TY - JOUR
T1 - Impact of a Community Empowerment Intervention on Sexually Transmitted Infections among Female Sex Workers in Baltimore, Maryland
AU - Sherman, Susan G.
AU - Tomko, Catherine
AU - Nestadt, Danielle F.
AU - Silberzahn, Bradley E.
AU - Clouse, Emily
AU - Haney, Katherine
AU - Allen, Sean T.
AU - Galai, Noya
N1 - Funding Information:
Sources of Funding: This work was supported by the National Institute on Drug Abuse under grant R01DA041243; National Institute of Mental Health under grant F31MH118817; and Johns Hopkins University Center for AIDS Research, a National Institutes of Health funded program under grant P30AI094189.
Publisher Copyright:
© Lippincott Williams & Wilkins.
PY - 2023/6/1
Y1 - 2023/6/1
N2 - 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.
AB - 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.
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U2 - 10.1097/OLQ.0000000000001781
DO - 10.1097/OLQ.0000000000001781
M3 - Article
C2 - 36749851
AN - SCOPUS:85159585826
SN - 0148-5717
VL - 50
SP - 374
EP - 380
JO - Sexually transmitted diseases
JF - Sexually transmitted diseases
IS - 6
ER -