Abstract
Innovative combination HIV-prevention and microfinance interventions are needed to address the high incidence of HIV and other STIs among women who use drugs. Project Nova is a cluster-randomized, controlled trial for drug-using female sex workers in two cities in Kazakhstan. The intervention was adapted from prior interventions for women at high risk for HIV and tailored to meet the needs of female sex workers who use injection or noninjection drugs. We describe the development and implementation of the Nova intervention and detail its components: HIV-risk reduction, financial-literacy training, vocational training, and a matched-savings program. We discuss session-attendance rates, barriers to engagement, challenges that arose during the sessions, and the solutions implemented. Our findings show that it is feasible to implement a combination HIV-prevention and microfinance intervention with highly vulnerable women such as these, and to address implementation challenges successfully.
Resumen
Existe la necesidad de una intervención innovadora que combine intervenciones de prevención del VIH y microfinanzas para manejar la alta incidencia de VIH u otras enfermedades de transmisión sexual con mujeres que usan drogas. Nova es un Ensayo Clínico Controlado Aleatorio Grupal para mujeres trabajadoras sexuales que usan drogas en dos ciudades en Kazakstán. La intervención fue adaptada de otras intervenciones anteriores dirigidas a mujeres con alto riesgo de contraer VIH y diseñada para satisfacer las necesidades de las mujeres trabajadoras sexuales que se inyectan o consumen drogas. Este documento describe el desarrollo y la implementación de la intervención Nova. Describimos los componentes de la intervención Nova, los cuales incluyen reducción del riesgo de VIH, entrenamiento en conocimiento financiero, entrenamiento vocacional, y programa de ahorros igualados. También describimos las tasas de asistencia a las sesiones, barreras para la participación, desafíos durante la implementación de las sesiones, y las soluciones implementadas. Los resultados muestran que es posible implementar una combinación de intervención de reducción del riesgo de VIH y micro-finanzas con mujeres altamente vulnerables y resolver problemas para manejar exitosamente los desafíos de la implementación.
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References
Ministry of Healthcare of the Republic of Kazakhstan. Population size estimate of people who inject drugs (PWID) in the Republic of Kazakhstan. Almaty: Republican Center on Prevention and Control of AIDS; 2016.
Ministry of Healthcare of the Republic of Kazakhstan. National report on the AIDS response. Almaty: Republican Center on Prevention and Control of AIDS; 2016.
UNAIDS. UNAIDS report on the global AIDS epidemic. Geneva: Joint United Nations Programme on HIV/AIDS; 2010.
UNAIDS. Global report: UNAIDS report on the global AIDS epidemic. Geneva: UNAIDS; 2013.
Baral S, Beyrer C, Muessig K, et al. Burden of HIV among female sex workers in low-income and middle-income countries: a systematic review and meta-analysis. Lancet Infect Dis. 2012;12(7):538–49.
Baral S, Todd CS, Aumakhan B, Lloyd J, Delegchoimbol A, Sabin K. HIV among female sex workers in the Central Asian Republics, Afghanistan, and Mongolia: contexts and convergence with drug use. Drug Alcohol Depend. 2013;132:S13–6.
Pinkham S, Malinowska-Sempruch K. Women, harm reduction and HIV. Rep Health Matters. 2008;16(31):168–81.
Stratford D, Mizuno Y, Williams K, Courtenay-Quirk C, O’Leary A. Addressing poverty as risk for disease: recommendations from CDC’s consultation on microenterprise as HIV prevention. Public Health Rep. 2008;123(1):9.
Shannon K, Kerr T, Allinott S, Chettiar J, Shoveller J, Tyndall MW. Social and structural violence and power relations in mitigating HIV risk of drug-using women in survival sex work. Soc Sci Med. 2008;66:911–21.
El-Bassel N, Terlikbaeva A, Pinkham S. HIV and women who use drugs: double neglect, double risk. Lancet. 2010;376(9738):312–4.
Rhodes T, Wagner K, Strathdee SA, Shannon K, Davidson P, Bourgois P. Structural violence and structural vulnerability within the risk environment: theoretical and methodological perspectives for a social epidemiology of HIV risk among injection drug users and sex workers. In: Rethinking Soc Epidemiology. Dordrecht: Springer; 2012. P. 205–230.
Blankenship KM, Koester S. Criminal law, policing policy, and HIV risk in female street sex workers and injection drug users. J Law Med Ethics. 2002;30(4):548–59.
