Social Cohesion Is Significantly Associated with Consistent Condom Use Among Female Sex Workers Living with HIV in Santo Domingo, Dominican Republic

Background: Previous studies indicate positive effects of social cohesion among female sex workers (FSW) on HIV/STI prevention.  These studies have not, however, explored the relationship between social cohesion and STI prevention behaviors among FSW living with HIV.

Methods: We conducted bivariate and multivariate logistic regression to explore the relationship between social cohesion and consistent condom use (CCU) among a group of 143 FSW who answered the social cohesion scale in the baseline survey for the Abriendo Puertas (Opening Doors) intervention currently being implemented in Santo Domingo.  We adjusted for socio demographic variables (age, education, and marital status), stigma and discrimination variables (HIV stigma, sex work stigma, and HIV discrimination), sexual and drug behaviors (alcohol use, drug use, and number of partners), and community mobilization.  We also conducted linear regression to explore the association between social cohesion and HIV stigma, adjusting for socio demographic variables.  Scales were adapted from validated measures and had good reliability: social cohesion (α=0.77), HIV stigma (α=0.88), sex work stigma (α=0.90), HIV discrimination (α=0.75), and community mobilization (α=0.91).

Results: CCU in the previous 30 days between FSW and all sexual partners was 64.3%. There was a low level of cohesion (median 15, possible range 0-40) and high level of internalized HIV stigma (median 18, possible range 0-32).  In multivariate analyses, social cohesion was significantly associated with CCU (Adjusted Odds Ratio [AOR] 1.08, 95% Confidence Interval [CI] 1.0-1.18). HIV stigma was significantly associated with CCU (AOR 0.88, CI 0.79-0.98) and with social cohesion (B -0.21, CI -0.48--0.01). 

Conclusions: Findings indicate that social cohesion is positively associated with CCU and that HIV stigma is inversely associated with social cohesion and CCU. Interventions that facilitate social cohesion and reduce stigma among FSW living with HIV could contribute to reducing risk for ongoing STI and onward HIV transmission through CCU.