Trajectories of HIV management among virally suppressed and unsuppressed female sex workers in the Dominican Republic: A comparative qualitative analysis

Authors

Virginia Savage, Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
Hoisex Gomez, HIV Vaccine Trials Research Unit, Instituto Dermatologico y Cirugia de la Piel, Santo Domingo, Dominican Republic.
Martha Perez, HIV Vaccine Trials Research Unit, Instituto Dermatologico y Cirugia de la Piel, Santo Domingo, Dominican Republic.
Yeycy Donastorg, HIV Vaccine Trials Research Unit, Instituto Dermatologico y Cirugia de la Piel, Santo Domingo, Dominican Republic.
Deanna Kerrigan, Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, District of Columbia, USA.
Clare Barrington, Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.

Document Type

Journal Article

Publication Date

12-1-2023

Journal

International journal of qualitative studies on health and well-being

Volume

18

Issue

1

DOI

10.1080/17482631.2023.2164947

Keywords

Dominican Republic; HIV; female sex workers; narrative analysis; stigma; viral suppression

Abstract

PURPOSE: Despite suboptimal HIV outcomes among female sex workers (FSW), limited research has been conducted on factors that impact viral suppression among this population. Examining narratives of HIV management, we examined how experiences of diagnosis, treatment initiation, and ongoing care behaviours shaped viral suppression outcomes over time. METHODS: We conducted 20 in-depth interviews with FSW in Santo Domingo, Dominican Republic. Using narrative and thematic qualitative approaches, we developed analytic summaries and matrices to compare trajectories of managing HIV between suppressed and unsuppressed participants. RESULTS: Regardless of suppression status, participants described similar narratives of overcoming initial challenges to HIV management through personal resilience and social support. Unsuppressed participants identified more delays in initiating antiretroviral therapy and more lapses in adherence due to less active acceptance of their HIV status and more persistent experiences of economic hardship and HIV stigma. CONCLUSIONS: We found that individual, interpersonal and structural factors, including stigma and economic precarity, differentiated trajectories towards viral suppression among FSW indicating the importance of multilevel interventions. Improved access to mental health services and social support could promote greater early acceptance of HIV status and progress towards viral suppression among FSW.

APA Citation

Savage, Virginia; Gomez, Hoisex; Perez, Martha; Donastorg, Yeycy; Kerrigan, Deanna; and Barrington, Clare, "Trajectories of HIV management among virally suppressed and unsuppressed female sex workers in the Dominican Republic: A comparative qualitative analysis" (2023). GW Authored Works. Paper 4092.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/4092

Department

Prevention and Community Health