Background: Transgender populations, and especially those in resource-limited settings, are at an elevated risk of experiencing stigma and discrimination. Aims: This study sought to examine the relationship between parental, familial, and other social support, experiences of stigma and discrimination, quality of life, and sex work in a national sample of transgender women in the Dominican Republic (n = 291). Methods: Descriptive analyses for the outcome variable, sex work, as well as for measures associated with socio-demographics, social support, stigma, quality of life, and experiences of abuse and violence were performed. Bivariate analysis examined differences between respondents involved in sex work and those not involved in sex work. Results: We found that participation in sex work was associated with low social support and quality of life and increased experiences of stigma, discrimination, and abuse. Specifically, Dominican transgender women involved in sex work received less social support than their non-sex working peers; they experienced heightened arguments and problems with non-parental family members, professors or bosses, classmates, and close friends, as well of loss of friendships. Involvement in sex work was also associated with higher levels of stigma and discrimination, lower quality of life, and experiences of sexual abuse, torture, and experiences of attempted murder on one’s life. Discussion: Transgender women participating in sex work require more rather than less social support from family members and loved ones, especially in areas where workplace discrimination policies that affect transgender individuals are nebulous, such as the Dominican Republic.

Background: In 2014 there was a Large chikungunya epidemic in the Dominican Republic, with 539 099 reported cases and 6 deaths. Although chikungunya is considered a Low-mortality disease, studies have suggested this is an underestimation. This study assessed deaths associated with the epidemic. Methods: Mortality data were obtained from the National Statistics Office, the surveillance system for acute febrile illnesses, and the National Epidemiological Surveillance System. Expected all-cause mortality by age group was estimated using the years 2010-2012 as the baseline. The excess deaths were calculated as the difference between observed and expected deaths during the epidemic. Results: The mortality rate increased during the chikungunya epidemic in 2014. There was a strong correlation between monthly excess of deaths and chikungunya cases (Pearson's r=0.89). There was an excess of deaths (>99% confidence interval) among individuals 40 y of age. The mortality rates were higher among the elderly. The death excess was 2853. Correcting for the estimated underreporting, there were 4952 deaths during the chikungunya epidemic (49.8 deaths/100 000 population). Conclusion: This study suggests that chikungunya is an important cause of death (underlying or contributing). It is urgent to review clinical protocols and investigate the causes associated with deaths during chikungunya epidemics.

Purpose : Studies on drug use in transgender populations, particularly those in resource-limited settings, are scarce. Considering that drug use can be a coping mechanism to deal with stigma and traumatic experiences, we examined associations between stigma, trauma, and drug use in a national sample of transgender women from the Dominican Republic. Methods : Bivariate analyses examined differences between drug users and abstainers (n=287). Multivariate analyses reported odds ratios (OR) with general drug, marijuana, and cocaine use as outcomes (n=243). Results : A quarter of respondents (24.5%) experienced sexual abuse, 12.1% were tortured, and 20.1% experienced a murder attempt. More than a quarter reported using illegal drugs (26.1%). Drug users had lower socioeconomic status; 30.0% of drug users had a primary level of education or less (18.2% of abstainers) and 17.6% of drug users had higher income, defined as greater than 10,001 pesos (∼$210 United States Dollars, USD) per month (28.1% of abstainers). More than half of drug users experienced some form of trauma (51.4%) compared to 43.5% of abstainers, and 28.4% of drug users, compared to 17.1% of abstainers, experienced a murder attempt on her life. Independent sample t-tests found significant differences between drug users and abstainers. Transgender women who experienced sexual abuse had three times high odds of using cocaine. Drug users were more likely to have experienced sexual abuse and attempted suicide (p<0.05 for both). Respondents who attempted suicide had higher odds of using drugs generally and using marijuana specifically, compared to respondents who had not attempted suicide (OR=2.665 and 3.168, respectively). Higher scores on the stigma scale were associated with higher odds of any drug use and cocaine use (OR=1.132 and 1.325, respectively). Conclusions : Although some nations have implemented antidiscrimination policies protecting transgender citizens, these policies are not consistently enforced. Eliminating stigma and stigmatizing policies may reduce rates of drug use as a coping mechanism.

Seroprevalence surveys are of utmost importance to assess the proportion of a population that has developed antibodies against a newly introduced virus and could therefore potentially exhibit immunologic protection against subsequent infection. This study aims to understand the distribution of IgM and IgG antibodies in the Dominican Republic. We surveyed a total of 12,897 participants between April and June 2020 in 10 provinces of the Dominican Republic. Survey efforts in emerging hotspots yielded a positivity for all participants of anti–SARS-CoV-2 IgM of 3.8% and IgG of 5.4%, indicating that the pathogen was in circulation before the identification of those particular communities as hotspots. We found important age differences between participants who participated in the serological study where a higher mean age is associated IgM positivity and a lower age with IgG positivity. Our results highlight the need for strategies that involve community-based seroprevalence monitoring. These should preclude syndromic case identification. Also, the higher mean age of IgM-positive participants suggests that strategies based on syndromic surveillance could identify hotspots at later phases, based on the number of cases detected at the healthcare center, as such community-based seroprevalence monitoring may be an effective intervention for future outbreaks.

This protocol details the adaptation and pilot testing of the Finding Respect and Ending Stigma around HIV (FRESH) intervention in Dominican Republic. FRESH is a healthcare setting stigma-reduction intervention designed to reduce stigmas affecting people living with HIV (PLHIV), focusing on HIV and intersectional stigmas experienced by sexual and gender minority (SGM) people living with HIV. After the successful adaptation of the FRESH intervention, it will be pilot-tested through the conduct of a pilot stepped wedge cluster randomized controlled trial. Three aims are included in this study; Aim 1 includes exploratory qualitative assessment, specifically the conduct four focus groups with men who have sex with men (MSM) living with HIV (n = 24–32) and in-depth interviews with transgender women living with HIV to explore their experiences with stigma in clinics (n = 9–12). In-depth interviews will also be held with HIV healthcare workers to elucidate their perceptions and behaviors towards their SGM clients (n = 9–12). In Aim 2, informed by Aim 1 data, we will use the sequential phases of the ADAPT-ITT framework to iteratively adapt the FRESH intervention for the Dominican Republic. In Aim 3, the adapted intervention will be pilot-tested via a cluster stepped wedge randomized controlled trial to assess feasibility and acceptability of the intervention and study protocols. If this pilot trial is successful, next steps will include testing the adapted intervention across Dominican Republic or in similar Spanish-speaking Caribbean nations in a larger trial to assess effectiveness in reducing stigma in clinical settings towards PLHIV.