BACKGROUND
Cisgender female sex workers (FSW) experience high rates of HIV and sexually transmitted infections (STIs) including chlamydia and gonorrhea. Community empowerment-based responses to the risk environment of female sex workers have been associated with significant reductions in HIV/STI risk and associated risk behaviors, yet evaluations of U.S. based interventions targeting FSW are limited.
OBJECTIVE
We describe the design, implementation, and evaluation of an ongoing comprehensive community-level intervention targeting FSW in Baltimore City, Maryland.
METHODS
The two intervention components are the SPARC drop-in center and the accompanying comprehensive mobile outreach program (in the west Baltimore area). The mission of SPARC is to provide low-barrier harm reduction services to at-risk non-men, with a special focus on women who sell sex and use drugs. SPARC addresses clients’ needs through nonjudgmental, convenient, safe, and non-stigmatizing interactions. Services are provided through a harm reduction framework and include: reproductive health and sexual health screenings; medication assisted treatment; legal aid, counseling; showers, lockers, laundry; and the distribution of harm reduction tools including naloxone and sterile drug use supplies (e.g., cookers, cotton, syringes, pipes). The SPARC intervention is being evaluated through the EMERALD study, which consists of: a prospective two-group comparative non-randomized trial (n=385); a cross sectional survey (n=100); and in-depth interviews assessing SPARC implementation (n=45). Participants enrolled in the non-randomized trial complete a survey and HIV/STI testing at four intervals (baseline, 6-, 12-, 18-months). Participants recruited from pre-defined areas closest to SPARC comprised the intervention group, and participants from all other areas of Baltimore were in the control.
RESULTS
We hypothesize that addressing structural drivers and more immediate medical needs, in combination with peer outreach, will lead to community empowerment and reduce FSWs’ HIV/STI cumulative incidence and behavioral risks.
CONCLUSIONS
In the United States, structural interventions aimed to reduce HIV and STIs among FSW are scarce, and to our knowledge this is the first intervention of its kind in the United States. The results of the EMERALD study can be used to inform the development of future interventions targeting FSW and other at-risk populations.
CLINICALTRIAL
NCT04413591
HIV, Syphilis, and Behavioral Risk Factors among Female Sex Workers before and after Implementation of Harm Reduction Programs in a High Drug-Using Area of China