Understanding factors associated with pregnancy desire, experience and care among female sex workers living with HIV in Santo Domingo, Dominican Republic.

Introduction: Female sex workers (FSWs) are at significantly increased risk for HIV as well as a number of health concerns, however research on living with HIV is severely lacking, particularly in relation to pregnancy and reproductive health. Methods: This study utilizes data from the cross-sectional baseline survey of a longitudinal study named Abriendo Puertas (opening doors) aiming to assess the feasibility of a multi-layered intervention program in Santo Domingo, Dominican Republic (DR). This study aims to assess factors related to pregnancy desire, having been pregnant since diagnosis and having communicated to a health provider about pregnancy among a cohort of FSWs living with HIV in the DR. Results: For the total population, almost all FSWs had children, had been pregnant with a majority having experienced a pregnancy loss. Manuscript one revealed that about 30% of FSWs of reproductive age wanted more children. Significant associations were seen between participants who desire more children and higher HIV related internalized/self stigma, a history of pregnancy loss, lower number of current children, and partner support. Manuscript two revealed that a little more than a third of FSWs have been pregnant since HIV diagnosis. Significant associations were found between having been pregnant since HIV diagnosis and reporting an interruption in anti-retroviral treatment (ART), knowledge of mother-to-child transmission, disclosure of serostatus to a sex partner and a more negative perception of their health provider. Lastly, manuscript 3 illustrated that a little less than half of FSWs who were of reproductive age when diagnosed with HIV have not had a conversation about HIV in pregnancy with any health provider. Significant associations were seen between having had a conversation about HIV and pregnancy with a health provider and a more positive perception of their health provider, no history of drug use and little to no reported alcohol use in the past 30 days. Conclusions: This study highlights the significant need for more research on this understudied population. Health services and conversations with health providers are central for comprehensive and tailored care for this population and for prevention of MTCT. Within this multi-level approach to understanding pregnancy among this high-risk population, health services factors, community level, interpersonal and intrapersonal level factors all play a role in the reproductive health care of this most at risk population