Structural and Psychosocial Impacts of the COVID-19 Pandemic on HIV Care and Treatment Outcomes Among Female Sex Workers in the Dominican Republic

Authors

Yan Wang, Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC.
Tahilin S. Karver, Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC.
Clare Barrington, Department of Health Behavior, Gillings Global School of Public Health, University of North Carolina, Chapel Hill, NC.
Yeycy Donastorg, 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.
Hoisex Gomez, HIV Vaccine Trials Research Unit, Instituto Dermatologico y Cirugia de la Piel, Santo Domingo, Dominican Republic.
Wendy Davis, Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC.
Noya Galai, Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD; and.
Deanna Kerrigan, Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC.

Document Type

Journal Article

Publication Date

4-15-2022

Journal

Journal of acquired immune deficiency syndromes (1999)

Volume

89

Issue

5

DOI

10.1097/QAI.0000000000002901

Abstract

BACKGROUND: The COVID-19 pandemic and its associated socioeconomic disruptions have disproportionally affected marginalized populations, including people living with HIV. Little is known about how the pandemic has affected populations experiencing multiple forms of stigma, discrimination, and violence, such as female sex workers (FSW) living with HIV. METHODS: We conducted a cross-sectional survey between August and December 2020 among 187 FSW living with HIV in the Dominican Republic to examine the impact of COVID-19. Using multivariable logistic regression, we examined associations between COVID-19-related financial concerns, mental health, substance use, and partner abuse on engagement in HIV care and antiretroviral therapy adherence. We conducted mediation analysis to assess whether mental health challenges mediated the impact of partner abuse or substance use on HIV outcomes. RESULTS: Most participants reported no income (72%) or a substantial decline in income (25%) since the COVID-19 pandemic. Approximately one-third of the participants (34%) reported COVID-19 had an impact on their HIV care and treatment. Greater COVID-19 financial concerns (adjusted odds ratio [aOR] = 1.14, 95% CI: 1.02 to 1.27), mental health challenges (aOR = 1.38, 95% CI: 1.06 to 1.79), and partner emotional abuse (aOR = 2.62, 95% CI: 1.01 to 6.79) were associated with higher odds of negatively affected HIV care, respectively. The relationship between increased emotional partner abuse and negatively affected HIV care was mediated by greater COVID-19-related mental health challenges. CONCLUSIONS: FSW living with HIV in the Dominican Republic have been significantly affected by the COVID-19 pandemic. Targeted interventions that address structural (financial security and partner abuse) and psychosocial (mental health) factors are needed to sustain HIV outcomes and well-being.

APA Citation

Wang, Yan; Karver, Tahilin S.; Barrington, Clare; Donastorg, Yeycy; Perez, Martha; Gomez, Hoisex; Davis, Wendy; Galai, Noya; and Kerrigan, Deanna, "Structural and Psychosocial Impacts of the COVID-19 Pandemic on HIV Care and Treatment Outcomes Among Female Sex Workers in the Dominican Republic" (2022). GW Authored Works. Paper 793.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/793

Department

Prevention and Community Health