Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
AIDS Care. 2021 Jan-Dec;33(sup1):1-10. doi: 10.1080/09540121.2021.1889954. Epub 2021 Feb 24.
HIV remains elevated among female sex workers (FSW) globally, with a number of structural (e.g., poverty, access to care) factors driving these persistently high rates. Pre-exposure prophylaxis (PrEP), a user-controlled prevention method, is a promising means of empowering vulnerable populations to protect themselves and enhance agency. Yet there is a dearth of PrEP research and interventions targeting cisgender women in the United States, and even fewer aimed to reach FSW. We developed and implemented a multifaceted PrEP pilot intervention, the Promoting Empowerment And Risk Reduction (PEARL) study, to meet this gap. This paper describes the development process and nature of a community-informed intervention for tenofovir/emticitrabine (TDF/FTC) pre-exposure prophylaxis engagement among street-based cisgender FSW in Baltimore, Maryland, U.S. In the course of the study's implementation, structural, programmatic, and medical barriers have already posed significant barriers to full engagement. PEARL implemented a number of strategies in an effort to counter barriers and facilitate increased success of PrEP uptake and maintenance. The study will provide critical insights into the nature of intervention components that could help FSW to initiate PrEP and reduce PrEP care cascade gaps.
艾滋病毒在全球范围内的女性性工作者（FSW）中仍然居高不下，许多结构性因素（如贫困、获得护理的机会）导致这些持续高发病率。暴露前预防（PrEP）是一种用户控制的预防方法，是增强弱势群体自我保护和增强代理权的有希望的手段。然而，在美国针对顺性别女性的 PrEP 研究和干预措施很少，针对性工作者的更是少之又少。我们开发并实施了一项多方面的 PrEP 试点干预措施，即促进赋权和降低风险（PEARL）研究，以填补这一空白。本文描述了在马里兰州巴尔的摩市为街头顺性别性工作者开展的基于社区的泰诺福韦/恩曲他滨（TDF/FTC）暴露前预防参与的社区知情干预措施的制定过程和性质。在研究实施过程中，结构性、方案性和医疗障碍已经对全面参与造成了重大障碍。PEARL 实施了多项策略，以克服障碍，促进 PrEP 的更多采用和维持。该研究将为了解干预措施的性质提供重要的见解，这些措施可能有助于性工作者启动 PrEP 并减少 PrEP 护理级联差距。
