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Effects of Micro-Enterprise Services on HIV Risk Behaviour Among Female Sex Workers in Kenya’s Urban Slums

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Abstract

This study assessed individual-level effects of adding micro-enterprise services to a peer-mediated HIV/AIDS intervention among 227 female sex workers (FSWs) in Kenya. Survey data were collected in May–July 2003 and July–August 2005. Two-thirds of participants had operational businesses by end-line survey. Nearly half reported to have stopped sex work. Self-reported weekly mean number of all sexual partners changed from 3.26 (SD 2.45) at baseline to 1.84 (SD 2.15) at end-line survey (P < 0.001). Weekly mean number of casual partners did not change significantly. Weekly mean number of regular partners changed from 1.96 (SD 1.86) to 0.73 (SD 0.98) over the follow-up period (P < 0.001). Consistent condom use with regular partners increased by 18.5% and remained above 90% with casual partners. Micro-enterprise services may empower FSWs by giving them an alternative livelihood when they wish to exit or reduce reliance on sex work. Determinants of successful business operation by FSWs deserve further research.

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References

  • Berenbach, S., & Guzman, D. (1994). The solidarity group experience worldwide. In M. Otero & E. Rhyne (Eds.), The new world of microenterprise finance: Building healthy financial institutions for the poor (pp. 119–139). Connecticut: Kumarian Press.

    Google Scholar 

  • Carr, M. (2000). Women’s economic empowerment: Key to development. In L. De Pauli (Ed.), Women’s empowerment and economic justice: Reflecting on experience on Latin America and the Caribbean (pp. 1–15). New York: UNIFEM.

    Google Scholar 

  • Celentano, D. D., Nelson, K. E., Lyles, C. M., Beyrer, C., Eiumtrakul, S., Go, V. F., et al. (1998). Decreasing incidence of HIV and sexually transmitted diseases in young Thai men: Evidence for success of the HIV/AIDS control and prevention program. AIDS (London, England), 12(5), F29–F36. doi:10.1097/00002030-199805000-00004.

    CAS  Google Scholar 

  • Central Bureau of Statistics (CBS) Kenya, Ministry of Health (MOH) Kenya, & ORC Macro. (2004). Kenya demographic and health survey 2003. Calverton, MD: CBS, MOH and ORC Macro.

    Google Scholar 

  • Cheluget, B., Baltazar, G., Orege, P., Ibrahim, M., Marum, L. H., & Stover, J. (2006). Evidence for population level declines in adult HIV prevalence in Kenya. Sexually Transmitted Infections, 82(Suppl. 1), i21–i26. doi:10.1136/sti.2005.015990.

    Article  PubMed  Google Scholar 

  • Chen, M. A. (1997). A guide for assessing the impact of microenterprise services at the individual level. Microenterprise Impact Project, USAID. Available at: http://www.usaidmicro.org/pubs/aims/. Accessed 5 July 2004.

  • Chowdhury, A. M. R., & Bhuiya, A. (2001). Do poverty alleviation programmes reduce inequity in health: Lessons from Bangladesh. In D. A. Leon & G. Walt (Eds.), Poverty, inequity and health (pp. 312–332). Oxford: Oxford University Press.

    Google Scholar 

  • Day, S., & Ward, H. (1997). Sex workers and the control of sexually transmitted disease. Genitourinary Medicine, 73(3), 155–156.

    Google Scholar 

  • Des Jarlais, D. C., Lyles, C., Crepaz, N., & TREND Team. (2004). Improving the reporting of quality of nonrandomized evaluations of behavioural and public health interventions: the TREND statement. American Journal of Public Health, 94(3), 361–366.

    Article  PubMed  Google Scholar 

  • Elmore-Meegan, M., Conroy, R. M., & Agala, C. B. (2004). Sex workers in Kenya: Numbers of clients and associated risks: an exploratory survey. Reproductive Health Matters, 12(23), 50–57. doi:10.1016/S0968-8080(04)23125-1.

    Article  PubMed  Google Scholar 

  • Ferguson, A. G., & Morris, C. N. (2007). Mapping transactional sex on the Northern corridor highway in Kenya. Health & Place, 13, 504–519. doi:10.1016/j.healthplace.2006.05.009.

    Article  Google Scholar 

  • Fonck, K., Kaul, R., Kimani, J., Keli, F., MacDonald, K. S., Ronald, A. R., et al. (2000). A randomized, placebo controlled trial of monthly azithromycin prophylaxis to prevent sexually transmitted infections and HIV-1 in Kenyan sex workers; study design and baseline findings. International Journal of STD and AIDS, 11, 804–811. doi:10.1258/0956462001915327.

