Barcelona 2013
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| Abstract #302 - Sex Workers | ||||
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Session: 15.5: Sex Workers (Parallel) on Monday @ 14.30-16.00 in Auditorium Chaired by Tonya Thurman, Angels Jaen Authors: Presenting Author: Ms. Rose Zulliger - Johns Hopkins Bloomberg School of Public Health, United States |
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| Additional Authors: Dr Kouassi Auguste Eric Komena, | ||||
| Aim: Female sex workers (FSW), men who have sex with men (MSM), and transgender women (TW) are disproportionately affected by HIV around the world and account for the majority of new infections in Latin America. Despite their important role within the HIV pandemic, there is limited understanding of the HIV service needs or experiences of these key populations. The purpose of this study was to examine experiences of HIV-positive FSW, MSM and TW with HIV services to guide the design of an integrated HIV prevention and care model. | ||||
| Method / Issue: We conducted in-depth interviews with 21 FSW, 16 MSM and 5 TW in Santo Domingo, all of whom were living with HIV. Each participant was interviewed twice to enable depth of responses. We also interviewed key informants (n=31) including HIV program planners, policy makers, clinicians and community leaders. Data were analyzed using narrative and thematic methods to summarize HIV experiences and code salient themes. We then conducted six focus group discussions with FSW living with HIV(n=3) and MSM living with HIV (n=3) to assist with interpretation of findings. | ||||
| Results / Comments: Participants described considerable challenges engaging with the formal health care system, starting with HIV testing and extending to HIV care access and treatment adherence. Some of these obstacles included cultural barriers to HIV testing, lack of HIV test counseling, inadequate linkage to care, insufficient psychosocial support, economic and systemic barriers to clinic access, and poor quality services within clinics. Participants also described how their stigmatized identities affected their access to treatment support and, at times, their interactions with health care providers. One of the most commonly described barriers to treatment initiation and adherence was the economic burden of frequent clinic and laboratory attendance due to the fragmented nature of HIV services. This was particularly challenging for sex workers who experienced economic insecurity. | ||||
| Discussion: FSW, MSM and TW confront substantial challenges along the HIV treatment cascade that complicate their access to and retention on treatment. There is a clear need for interventions at the individual, peer, community and structural levels to address these barriers in order to improve patient outcomes and prevent further HIV transmission. | ||||
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