HIV testing, care, and treatment experiences among the steady male partners of female sex workers living with HIV in the Dominican Republic

ABSTRACT

Male steady partners of female sex workers (FSW) living with human immunodeficiency virus (HIV) represent a key population for treatment as prevention and/or pre-exposure prophylaxis interventions. This study uses data collected from male steady partners who were referred by FSW living with HIV participating in a multi-level HIV prevention and care intervention in Santo Domingo, Dominican Republic. We conducted a socio-behavioral survey and HIV testing with all men (n = 64) and 16 in-depth interviews with a sub-sample to obtain more depth. Thirty-five of the 64 participants were living with HIV; 27 were previously diagnosed and 8 were diagnosed during our study. As a result, 45% of men were members of sero-discordant sexual partnerships. Of men with no previous HIV diagnosis (n = 37), 15 had never been tested for HIV and nine had not been tested in the past two years. Ninety-three percent of men previously diagnosed with HIV reported receiving HIV care in the past 6 months and 78% were taking anti-retrovirals. Low HIV testing was partly due to men not feeling at risk for HIV, despite having an HIV-infected partner. Additionally, a lack of tailored care inhibited engagement in anti-retroviral treatment for those infected. HIV testing was low, highlighting a need for test-and-treat strategies. Men not living with HIV would benefit from regular testing and would be good candidates for pre-exposure prophylaxis. While almost all men who had been diagnosed with HIV were engaged in care and adherent to anti-retroviral therapy, future research should assess whether they are achieving optimal HIV outcomes for their health and prevention of ongoing transmission.

KEYWORDS:

• Non-commercial partners
• HIV-positive
• pre-exposure prophylaxis
• anti-retroviral treatment
• AIDS

Acknowledgements

We would like to thank all study participants for their time, dedication and commitment, as well as the Abriendo Puertas research and intervention team including staff and community members from IDCP, COIN and MODEMU.

Disclosure statement

The authors have no conflicts of interest to report.

ORCID

Paul J. Fleming http://orcid.org/0000-0001-9150-1254

Additional information

Funding

This Research to Prevention (R2P) project was supported by USAID Project SEARCH, Task Order No. 2, funded by the US Agency for International Development under [Contract No. GHH-I-02-07-00032-00], beginning 30 September 2008, and supported by the President’s Emergency Plan for AIDS Relief. The Johns Hopkins University Center for AIDS Research, [1P30AI094189], provided additional support. Paul J. Fleming was supported by the National Institute of Allergy and Infectious Diseases under [grant number T32 AI007001] and subsequently by the National Institute on Drug Abuse under [grant number T32 DA023356]. The Carolina Population Center provided training support [T32 HD007168] and general support [R24 HD050924].