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The JEWEL (Jewellery Education for Women Empowering Their Lives) pilot study examined the efficacy of an economic empowerment and HIV prevention intervention targeting illicit drug-using women (n=50) who were involved in prostitution in Baltimore, Maryland. The intervention was comprised of six 2-hour sessions that taught HIV prevention risk reduction and the making, marketing and selling of jewellery. Bivariate comparisons examined behaviour change pre- and 3-months post-intervention. The intervention's effect on the change in the number of sex trade partners from baseline to follow-up was explored with multiple linear regression. Participants were 62.0% African American, 5.0% were currently employed, and the median age was 39 years old (Inter Quartile Range [IQR]: 34-45). Women attended an average of six (IQR: 4.5-6.0) sessions. The women sold over $7,000 worth of jewellery in eleven sales. In comparing self-reported risk behaviours pre and 3-month post intervention participation, we found significant reductions in: receiving drugs or money for sex (100% versus 71.0%, p<0.0005); the median number of sex trade partners per month (9 versus 3, p=0.02); daily drug use (76.0% vs. 55.0%, p=0.003); the amount of money spent on drugs daily (US$52.57 versus US$46.71, p = 0.01); and daily crack use (27.3% versus 13.1.0%, p = 0.014). In the presence of other variables in a multivariate linear model, income from the jewelry sale was associated with a reduction in the number of sex trade partners at follow-up. The pilot indicated effectiveness of a novel, HIV prevention, economic enhancement intervention upon HIV sexual risk behaviours and drug utilization patterns.

There are an estimated 3,500-5,000 street children living on the streets of Lahore, Pakistan. A disproportionate number of these children use drugs and engage in survival sex as coping mechanisms. Since August, 2003, Project Smile provides mobile social and health services to street children 6 days a week in selected neighborhoods. This study utilizes data from Project Smile registration data on the program's initial clients (n=347). The study aimed to compare current, former, and nondrug users regarding their reasons for living on the streets, survival and coping mechanisms, and reasons for drug initiation. Of the total sample, 17.0% reported never having used drugs, 15.9% reported being former drug users, and 67.1% reported having used drugs in the month before registration. Participants were 96% boys with a median age of 13 years. The median length of living on the streets was 18 months, and 52.7% had ever been arrested by the police. Odd jobs, begging, and pickpocketing were the primary sources of reported income. Forty-eight percent reported ever having engaging in transactional sex, and 40% reported cutting themselves, primarily to cope with their anger. Variables that were significantly correlated with being a current drug user (vs. never) in the presence of other variables included: being 13 years or older [adjusted odds ratio (AOR)=3.0; 95% confidence interval (95% CI)=1.3-7.0]; reporting a daily income > or =Rs 60 (AOR=2.7; 95% CI=1.1-6.4); having a history of arrest (AOR=3.3; 95% CI=1.3-8.3); wanting to return home (AOR=0.3; 95% CI=0.1-0.8); feeling hatred from the public (AOR=5.1; 95% CI=2.0-12.9); ever exchanging sex for food, shelter, drugs, or money (AOR=3.4; 95% CI=1.3-8.9); and ever having cut themselves (AOR=15.4; 95% CI=3.4-70.7). Drug use is a major coping mechanism among street children in Lahore and is associated with many behaviors. Targeted programs are needed to meet their special needs.