“There is no other option; we have to feed our families…who else would do it?”: The Financial Lives of Women Engaging in Sex Work in Ulaanbaatar, Mongolia

Abstract

Introduction: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.

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

“…As both primary caregivers and the primary income source for their families, 40 women reported missing sessions because of family emergencies, their poor health or that of their children or parents, or alcohol use. Such daily challenges may not be surmountable, but methods to consolidate the intervention to fewer sessions or to offer weekend workshop formats or use of technology such as mobile phones to deliver session content could be tested as more manageable alternatives.…”

Understanding the financial lives of female sex workers in Abidjan, Côte d’Ivoire: implications for economic strengthening interventions for HIV prevention

“…Given the importance of "upstream" drivers of HIV (Auerbach, Parkhurst, & Caceres, 2011;Gupta, Ogden, & Warner, 2011), there have been calls to address structural issues and economic factors that impede or facilitate HIV risk-reduction (Blankenship, Friedman, Dworkin, & Mantell, 2006; Joint United Nations Programme on HIV/ AIDS, 2012; Sumartojo, 2000;Sumartojo, Doll, Holtgrave, Gayle, & Merson, 2000;WHO, 2005), but there is surprisingly little information on the financial needs and habits of FSWs, aside from two examples from Asia (Ngo et al, 2007;Tsai et al, 2013). Integrated economic strengthening approaches to HIV prevention for FSWs have proceeded nonetheless, to mixed results.…”

“…However, contextual, social, and structural factors such as stigma, criminalization, discriminatory policies, gender-based violence, and poverty further exacerbate sex workers' vulnerability to HIV (Baral et al, 2012;Papworth et al, 2013;WHO, 2015) by reducing opportunities for or disincentivizing HIV risk-reduction practices. For example, underlying economic determinants of HIV risk affect women's decisions about whether and how they will take part in sex work (Baleta, 2015;Bamba et al, 2014;Karamouzian et al, 2016;Kiernan, Mishori, & Masoda, 2016;Scorgie et al, 2012;Strathdee, Crago, Butler, Bekker, & Beyrer, 2015), and many economic strengthening programs for FSWs are premised on observations that economic vulnerability and food insecurity can lead to riskier sexual transactions, including condomless and anal sex (Beckham, Shembilu, Winch, Beyrer, & Kerrigan, 2015;Cange et al, 2017;Elmes et al, 2014;Scorgie et al, 2012;Tsai et al, 2013;Tucker, Krishna, Prabhakar, Panyam, & Anand, 2012;Veldhuijzen et al, 2011;Weiser et al, 2007). Rather than attempting to directly change proximal-level sexual risk behaviors, these economic strengthening-focused HIV prevention programs attempt to change distal economic factors, by stabilizing income and/or increasing economic resilience, as a means of empowering women to reduce financially-driven decisions about sex partners or practices (Ndoye, 2010;Odek et al, 2009) (see Figure 1).…”

Correlates of unprotected sex with male clients among female sex workers in 13 Mexican cities

“…Previous research has shown associations between sexual risk behavior with clients and lower education (Fernandes et al, 2014), older age (Hao et al, 2014), being married (Kamal, Hassan, & Salikon, 2013), and having dependent children (Reed et al, 2013; Tsai et al, 2013; Witte, Batsukh, & Chang, 2010). Substance use has also been associated with increased vulnerability among FSWs to HIV/STIs (Medhi et al, 2013; Strathdee et al, 2008).…”