Effects of Micro-Enterprise Services on HIV Risk Behaviour Among Female Sex Workers in Kenya’s Urban Slums

Abstract

This study assessed individual-level effects of adding micro-enterprise services to a peer-mediated HIV/AIDS intervention among 227 female sex workers (FSWs) in Kenya. Survey data were collected in May-July 2003 and July-August 2005. Two-thirds of participants had operational businesses by end-line survey. Nearly half reported to have stopped sex work. Self-reported weekly mean number of all sexual partners changed from 3.26 (SD 2.45) at baseline to 1.84 (SD 2.15) at end-line survey (P < 0.001). Weekly mean number of casual partners did not change significantly. Weekly mean number of regular partners changed from 1.96 (SD 1.86) to 0.73 (SD 0.98) over the follow-up period (P < 0.001). Consistent condom use with regular partners increased by 18.5% and remained above 90% with casual partners. Micro-enterprise services may empower FSWs by giving them an alternative livelihood when they wish to exit or reduce reliance on sex work. Determinants of successful business operation by FSWs deserve further research.

A global comprehensive review of economic interventions to prevent intimate partner violence and HIV risk behaviours

“…age 17.549 women; pre-test, post-test; 6-month follow-up; no randomisation* Use condom with primary partner: post 38% vs pre 67% ( p  = 0.35)*Currently sexually active: post 22% vs pre 18% ( p  = 0.79)* Power in sexual relationship: post 50% vs pre 11% ( p  = 0.79)* Power in non-sexual relationship: post 38% vs pre 5% ( p  = 0.04) Bandiera et al [60]Life skills training; vocational training; microfinanceUgandaAdolescent girls; av. age 164800 adolescent girls; 100 communities randomly assigned to intervention or control; 2-year follow-up* Improved condom use ( p  < 0.05)* 76% reduction in unwilling sex ( p  < 0.01)Erulkar and Chong [61]Modified microfinance; mentoring; life skillsKenyaGirls out-of-school 16–22326 matched pairs; interviews as exited programme – mixed follow-up time* Condom use at last sex: at endline TRY = 52.1% vs control = 44.3% (N.S)* Able to refuse sex to spouse/partner: at endline TRY = 80.3% vs control = 71.6% ( p  < 0.05) Souverein et al [62]Comprehensive sex worker community mobilisation, including STI prevention and treatment, crisis support and microfinanceIndiaFemale sex workers17,092; using entry and exit from systems, 2005–2010; descriptive study* Significant reduction in STIs ( p  < 0.001)*Increase in condom use ( p  < 0.001) Odek et al [63]Existing peer education intervention on HIV; microfinanceKenyaFemale sex workers; av. age: 41.09227 women; 2-year follow-up; pre-test, post-test; no randomisation* Reduction in number of sexual partners in past week ( p  < 0.001)* Reduction in number of casual partners ( p  = 0.098)* Reduction in number of regular partners ( p  < 0.001)* No impact on condom use with casual partners ( p  = 0.727)* Increase in condom use with regular partners ( p  = 0.031) Witte et al [64]34-session HIV sexual risk reduction intervention; microfinance; vocational trainingMongoliaFemale sex workers; av.…”

“…Seven studies were undertaken in SSA, three in Asia and one in Latin America. Study design varied: six were RCTs [54–57,60,64], four were quasi-experimental [59,61–63,76] and one was cross-sectional [58]. The additional gender transformative components varied widely.…”

“…For HIV-related outcomes, six reported significant improvements in condoms use [23,58,60,62–64], while two reported non-significant improvements [59,77] and one reported no change [56]. Other changes in reported HIV risks included a reduction in STIs [62] and a reduction in the number of sexual partners [63,64], all in sex worker populations.…”

HIV prevention among female sex workers in Africa

“…Experience from Kenya states that 20% of sex workers involved in a study stopped sex work after accessing microcredit (Costigan, Odek, Ngugi, Oneko, Moses & Plummer, et al 2002). In both west and east Africa, providing opportunities for sex workers to diversify their sources of income lead to a reduction in the number of commercial sex partners (Odek, Busza, Morris, Cleland, Ngugi & Ferguson 2009) Discrimination, stigma and violence (verbal, physical and sexual) by law enforcement officers, clients, family members, community members and service providers negatively affect the health of sex workers and increases their vulnerability to HIV (Shannon & Csete 2010). Addressing such issues can be challenging, but efforts to change policy frameworks and sensitise policy makers, service providers, law enforcement agencies and communities to the effects of discrimination, exclusion and associated violence are essential if real change is desired (Richter 2010).…”

Self-Efficacy Mediates the Association between Partner Trust and Condom Usage among Females but not Males in a Kenyan Cohort of Orphan and Vulnerable Youth

“…African Journal of Reproductive Health June 2016; 20 (2): 95 between older men and younger women 3 , professional sex workers and clients 5 , men who have sex with men 6 , and among people who have concurrent sex partnerships 7 . While people fitting these categories have been targeted by public health programs and policies in order to decrease HIV incidence, in Kenya most new HIV infections occur among heterosexual couples in a stable partnership 8 .…”