Efficacy of a Savings-Led Microfinance Intervention to Reduce Sexual Risk for HIV Among Women Engaged in Sex Work: A Randomized Clinical Trial (original) (raw)
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The Open women's health journal, 2011
This paper describes a pilot study testing the feasibility of an innovative savings-led microfinance intervention in increasing the economic empowerment and reducing the sexual risk behavior of women engaging in sex work in Mongolia. Women's economic vulnerability may increase their risk for HIV by compromising their ability to negotiate safer sex with partners and heightening the likelihood they will exchange sex for survival. Microfinance has been considered a potentially powerful structural HIV prevention strategy with women conducting sex work, as diversification of income sources may increase women's capacity to negotiate safer transactional sex. With 50% of all reported female HIV cases in Mongolia detected among women engaging in sex work, direct prevention intervention with women conducting sex work represents an opportunity to prevent a potentially rapid increase in HIV infection in urban Mongolia. The piloted intervention consisted of a matched savings program in which matched savings could be used for business development or vocational education, combined with financial literacy and business development training for women engaging in sex work. Results of the pilot demonstrate participants' increased confidence in their ability to manage finances, greater hope for pursuing vocational goals, moderate knowledge gains regarding financial literacy, and an initial transition from sex work to alternative income generation for five out of nine participants. The pilot findings highlight the potential for such an intervention and the need for a clinical trial testing the efficacy of savings-led microfinance programs in reducing HIV risk for women engaging in sex work in Mongolia.
AIDS and Behavior, 2018
Innovative combination HIV-prevention and microfinance interventions are needed to address the high incidence of HIV and other STIs among women who use drugs. Project Nova is a cluster-randomized, controlled trial for drug-using female sex workers in two cities in Kazakhstan. The intervention was adapted from prior interventions for women at high risk for HIV and tailored to meet the needs of female sex workers who use injection or noninjection drugs. We describe the development and implementation of the Nova intervention and detail its components: HIV-risk reduction, financial-literacy training, vocational training, and a matched-savings program. We discuss session-attendance rates, barriers to engagement, challenges that arose during the sessions, and the solutions implemented. Our findings show that it is feasible to implement a combination HIV-prevention and microfinance intervention with highly vulnerable women such as these, and to address implementation challenges successfully.
A Systematic Review of Microfinance-Based Interventions for HIV/AIDS Prevention
AIDS Education and Prevention, 2014
The aim of this study is to describe the scope of microfinance-based interventions for HIV/AIDS prevention. A systematic review was carried out of literature published between 1986 and 2012 from EBSCO, ProQuest, Science Direct, Emerald, and JSTOR. The search included original research articles that presented evaluated interventions. Books, dissertations, gray literature, and theoretical reviews were excluded. Findings revealed a total of fourteen studies focused on the evaluation of: the IMAGE project, female sex workers, life skills and risk behavior reduction, adherence to treatment, and children and their families. Most of these interventions have shown to have beneficial effects, although results depend on: the type of program, monitoring, sustainability of microcredits, and contextual conditions. The findings of this review should be complemented with interventions carried out by various NGOs and microfinance institutions in different countries that present their results in a dissimilar way.
Microfinance and HIV/AIDS Prevention: Assessing its Promise and Limitations
AIDS and Behavior, 2009
Researchers increasingly argue that poverty and gender inequality exacerbate the spread of HIV/ AIDS and that economic empowerment can therefore assist in the prevention and mitigation of the disease, particularly for women. This paper critically evaluates such claims. First, we examine the promises and limits of integrated HIV/AIDS prevention and microfinance programs by examining the available evidence base. We then propose future research agendas and next steps that may help to clear current ambiguities about the potential for economic programs to contribute to HIV/ AIDS risk reduction efforts.
