Substance Use and Depression Impede ART Adherence Among Female Sex Workers Living with HIV in the Dominican Republic

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

Research output: Contribution to journalArticlepeer-review


Female sex workers (FSW) have worse HIV outcomes in part due to lower anti-retroviral therapy (ART) adherence. Substance use and depression are important barriers to ART adherence, yet few studies have assessed these relationships among FSW in longitudinal studies. Cross-Lagged Panel Models and autoregressive mediation analyses assessed substance use (illicit drug use and alcohol use disorders) in relation to ART non-adherence and the mediation role of depressive symptoms among 240 FSW living with HIV in the Dominican Republic. In annual visits (T1, T2, T3), the majority (70%, 66%, and 53%) reported at-risk drinking and 15%, 13% and 9% used illicit drug during the past 6 months. Most FSW (70%, 62% and 46%) had mild-to-severe depression. Illicit drug use predicted later ART non-adherence. This relationship was not mediated via depressive symptoms. Integrated substance use and HIV care interventions are needed to promote ART adherence and viral suppression among FSW.

Original languageEnglish
Pages (from-to)2079-2088
Number of pages10
JournalAIDS and Behavior
Issue number7
StatePublished - Jul 2023

Bibliographical note

Publisher Copyright:
© 2022, The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.


  • ART adherence
  • Depression
  • HIV
  • Sex work
  • Substance use

ASJC Scopus subject areas

  • Social Psychology
  • Public Health, Environmental and Occupational Health
  • Infectious Diseases


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