The evaluation of the JEWEL project: An innovative economic enhancement and HIV prevention intervention study targeting drug using women involved in prostitution

Abstract

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.

Income generating activities of people who inject drugs

“…It is important that policy makers recognize these realities and balance the perceived benefits of criminal-prohibition with other associated outcomes, such as increased levels of crime and IDU engagement in risky prohibited income generating activities While this analysis suggests that higher intensity addiction and the costs associated with purchasing illegal drugs are central factors influencing active IDU to engage in prohibited income generating activities, the lack of available alternative income sources is also an important aspect of this relationship. Many active IDU have difficulty finding sufficient legitimate paid work due in part to unstable housing, limited employable skills and low levels of education (Sherman et al, 2006). One alternative for these individuals is to obtain income assistance and other forms of social assistance; however, income analysis in the present study found the median income from social assistance to be $800, which for most IDU is insufficient to support a secure living and habitual drug consumption (Casavant and Collin, 2001;Fischer et al, 1999).…”

“…This would involve supporting the development of legitimate means of earning income through various low threshold employment opportunities and skill building measures. A recent intervention designed to economically empower drug addicted sex trade workers to develop alternative legitimate sources of income has been shown to have a positive influence on reducing involvement in the sex trade industry (Sherman et al, 2006). Alternatively, policy makers could intervene by providing addiction prescription and substitution therapies to individuals with markers of serious addiction to decrease their reliance on, and subsequent need to purchase, street drugs.…”

“…High levels of prohibited activity have also been found to coincide with periods of heavy drug consumption (Grapendaal, et al, 1995;Nurco et al, 1985;Ball et al, 1983). Additionally a lack of employable job skills, past criminal histories and high profits derived from drug dealing have been identified as factors influencing substance dependent individuals to engage in prohibited income generating behaviour (Sherman et al, 2006;Rothbard et al, 1999;Bretteville-Jensen and Sutton, 1996;Hammersley et al, 1989).…”

Relationship Power and Sexual Risk among Women in Community-Based Substance Abuse Treatment

“…Negotiating power (i.e., safer sex communication, ability to insist on condom use, discussion of previous sexual partners) and economic independence were both associated with increased condom use. 50 These authors, along with promising results from an economic empowerment and HIV prevention intervention study with commercial sex workers in the USA, 51 indicate that empowering women through income-generating activities and negotiation skill building may influence safer sex behaviors. These findings and others suggest that structural-level interventions show potential to increase economic resources and decrease HIV/ AIDS risks, particularly for disenfranchised women.…”

Social capital and the decline in HIV transmission – A case study in three villages in the Kagera region of Tanzania

“…That women's empowerment and other interventions that address the socioeconomic vulnerability of women may contribute to reductions in HIV risk behaviour is also emphasised in a study from South Africa (Pronyk et al, 2008c). In the US context economic empowerment programmes enabling women to earn income, resulted in reduction in sexual partners and as well as commercial sex (Sherman, German, Cheng, Marks & Bailey-Kloche, 2006). …”