2012
The aim of this study was to understand the impact of two vulnerability reduction strategies-collectivisation and participation in savings activities-on HIV risk reduction among female sex workers across three districts in Karnataka-Shimoga, Bellary and Bangalore Urban. The risk reduction behaviours included in the study were consistent condom use and use of clinical services. The study hypothesised that FSWs who benefited from group membership and participation in savings activities would be more likely to adopt safer sex practices. Six sets of factors each were identified as influencing condom usage and clinic access by the FSWs. It was assumed that risk reduction would be higher among members of groups than non-members, due to their positive association with the factors. Methods Multivariate analysis of the data was performed for round 2 of the IBBA data to explore the relationship between membership in a group and safe sex behaviour among FSWs in three districts with three different collectivisation strategies. The primary outcome was defined as collectivisation and condom use in the previous year. Secondary outcomes were HIV/STI prevalence, condom use (with clients and regular partners) and experience of the HIV prevention (contact with a peer educator, and contact with the drop-in centre and the project STI clinic). Odds Ratios (ORs) were used as the measure of association, and the Wald chi-square test was the statistical test used. Focus group discussions (FGD) were conducted to understand how the set of identified factors influenced condom usage and use of clinical services. Twenty-eight FGDs were conducted with homogenous groups of 6-15 home-based (157) and street-based female sex workers (150). These included both members of groups (159) and non-members (148) in the three districts. Interviews were digitally recorded, transcribed, translated and analysed to examine the influence of group membership and access to micro-savings on use of condoms and clinical services.
AIDS and Behavior
In sub-Saharan Africa, women bear a disproportionate burden of HIV/AIDS while also facing economic and gender inequalities. To explore the association of women’s economic contribution and relationship status with risky sexual behaviour, this study analysed cross-sectional data from 626 women aged 22 to 84 in rural South Africa. All women were enrolled in a microfinance plus gender training programme (Intervention with Microfinance for AIDS and Gender Equity (IMAGE)). We used univariable and multivariable logistic regression to explore the associations of relationship status and women’s household income contribution with inconsistent condom use, multiple sexual partners and transactional sex, respectively. We found that married, older women had the highest odds of inconsistent condom use, while those contributing all the household income had higher odds of multiple sexual partnerships, but lower odds of transactional sex compared to those with no contribution. Income contribution and...
Background In much of eastern and southern Africa, the incidence of HIV and other sexually transmitted infections (STIs) remains high despite the scale-up of promising biomedical and behavioral interventions. Studies have documented the crucial role of transactional sex – the exchange of money, material support or goods in, sexual relationships – and heavy alcohol use in driving HIV/STI incidence and influencing men’s and women’s health outcomes. Existing policy responses to this challenge have largely focused on interventions to reduce women’s engagement in transactional sex such as vocational training and cash transfers for economic empowerment. However, the effectiveness of these interventions has been hindered by the relative lack of programs targeting men’s behavior. There is a vital need for interventions that can reduce men’s engagement in risky behaviors that increase HIV/STI risk. We describe here a protocol for an economic intervention to reduce men’s engagement in HIV ris...
Global Journal of Health Science, 2013
This article provides an overview of the financial lives of women (n = 204) engaging in sex work in Ulaanbaatar, Mongolia. Methods: This paper presents findings from a computer-based, interviewer-administered baseline assessment administered with women recruited for participation in a randomized controlled trial testing the feasibility of a combined HIV risk reduction and savings-led microfinance intervention for women engaging in sex work in Mongolia. Findings: Findings demonstrate that most women are the primary financial providers for their households, using an array of earning strategies to provide for themselves and other dependents, with sex work often constituting the primary household income source. Financial instability in the lives of people engaging in sex work may increase their risk for HIV and STIs due to a compromised ability to negotiate safer sex with partners in times of economic crisis or need. High levels of financial responsibility for household welfare, when combined with low reported savings, the presence of debt, higher premiums offered for sex without a condom, and high levels of harmful alcohol use, may heighten women's risk for HIV and other STIs. Conclusion: Further research that documents the financial lives of people working in sex work is needed in order to understand the complex relationship between financial stability and engagement in sex work, and to inform the development and testing of structural HIV prevention interventions which target the economic determinants of risk. These findings highlight the importance of economic support programming for women engaged in sex work in Mongolia at a time of rapid economic change in Mongolia.