Economic Abuse and Care-seeking Practices for HIV and Financial Support Services in Women Employed by Sex Work: A Cross-Sectional Baseline Assessment of a Clinical Trial Cohort in Uganda

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  • Jennings Mayo-Wilson, Larissa
  • Yen, Bing-Jie
    • ORCID: https://orcid.org/0000-0002-4024-1314
    • Other Affiliation: Department of Applied Health Science, Center for Sexual Health Promotion, Indiana University School of Public Health, Bloomington, IN, USA
  • Nabunya, Proscovia
    • Other Affiliation: Washington University in St. Louis, Brown School, St. Louis, MO, USA
  • Bahar, Ozge Sensoy
    • Other Affiliation: Washington University in St. Louis, Brown School, St. Louis, MO, USA
  • Wright, Brittanni N.
    • ORCID: https://orcid.org/0000-0003-2051-8205
    • Other Affiliation: Department of Applied Health Science, Center for Sexual Health Promotion, Indiana University School of Public Health, Bloomington, IN, USA
  • Kiyingi, Joshua
    • Other Affiliation: Washington University in St. Louis, Brown School, St. Louis, MO, USA
  • Filippone, Prema L.
    • Other Affiliation: Columbia School of Social Work, New York, NY, USA
  • Mwebembezi, Abel
    • Other Affiliation: International Center for Child Health and Development, Masaka, Uganda
  • Kagaayi, Joseph
    • Other Affiliation: Rakai Health Sciences Program, Kalisizo, Uganda
  • Tozan, Yesim
    • Other Affiliation: New York University College of Global Public Health, New York, NY, USA
  • Nabayinda, Josephine
    • Other Affiliation: Washington University in St. Louis, Brown School, St. Louis, MO, USA
  • Witte, Susan S.
    • Other Affiliation: Columbia School of Social Work, New York, NY, USA
  • Ssewamala, Fred M.
    • Other Affiliation: Washington University in St. Louis, Brown School, St. Louis, MO, USA
Abstract
  • Economic hardship is a driver of entry into sex work, which is associated with high HIV risk. Yet, little is known about economic abuse in women employed by sex work (WESW) and its relationship to uptake of HIV prevention and financial support services. This study used cross-sectional baseline data from a multisite, longitudinal clinical trial that tests the efficacy of adding economic empowerment to traditional HIV risk reduction education on HIV incidence in 542 WESW. Mixed effects logistic and linear regressions were used to examine associations in reported economic abuse by demographic characteristics, sexual behaviors, HIV care-seeking, and financial care-seeking. Mean age was 31.4 years. Most WESW were unmarried (74%) and had less than primary school education (64%). 48% had savings, and 72% had debt. 93% reported at least one economic abuse incident. Common incidents included being forced to ask for money (80%), having financial information kept from them (61%), and being forced to disclose how money was spent (56%). WESW also reported partners/relatives spending money needed for bills (45%), not paying bills (38%), threatening them to quit their job(s) (38%), and using physical violence when earning income (24%). Married/partnered WESW (OR = 2.68, 95% CI:1.60–4.48), those with debt (OR = 1.70, 95% CI:1.04–2.77), and those with sex-work bosses (OR = 1.90, 95% CI:1.07–3.38) had higher economic abuse. Condomless sex (β = +4.43, p < .05) was higher among WESW experiencing economic abuse, who also had lower odds of initiating PrEP (OR = .39, 95% CI:.17–.89). WESW experiencing economic abuse were also more likely to ask for cash among relatives (OR = 2.36, 95% CI:1.13–4.94) or banks (OR = 2.12, 95% CI:1.11–4.03). The high prevalence of HIV and economic abuse in WESW underscores the importance of integrating financial empowerment in HIV risk reduction interventions for WESW, including education about economic abuse and strategies to address it. Programs focusing on violence against women should also consider economic barriers to accessing HIV prevention services.
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Resource type
  • Article
Rights statement
  • In Copyright
Rights holder
  • SAGE Publications
License
  • Attribution 4.0 International
Journal title
  • Journal of Interpersonal Violence
Journal volume
  • 38
Journal issue
  • 1-2
Page start
  • NP1920
Page end
  • NP1949
Funder
  • National Institute of Mental Health
ISSN
  • 1552-6518
Copyright date
  • 2022
Publisher
  • SAGE Publications

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