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Deanna Kerrigan, PhD, MPH, Luis Moreno, BA, Santo Rosario, BA, Bayardo Gomez, MD, Hector Jerez, MA, Clare Barrington, MPH, Ellen Weiss, MA and Michael Sweat, PhD

Deanna Kerrigan, Clare Barrington, and Michael Sweat are with the Johns Hopkins Bloomberg School of Public Health, Baltimore, Md. Luis Moreno and Santo Rosario are with the Centro de Orientación e Investigación Integral, Santo Domingo, Dominican Republic. Bayardo Gomez and Hector Jerez are with the Centro de Promoción y Solidaridad Humana, Puerto Plata, Dominican Republic. Ellen Weiss is with the International Center for Research on Women, Washington, DC.

Correspondence: Requests for reprints should be sent to Deanna Kerrigan, PhD, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Room 5523A, Baltimore, MD 21205 (e-mail: dkerriga{at}jhsph.edu).

Objectives. We assessed the effectiveness of 2 environmental–structural interventions in reducing risks of HIV and sexually transmitted infections (STIs) among female sex workers in the Dominican Republic.

Methods. Two intervention models were implemented over a 1-year period: community solidarity in Santo Domingo and solidarity combined with government policy in Puerto Plata. Both were evaluated via preintervention–postintervention cross-sectional behavioral surveys, STI testing and participant observations, and serial cross-sectional STI screenings.

Results. Significant increases in condom use with new clients (75.3%–93.8%; odds ratio [OR]=4.21; 95% confidence interval [CI]=1.55, 11.43) were documented in Santo Domingo. In Puerto Plata, significant increases in condom use with regular partners (13.0%–28.8%; OR=2.97; 95% CI=1.33, 6.66) and reductions in STI prevalence (28.8%–16.3%; OR = 0.50; 95% CI = 0.32, 0.78) were documented, as were significant increases in sex workers’ verbal rejections of unsafe sex (50.0%–79.4%; OR=3.86; 95% CI=1.96, 7.58) and participating sex establishments’ ability to achieve the goal of no STIs in routine monthly screenings of sex workers (OR=1.17; 95% CI=1.12, 1.22).

Conclusions. Interventions that combine community solidarity and government policy show positive initial effects on HIV and STI risk reduction among female sex workers.

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