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

Yan Wang, Tahilin S. Karver, Clare Barrington, Yeycy Donastorg, Martha Perez, Hoisex Gomez, Wendy Davis, Noya Galai, Deanna Kerrigan

Research output: Contribution to journalArticlepeer-review

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.

Original languageEnglish
Pages (from-to)481-488
Number of pages8
JournalJournal of Acquired Immune Deficiency Syndromes
Volume89
Issue number5
DOIs
StatePublished - 15 Apr 2022

Bibliographical note

Funding Information:
D.K. received an R01 grant from the NIH as a PI (R01MH110158). Y.W. received a pilot award (PI: Y.W.) from the District of Columbia Center for AIDS Research, an NIH-funded program (P30AI117970), which is supported by the following NIH cofunding and participating institutes and centers: NIAID, NCI, NICHD, NHLBI, NIDA, NIMH, NIA, NIDDK, NIMHD, NIDCR, NINR, FIC, and OAR. The authors have no conflicts of interest to disclose. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

Publisher Copyright:
© 2022 Lippincott Williams and Wilkins. All rights reserved.

Keywords

  • COVID-19
  • female sex worker
  • HIV care
  • mental health
  • partner abuse
  • substance use

ASJC Scopus subject areas

  • Infectious Diseases
  • Pharmacology (medical)

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