Savings-led microfinance programme leads to lower sexual risk among sex workers 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.

Witte SS, Aira T, Tsai L, Riedel M, Offringa R, Chang M, El-Bassel N, Ssewamala F. Am J Public Health. 2015 Mar;105(3):e95-e102. doi: 10.2105/AJPH.2014.302291. Epub 2015 Jan 20.

Objectives: We tested whether a structural intervention combining savings-led microfinance and HIV prevention components would achieve enhanced reductions in sexual risk among women engaging in street-based sex work in Ulaanbaatar, Mongolia, compared with an HIV prevention intervention alone.

Methods: Between November 2011 and August 2012, we randomized 107 eligible women who completed baseline assessments to either a 4-session HIV sexual risk reduction intervention (HIVSRR) alone (n = 50) or a 34-session HIVSRR plus a savings-led microfinance intervention (n = 57). At 3- and 6-month follow-up assessments, participants reported unprotected acts of vaginal intercourse with paying partners and number of paying partners with whom they engaged in sexual intercourse in the previous 90 days. Using Poisson and zero-inflated Poisson model regressions, we examined the effects of assignment to treatment versus control condition on outcomes.

Results: At 6-month follow-up, the HIVSRR plus microfinance participants reported significantly fewer paying sexual partners and were more likely to report zero unprotected vaginal sex acts with paying sexual partners.

Conclusions: Findings advance the HIV prevention repertoire for women, demonstrating that risk reduction may be achieved through a structural intervention that relies on asset building, including savings, and alternatives to income from sex work.

Abstract access [1]

Editor’s notes: This study on sexual risk among sex workers in Ulaanbaatar, Mongolia, contributes to evidence that economic empowerment reduces HIV risk. Mongolia has a low prevalence of HIV. But it is considered highly vulnerable to the spread of HIV. This suggests that such programmes should be implemented to prevent concentrated epidemics becoming generalised epidemics. The authors acknowledge that while microfinance might be economically empowering it may represent “saving down”, which can keep women in debt and in a cycle of poverty and a reliance on sex work. The trial tested whether increasing financial literacy, business development knowledge and skills and personal savings would lead to more significant reductions in sexual risk behaviours than a sexual risk reduction programme alone. Groups of sex workers were randomised to receive either a four session HIV sexual risk reduction programme (HIVSRR) or HIVSRR plus a savings-led microfinance programme. The HIVSRR alone involved the delivery of two sessions per week for two weeks and focused on skills to develop self-efficacy for risk reduction. The HIVSRR plus savings-led microfinance programme involved the four sessions on self-efficacy for risk reduction, followed by 12 financial literacy sessions three times a week and then 12 sessions of business development training three times a week. The activities were tested at three months and six months to explore the short time impact on sexual risk. The authors found that women who received the HIVSSRR plus savings-led microfinance programme reported greater reductions in number of paying sexual partners and fewer sexual partners at six months follow up. These women were also more likely to report no unprotected vaginal sex acts at six months follow up. This study is important in illustrating that as a structural programme, the provision of microfinance is more effective if women are provided with skills to manage finances and to save money instead of ending up in a cycle of debt repayment. This has important implications for other microfinance programmes, such as programmes to reduce gender-based violence.

Asia [5]
Mongolia [6]
  • [7]