Pilot Award Recipient: Yan Wang, DrPH, MD

Globally, female sex workers (FSW) are disproportionately affected by HIV compared to adult women overall. Antiretroviral therapy (ART) has been proven to be effective in the treatment of HIV. However, the benefits of ART rely on successful engagement in HIV care and adherence to ART. FSW living with HIV have worse ART adherence and HIV outcomes compared to women not involved in sex work. Substance use and mental health problems are known to be an important barrier for optimal adherence to ART among people living with HIV (PLWH) overall. The prevalence of substance use and the prevalence of mental health problems are disproportionately high among FSW. However, limited research has assessed the role of substance use and mental health on HIV treatment outcomes among FSW living with HIV. In addition, most of the studies on substance use and mental health among FSW have been cross-sectional. Unentangling the temporal relations among substance use, mental health and HIV outcomes in longitudinal studies could enable a better understanding of their mechanisms of effects and inform effective intervention efforts to improve HIV outcomes among FSW living with HIV. To fill the gaps, secondary data analyses will be conducted, leveraging data from an existing longitudinal NIH-funded study in the Dominican Republic (DR). Substance use, HIV outcomes and other psychosocial factors were assessed at three time points over 3 years among ~200 cisgender FSW living with HIV. This study will examine the relationship between substance use (alcohol use disorder and illicit drug use) and HIV outcomes (HIV care engagement, ART adherence and viral suppression) over time among FSW living HIV (Aim 1). In addition, it will examine the relationship between substance use and mental health problems (depression, anxiety) over time among FSW living HIV (Aim 2). Furthermore, it will examine the mediating effect of mental health and moderating effect of peer navigation on the relationship between substance use and HIV outcomes over time among FSW living HIV (Aims 3 and 4). This study will provide insights into the dynamics of substance use and HIV outcomes among FSW living with HIV in the DR and provide insights into these dynamics for other settings including the Washington D.C. area.