Reducing Sexual HIV/STI Risk and Harmful Alcohol Use Among Female Sex Workers in Mongolia: A Randomized Clinical Trial

Abstract

This study examined the efficacy of an enhanced intervention to reduce sexual risk of HIV/STI and harmful alcohol use among female sex workers in Mongolia. Women (n = 166) were recruited and randomized to either (1) a relationship-based HIV sexual risk reduction intervention; (2) the same sexual risk reduction intervention plus motivational interviewing; or (3) a control condition focused on wellness promotion. At three and six month follow-up, both treatment interventions and the wellness promotion condition were effective in reducing the percentage and the number of unprotected acts of vaginal sex with paying partners in the past 90 days. All three conditions demonstrated efficacy in reducing harmful alcohol use. No significant differences in effects were observed between conditions. Findings suggest that even low impact behavioral interventions can achieve considerable reductions of HIV/STI risk and harmful alcohol use with a highly vulnerable population in a low resourced setting.

Efficacy of a Savings-Led Microfinance Intervention to Reduce Sexual Risk for HIV Among Women Engaged in Sex Work: A Randomized Clinical Trial

“…In urban Ulaanbaatar, residents construct gers in congregated areas called ger districts.) As suggested by Peterson et al, 29 we first developed a list of street-based venues informed by participants in previous studies 27 and community advisory board members. After compiling a list of sites, the study team conducted observations over several weeks at varying times of day to monitor how many women were soliciting at each site.…”

“…For this reason, we used a group randomization schema implemented successfully with the target population in a previous trial. 27 When 10 eligible women were accrued, we used a randomnumber generator to randomly assign each new group of participants to either the HIVSRR plus microfinance intervention (treatment) or HIVSRR alone (control). Using the generator, we sought to balance group assignments evenly across a total estimated number of groups needed to provide intervention to all participants.…”

“…The 4 HIVSSR sessions focused on building knowledge and skills such as identifying safety risks, negotiating safer sex, and avoiding unsafe situations. 27 Treatment condition. The Undarga Program is the HIVSSR intervention enhanced with a microfinance component that was tested in this study.…”

“…27 These sessions are followed by 12 financial literacy sessions, led 3 times per week by trained research assistants. Sessions focus on banking services, savings, budgeting, debt management, and financial negotiation.…”

“…25,26 Participants in a previous trial testing an individual-level HIV risk reduction program indicated that although they benefited from risk reduction skills and safety components, they were often offered more money for unprotected sex, and their goals included transitioning out of sex work to alternative forms of employment. 26,27 This study builds on this work by testing a combination microfinance and HIV risk reduction intervention. This intervention is novel in that it incorporates a savings-based approach to microfinance, enabling participants to build assets faster and pay for life-cycle events without accumulating debt or fostering an overreliance on microloans.…”