Wechsberg WM, Krupitsky E, Romanova T, et al. Double jeopardy—drug and sex risks among Russian women who inject drugs: initial feasibility and efficacy results of a small randomized controlled trial. Subst Abuse Treat Pr. 2012;7(1):1.
El-Bassel N, Strathdee SA, El Sadr WM. HIV and people who use drugs in central Asia: confronting the perfect storm. Drug Alcohol Depend. 2013;132(1):S2–6.
Dworkin SL, Blankenship K. Microfinance and HIV/AIDS prevention: assessing its promise and limitations. AIDS Behav. 2009;13(3):462–9.
Kennedy CE, Fonner VA, O’Reilly KR, Sweat MD. A systematic review of income generation interventions, including microfinance and vocational skills training, for HIV prevention. AIDS Care. 2014;26(6):659–73.
Arrivillaga M, Salcedo JP. A systematic review of microfinance-based interventions for HIV/AIDS prevention. AIDS Educ Prev. 2014;26(1):13–27.
Cui RR, Lee R, Thirumurthy H, Muessig KE, Tucker JD. Microenterprise development interventions for sexual risk reduction: a systematic review. AIDS Behav. 2013;17(9):2864–77.
Pronyk PM, Kim JC, Abramsky T, et al. A combined microfinance and training intervention can reduce HIV risk behavior in young female participants. AIDS. 2008;22:1659–65.
Witte SS, Aira T, Tsai LC, et al. Efficacy of a savings-led microfinance intervention to reduce sexual risk for HIV among women engaged in sex work: a randomized clinical trial. Am J Public Health. 2015;105(3):e95–102.
Sherman SG, German D, Cheng Y, Marks M, Bailey-Kloche M. The evaluation of the JEWEL project: an innovative economic enhancement and HIV prevention intervention study targeting drug using women involved in prostitution. AIDS Care. 2006;18(1):1–11.
Sherman SG, Srikrishnan AK, Rivett KA, Liu SH, Solomon S, Celentano DD. Acceptability of a microenterprise intervention among female sex workers in Chennai, India. AIDS Behav. 2010;14(3):649–57.
Frantz D. Drug use begetting AIDS in Central Asia. New York Times. August 5, 2001.
Buzurukov A. HIV/AIDS epidemic: time is running out for Central Asia. Central Asia/Caucasus Analyst. 2002.
McCrimmon T, Witte S, Mergenova G, et al. Microfinance for women at high risk for HIV in Kazakhstan: study protocol for a cluster-randomized controlled trial. BMC Trials. 2008;19(1):187.
Bandura A. Social foundations of thought and action: a social and cognitive theory. Englewood Cliffs, NJ: Prentice-Hall; 1986.
Bandura A. Self-efficacy: the exercise of control. New York: W. H. Freeman; 1997.
Marlatt GA, Witkiewitz K. Update on harm-reduction policy and intervention research. Annu Rev Clin Psychol. 2010;6(1):591–606.
Ti L, Kerr T. The impact of harm reduction on HIV and illicit drug use. Harm Reduct J. 2014;11(1):7.
Sherraden M. Stakeholding: notes on a theory of welfare based on assets. Soc Ser Rev. 1990;64(4):580–601.
Sherraden M. Assets and the poor: a new American welfare policy. New York: M. E. Sharpe; 1991.
Oosterhoff P, Nguyen T, Pham N, Wright P, Hardon A. Can micro-credit empower HIV + women? An exploratory case study in Northern Vietnam. Womens Health Urban Life. 2008;7(1):40–55.
Amin R, Becker S. NGO-promoted microcredit programs and women’s empowerment in rural Bangladesh: quantitative and qualitative evidence. J Dev Areas. 1998;32(2):221–36.
Ssewamala F, Sherraden M. Integrating saving into microenterprise programs for the poor: do institutions matter? Soc Ser Rev. 2004;78(3):404–29.
Ssewamala FM, Chang-Keun H, Neilands T, Ismayilova L, Sperber E. The effect of economic assets on sexual risk taking intentions among orphaned adolescents in Uganda. Am J Public Health Rep. 2010;100(3):483–9.
Ssewamala FM, Chang-Keun H, Neilands T. Asset ownership and health and mental health functioning among AIDS-orphaned adolescents: findings from a randomized clinical trial in rural Uganda. Soc Sci Med. 2009;69(2):191–8.