    Article  PubMed  CAS  Google Scholar 

  • Government of Kenya (GOK). (2007). Economic survey. Nairobi: Government Printers.

    Google Scholar 

  • Gupta, G. R. (2002). How men’s power over women fuels the HIV epidemic. British Medical Journal, 324, 183–184. doi:10.1136/bmj.324.7331.183.

    Article  PubMed  Google Scholar 

  • Hulme, D., Montgomery, R., & Bhattacharya, D. (1996). Mutual finance and the poor: Study of the federation thrift and credit cooperatives in Sri Lanka (SANASA). In D. Hulme & P. Mosley (Eds.), Finance against poverty: Country case studies (Vol. 2, pp. 228–315). London: Routledge.

    Google Scholar 

  • Karim, Q. A., Karim, S. S., Soldan, K., & Zondi, M. (1995). Reducing the risk of HIV infection among South African sex workers: Socioeconomic and gender barriers. American Journal of Public Health, 85, 1521–1525.

    Article  PubMed  CAS  Google Scholar 

  • Mitulla, W. (2004). A review of street trade in Africa. Unpublished manuscript. Cambridge, MA. WIEGO. Available at: http://www.wiego.org/publications/. Retrieved 23 June 2006.

  • MkNelly, B. & Dunford, C. (1998). Impact of credit with education on mothers and their children’s nutrition: Lower Pra Rural Bank Credit Program with Education in Ghana. Freedom from Hunger Research Paper No. 4. Davis, CA: Freedom from Hunger.

  • Morris, C. N., & Ferguson, A. (2006). Estimation of the sexual transmission of HIV in Kenya and Uganda on the Trans-Africa highway: The continuing role for prevention in high risk groups. Sexually Transmitted Infections, 82(5), 368–371. doi:10.1136/sti.2006.020933.

    Article  PubMed  CAS  Google Scholar 

  • National AIDS and STI Control Programme (NASCOP), Ministry of Health, Kenya. (2005). AIDS in Kenya (7th ed.). Nairobi: NASCOP.

    Google Scholar 

  • National AIDS and STI Control Programme (NASCOP), Ministry of Health, Kenya. (2008). Kenya AIDS indicator survey 2007: Preliminary report. Nairobi: NASCOP.

    Google Scholar 

  • Ngugi, E. N., Wilson, D., Sebstad, J., Plummer, F. A., & Moses, S. (1996). Focused peer-mediated educational programs among FSWs to reduce sexually transmitted disease and human immunodeficiency virus transmission in Kenya and Zimbabwe. The Journal of Infectious Diseases, 174(Suppl. 2), S240–S247.

    PubMed  Google Scholar 

  • Odek, W. O., Costigan, A., Ngugi, E. N., Moses, S., Plummer, F. A., & Oneko, M. (2002). Adapting micro-finance to HIV vulnerable communities: Lessons for scaling up from a Kenyan pilot project targeting FSWs. International Conference on AIDS, Barcelona, Spain, July 7–12; 14: Abstract no. MoOrF1046.

  • Odek, W. O., Ngugi, E. N., Morris, C., Ferguson, A., & Oneko, M. (2004). Economic necessity and STD/HIV risk and vulnerability among sex workers in Nairobi, Kenya: A justification for incorporating micro-enterprise development services into sex worker interventions. International Conference on AIDS, Bangkok, Thailand, July 11–16; 15: Abstract no. ThPeD7604.

  • Olusoji, A., Hercht, R., Njobvu, E., & Soucat, A. (2001). AIDS, poverty reduction and debt relief: A toolkit for mainstreaming HIV/AIDS programmes into development instruments. Geneva: UNAIDS.

    Google Scholar 

  • Parker, J. C., & Torres, T. R. (1994). Micro and small business enterprises in Kenya: Results of the 1993 national baseline survey. Nairobi: USAID.

  • Pronyk, P. M., Hargreaves, J. R., Kim, J. C., Morison, L., Phetla, G., Watts, C., et al. (2006). Effect of a structural intervention for the prevention of intimate partner violence and HIV in rural South Africa: Results of a cluster randomized trail. Lancet, 368, 1973–1983. doi:10.1016/S0140-6736(06)69744-4.

    Article  PubMed  Google Scholar 

  • Rossi, P. H., Freeman, H. E., & Lipsey, M. W. (1999). Evaluation: A systematic approach (6th ed.). Thousand Oaks: SAGE Publications.

  • Schuler, S. R., & Hashemi, S. H. (1994). Credit programs, women’s empowerment and contraceptive use in rural Bangladesh. Studies in Family Planning, 25(2), 65–67. doi:10.2307/2138085.

