Country Case Studies on Sex Work and HIV Prevention   77
with COIN and CEPROSH on HIV prevention efforts but also as a resource center for sex workers who have had their human or labor rights violated. Additionally, MODEMU proactively advocates for the rights of sex workers and represents this constituency in political and public health forum both nationally and internationally. MODEMU has traditionally included mostly sex workers from establishments rather than street-based or other forms of sex work. Recently, an additional sex worker organization called COVIH has formed to represent the voices and needs of SWs living with HIV including issues of access to treatment, care and support. A transgender rights, community-based organization called TRANSA has recently formed in the Dominican Republic (Personal communication, COIN, 2011) and a small group of male sex workers has also recently developed (Personal Communication, MODEMU, 2011). Given restrictions in United States government funding, which has historically been the largest HIV prevention donor for the country, limited resources have been channeled directly to sex worker organizations in the Dominican Republic but rather have reached sex workers indirectly via local non-governmental organizations. Gaps in Research and Practice Current gaps in research in practice in the Dominican Republic in relation to sex work and HIV prevention include the need to further understand and address the diversity of types of sex work establishments and settings, including less formal, indirect sex work establishments and non-establishment based sex work; the expansion of evidence-based interventions to less intervened areas of the country where prevalence has not declined; systematic interventions with male and transgender sex workers particularly in tourist areas of the country; the differential needs of sex workers living with HIV; and the increasing role of substance use within the context of sex work in the Dominican Republic. Human rights and advocacy work continues to be critical particularly given the recent introduction of laws and policies which would segregate sex work into geographic tolerance zones further marginalizing sex workers and placing them at risk for greater stigma, discrimination and violence. Further engagement of clients and the regular paying and non-paying partners of sex workers is key to reducing HIV risk given the lower levels of consistent condom use with these partners. Lastly, funding for sex worker interventions have been intermittent and lacking in robustness during recent years. Interventions demonstrated to be effective have not been scaled up as needed. The potential ramifications of