: peer-led HIV care and prevention service navigation; clinical health care provider training; individual counseling and education; and community solidarity and mobilization.

Key Issues Identified in Mechanism
Addressing male norms and behaviors
Increasing gender equity in HIV/AIDS activities and services