    Article  PubMed  CAS  Google Scholar 

  • Sebstad, J., & Barnes, C. (2000). Guidelines for microfinance impact assessments. USAID’s AIMS Project. Available at: http://www.usaidmicro.org/pubs/aims/. Accessed 5 July 2004.

  • Sebstad, J., & Chen, G. (1996). Overview of studies on the impact of microenterprise credit. USAID’s AIM Project. Available at: http://www.usaidmicro.org/pubs/aims/. Accessed 5 July 2004.

  • Sebstad, J., Neill, C., Barnes, C., & Chen, G. (1995) Assessing the impacts of microenterprise interventions: A framework for analysis. USAID Managing For Results Working Paper No. 7. Washington, DC: USAIDS’s Centre for Development Information and Evaluation. Available at: http://www.usaidmicro.org/pubs/aims/. Accessed 5 July 2004.

  • Simonsen, J. N., Plummer, F. A., Ngugi, E. N., Black, C., Kreiss, J. K., Gakinya, M. N., et al. (1990). HIV infection among lower socio-economic strata prostitutes in Nairobi. AIDS (London, England), 4, 139–144.

    CAS  Google Scholar 

  • Sumartojo, E., Doll, L., Holtgrave, D., Gayle, H., & Merson, M. (2000). Enriching the mix: Integrating structural factors into HIV prevention. AIDS (London, England), 14(Suppl. 1), S1–S2. doi:10.1097/00002030-200006001-00001.

    Google Scholar 

  • UNAIDS. (2000). Female sex worker HIV prevention projects: Lessons learnt from Papua New Guinea, India and Bangladesh. Geneva: UNAIDS Best Practice.

    Google Scholar 

  • UNAIDS. (2002). Sex work and HIV/AIDS: UNAIDS technical update. Geneva: UNAIDS.

    Google Scholar 

  • United Nations Development Programme (UNDP). (2006). Kenya national human development report 2006 (Human security and human development: A deliberate choice). Nairobi: UNDP.

    Google Scholar 

  • Weiss, E., & Gupta, G. R. (1998). Bridging the gap: Addressing gender and sexuality in HIV prevention. Washington, DC: International Centre for Women Research (ICRW). Available at: http://www.icrw.org/docs/archive/1998_report_bridgingthegap.pdf. Accessed 10 July 2004.

  • World Bank. (1994). Micro and small enterprise training and technology project (Staff Appraisal Report No. 12275-KE).

  • Zierler, S., & Krieger, N. (1997). Reframing women’s risk: Social inequalities and HIV infection. Annual Review of Public Health, 18, 401–436. doi:10.1146/annurev.publhealth.18.1.401.

    Article  PubMed  CAS  Google Scholar 

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Acknowledgments

This study was undertaken by Willis Odek as part of a research training fellowship funded by The Wellcome Trust, London, United Kingdom (UK), under Health Consequences of Population Change (HCPC) Programme (Grant: 072118/Z/03/Z). Strengthening STI/HIV Control in Kenya Project (SHCP) was supported by a grant from the Canadian International Development Agency (KE30138-P.O. #7019662). Joanna Busza and John Cleland taught, supervised and mentored Willis Odek during his training for Master of Science (MSc) in Demography and Health at the London School of Hygiene and Tropical Medicine, UK, as a component of the Wellcome Trust’s fellowship. Alan G. Ferguson, Chester N. Morris and Elizabeth N. Ngugi mentored Willis Odek during field work. A special appreciation is expressed to all the women participating in the programme that was studied and the research assistants who helped with data collection for their great cooperation.

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Authors and Affiliations

  1. Department of Community Health, University of Nairobi, P.O. Box 1086, City Square 00200, Nairobi, Kenya

    Willis Omondi Odek & Elizabeth N. Ngugi

  2. Centre for Population Studies, London School of Hygiene and Tropical Medicine, London, UK

    Joanna Busza & John Cleland

  3. Department of Medical Microbiology, University of Manitoba, Winnipeg, MB, Canada

    Chester N. Morris

  4. Constellafutures, Nairobi, Kenya

    Alan G. Ferguson

Authors
  1. Willis Omondi Odek
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  2. Joanna Busza
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  3. Chester N. Morris
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  4. John Cleland
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  5. Elizabeth N. Ngugi
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  6. Alan G. Ferguson
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Correspondence to Willis Omondi Odek.

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Odek, W.O., Busza, J., Morris, C.N. et al. Effects of Micro-Enterprise Services on HIV Risk Behaviour Among Female Sex Workers in Kenya’s Urban Slums. AIDS Behav 13, 449–461 (2009). https://doi.org/10.1007/s10461-008-9485-y

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