Background: The HIV epidemic among female sex workers (FSWs) is shaped by structural, social network, and behavioral factors. Violence is pervasive and associated with risk behavior and infection, yet interventions to respond to violence are limited.
Methods: Our intervention was developed in partnership with practitioners and clients from community-based organizations, who prioritized violence-related support, connection to services and responding to the myth that sex workers cannot be raped. The brief (3-5 minute), trauma-informed intervention (INSPIRE) was implemented with drug-involved FSWs in Baltimore, MD and evaluated for feasibility, acceptability and effect via a quasi-experimental, single group pretest-posttest study; baseline n=60; n=39 (65%) at follow-up; non-differential by baseline measures.
Results: At follow-up, participants had improved condom negotiation confidence (p=0.04), and reduced frequency of sex trade under the influence of drugs/alcohol (p=0.04). Endorsement of sex work-related rape myths decreased (p=0.04), and safety behavior scores increased (p< .001). Participants improved knowledge and use of support services for sexual violence and intimate partner violence. At follow-up, 68% knew at least one place to obtain assistance reporting violence to police, and 29% had approached such a program. Participants emphasized the value of a safe and supportive space to discuss violence; their feedback and that of community partners indicated high feasibility and acceptability of this brief, low-dose intervention.
Conclusions: Findings indicate the feasibility and acceptability of brief, trauma-informed discussion of safety and resources in the context of HIV risk reduction for FSWs, and suggest the potential for impact. This approach appears to prompt engagement in safety strategies, decrease the extent of sex trade under the influence, and bolster confidence in condom negotiation. INSPIRE influenced endpoints identified as valuable by community partners, specifically connection to support services and countering structural forces that falsely blame sex workers for violence. Future implementation research can advance limitations of our pilot study, including the short follow-up duration and attrition. These early results can inform scalable interventions that address the impact of trauma on HIV acquisition and care trajectories for FSWs, and in doing so address the dual epidemics of violence and HIV to support health and human rights.

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