Development and Testing of the Healthcare Empowerment and Advocacy for Recovery from Trafficking (HEART) Intervention for Syringe Service Programs - PROJECT SUMMARY Sex trafficking, opioid crisis, and HIV epidemic are intersecting public health emergencies. Data show that 15% of human trafficking victims in the U.S. have addiction induced or exploited as a means of control—81% of these victims are women experiencing sex trafficking (defined as involuntary or underage entry into sex work). History of sex trafficking among sex workers is associated with 11x greater odds of having HIV, with prevalence of HIV among survivors of sex trafficking as high as 38%. Elevated risk for HIV is accounted for by higher client volume, rates of forced non-condom use, physical and sexual violence, and injection drug use (IDU) and higher risk IDU practices (e.g., syringe sharing). People with experiences of sex trafficking are an important population for ending the HIV epidemic yet have been left behind by current national efforts. We propose that syringe service programs (SSPs) are a novel site for engaging women who have experience with or are vulnerable to sex trafficking. Decades of research has highlighted the effectiveness of SSPs in HIV prevention. In this R34 application, we will develop and test novel and innovative peer-delivered brief intervention to engage women with experiences of sex trafficking and women vulnerable to sex trafficking into comprehensive care services, including HIV, SUD, and other health (e.g., mental) and social (e.g., legal) services by (1) providing low barrier access to care in a non-stigmatizing setting (SSPs); (2) using peer delivery with techniques of motivational interviewing to increase self-efficacy and empowerment; (3) offering trauma-informed and gender-sensitive integrated harm reduction and addiction services (e.g., PrEP, MOUD, naloxone); (4) providing education and safety planning for sex trafficking and commercial sex work from a harm reduction perspective; (5) and offering women-specific reproductive health services (e.g., contraception). Using the human-centered Discover, Design and Build, and Test model and the Stop Observe Ask and Respond (SOAR) framework for addressing human trafficking, we will co-create the Healthcare Empowerment and Advocacy for Recovery from Trafficking (HEART) intervention with end users of the intervention (e.g., SSP staff) and women with experience of sex trafficking. The specific aims of the study are: Aim 1. (a) Develop HEART intervention components and (b) identify implementation determinants for implementing HEART within SSPs. Aim 2. Examine the feasibility and acceptability of the HEART intervention to improve HIV and SUD prevention and treatment uptake (primary outcomes). Aim 3. Document factors relevant to implementation and sustainment to inform a full-scale randomized control trial of the HEART intervention at SSPs following the RE- AIM/PRISM frameworks. Findings will provide critical data on the prevalence of sex-trafficking and sex trafficking risk among an SSP population and will position us to apply for an R01 to conduct a formal evaluation of the effectiveness of the HEART intervention in mitigating the ongoing HIV epidemic in this population that has been left behind in the advances for HIV prevention and treatment. Based on our team’s track record at implementation of novel interventions in an SSP setting, the HEART intervention could be a critical step toward Ending the HIV Epidemic in this high incidence population.