Ssewamala FM, Alicea S, Bannon W, Ismayilova L. A novel economic intervention to reduce HIV risks among school-going AIDS-orphaned children in rural Uganda. J Adolesc Health. 2008;42(1):102–4.
Odek WO, Busza J, Morris CN, Cleland J, Ngugi EN, Ferguson AG. Effects of micro-enterprise services on HIV risk behavior among female sex workers in Kenya’s urban slums. AIDS Behav. 2009;13:449–61.
Karlan D, Valdivia M. Teaching entrepreneurship: impact of business training on microfinance clients and institutions. Rev Econ Stat. 2011;93(2):510–27.
El-Bassel N, Gilbert L, Goddard-Eckrich D, et al. Efficacy of a group-based multimedia HIV prevention intervention for drug-involved women under community supervision: project worth. PLoS ONE. 2014;9(11):e111528.
El-Bassel N, Gilbert L, Terlikbayeva A, et al. Effects of a couple-based intervention to reduce risks for HIV, HCV, and STIs among drug-involved heterosexual couples in Kazakhstan: a randomized controlled trial. J Acquir Immune Defic Syndr. 2014;67(2):196–203.
Opportunities Microfinance. Global financial education program. Washington, DC: Microfinance Opportunities; 2002.
Tsai LC, Witte SS, Aira T, Riedel M, Offringa R, Chang M. Efficacy of a microsavings intervention in increasing income and reducing economic dependence upon sex work among women in Mongolia. Int Soc Work. 2015;61(1):6–22.
El-Bassel N, Jemmott JB, Landis JR, et al. National Institute of Mental Health multisite Eban HIV/STD prevention intervention for African American HIV serodiscordant couples: a cluster randomized trial. Arch Intern Med. 2010;170(17):1594–601.
El-Bassel N, Witte SS, Gilbert L, et al. The efficacy of a relationship-based HIV/STD prevention program for heterosexual couples. Am J Public Health. 2003;93(6):963–9.
World Bank. Global economic prospects: weak investments in uncertain times. Washington, DC: International Bank for Reconstruction and Development/World Bank; 2017.
WHO, UNFPA, UNAIDS, NSWP, Bank W, UNDP. Implementing comprehensive HIV/STI programmes with sex workers: practical approaches from collaborative interventions. Geneva: World Health Organization; 2013.
Network of Sex Work Projects. Policy brief: impact of criminalization of sex workers’ vulnerability to HIV and violence; 2017.
El-Bassel N, Gilbert L, Witte S, Wu E, Chang M. Intimate partner violence and HIV among drug-involved women: contexts linking these two epidemics—challenges and implications for prevention and treatment. Subst Use Misuse. 2011;46(2–3):295–306.
Weaver TL, Gilbert L, El-Bassel N, Resnick HS, Noursi S. Identifying and intervening with substance-using women exposed to intimate partner violence: phenomenology, comorbidities, and integrated approaches within primary care and other agency settings. J Women’s Health. 2015;24(1):51–6.
Acknowledgements
The authors would like to thank the study participants who shared their time and experiences with Project Nova and the project staff who assisted with recruitment, data collection and project implementation. We would like to thank Republican Center on Prevention and Control of AIDS and Dr. Baiserkin, city AIDS center of Almaty, Temirtau and Karaganda for collaboration. We appreciate assistance in recruitment and support of our study participants of NGO “Moi Dom” and “Shapagat” in Temirtau, NGO “Doverie” in Almaty.
Funding
This study was funded by the National Institute on Drug Abuse (NIDA), Grant No. R01 DA036514, to Drs. Nabila El-Bassel and Susan Witte (Multiple PIs). The funders had no involvement in the design of the study or in collection, analysis and interpretation of data.
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All procedures performed in studies involving human participants were in accordance with the ethical standards of Columbia University’s IRB and the ethics committee of the Kazakhstan School of Public Health (KSPH), and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
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Informed consent was obtained from all individual participants included in this study.
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Mergenova, G., El-Bassel, N., McCrimmon, T. et al. Project Nova: A Combination HIV Prevention and Microfinance Intervention for Women Who Engage in Sex Work and Use Drugs in Kazakhstan. AIDS Behav 23, 1–14 (2019). https://doi.org/10.1007/s10461-018-2268-1
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DOI: https://doi.org/10.1007/s10461-018-2268-1