Impact of a Community Empowerment Intervention on Sexually Transmitted Infections among Female Sex Workers in Baltimore, Maryland

Susan G. Sherman, Catherine Tomko, Danielle F. Nestadt, Bradley E. Silberzahn, Emily Clouse, Katherine Haney, Sean T. Allen, Noya Galai

Research output: Contribution to journalArticlepeer-review


BACKGROUND: Female sex workers ( FSWs) are vulnerable to a number of health issues, but often delay seeking health care due to structural barriers. Multiservice drop-in centers have been shown to increase FSW access to health services globally, but their impact on FSW in the United States is lacking. This study seeks to evaluate the effect of a community-level empowerment intervention (the multiservice drop-in SPARC center) on cumulative sexually transmitted infections (STIs) among FSW in a city in the United States.

METHODS: Between September 2017 and January 2019, 385 FSWs were recruited in Baltimore. Participants from areas served by SPARC were recruited to the intervention; other areas of Baltimore were the control. Follow-up occurred at 6, 12, and 18 months. The primary outcome is cumulative STI (ie, positive gonorrhea or chlamydia test at any follow-up). We tested effect modification by condomless sex with paying clients reported at baseline. Logistic regressions with propensity score weighting were used to estimate intervention effect, accounting for loss to follow-up, with bootstrap confidence intervals.

RESULTS: Participants completed 713 follow-up study visits (73%, 70%, 64% retention at 6, 12, and 18 months, respectively). Baseline STI prevalence was 28% and cumulative STI prevalence across follow-ups was 26%; these both did not differ between control and intervention communities in bivariate analyses. After adjusting for covariates, FSW in the intervention had a borderline-significant decrease in odds of cumulative STI compared with control (odds ratio, 0.61, P = 0.09 ) . There was evidence of effect modification by baseline condomless sex, such that FSW in the intervention who reported condomless sex had lower odds of cumulative STI compared with FSW in the control community who also reported baseline condomless sex (odds ratio, 0.29; P = 0.04).

CONCLUSIONS: Results demonstrate the value of a low-barrier, multiservice model on reducing STIs among the highest-risk FSW.Clinical Trial Number: NCT04413591.

Original languageEnglish
Pages (from-to)374-380
Number of pages7
JournalSexually Transmitted Diseases
Issue number6
StatePublished - 1 Jun 2023
Externally publishedYes

Bibliographical note

Publisher Copyright:
© Lippincott Williams & Wilkins.


  • Baltimore/epidemiology
  • Female
  • Follow-Up Studies
  • Gonorrhea/epidemiology
  • HIV Infections/epidemiology
  • Humans
  • Prevalence
  • Sex Workers
  • Sexually Transmitted Diseases/epidemiology


Dive into the research topics of 'Impact of a Community Empowerment Intervention on Sexually Transmitted Infections among Female Sex Workers in Baltimore, Maryland'. Together they form a unique fingerprint.

Cite this