Environmental-structural interventions to reduce HIV/STI risk among female sex workers in the Dominican Republic

Am J Public Health. 2006 Jan;96(1):120-5. doi: 10.2105/AJPH.2004.042200. Epub 2005 Nov 29.


Objectives: We assessed the effectiveness of 2 environmental-structural interventions in reducing risks of HIV and sexually transmitted infections (STIs) among female sex workers in the Dominican Republic.

Methods: Two intervention models were implemented over a 1-year period: community solidarity in Santo Domingo and solidarity combined with government policy in Puerto Plata. Both were evaluated via preintervention-postintervention cross-sectional behavioral surveys, STI testing and participant observations, and serial cross-sectional STI screenings.

Results: Significant increases in condom use with new clients (75.3%-93.8%; odds ratio [OR]=4.21; 95% confidence interval [CI]=1.55, 11.43) were documented in Santo Domingo. In Puerto Plata, significant increases in condom use with regular partners (13.0%-28.8%; OR=2.97; 95% CI=1.33, 6.66) and reductions in STI prevalence (28.8%-16.3%; OR = 0.50; 95% CI = 0.32, 0.78) were documented, as were significant increases in sex workers' verbal rejections of unsafe sex (50.0%-79.4%; OR=3.86; 95% CI=1.96, 7.58) and participating sex establishments' ability to achieve the goal of no STIs in routine monthly screenings of sex workers (OR=1.17; 95% CI=1.12, 1.22).

Conclusions: Interventions that combine community solidarity and government policy show positive initial effects on HIV and STI risk reduction among female sex workers.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Community Participation / methods*
  • Condoms / statistics & numerical data
  • Cross-Sectional Studies
  • Dominican Republic / epidemiology
  • Female
  • HIV Infections / prevention & control
  • Health Education / organization & administration
  • Health Policy*
  • Humans
  • Mass Screening / organization & administration
  • Prevalence
  • Risk Factors
  • Sex Work*
  • Sexually Transmitted Diseases / epidemiology
  • Sexually Transmitted Diseases / prevention & control*
  • Unsafe Sex