Enhancing financial security of female sex workers through a community-led intervention in India: Evidence from a longitudinal survey

Autoři: Sangram Kishor Patel aff001;  Saradiya Mukherjee aff001;  Bidhubhusan Mahapatra aff001;  Madhusudana Battala aff001;  Matangi Jayaram aff002;  Sameer Kumta aff002;  Yamini Atmavilas aff002;  Niranjan Saggurti aff001
Působiště autorů: HIV and AIDS Program, Population Council, New Delhi, India aff001;  Bill & Melinda Gates Foundation, New Delhi, India aff002
Vyšlo v časopise: PLoS ONE 14(10)
Kategorie: Research Article
doi: 10.1371/journal.pone.0223961



Community-led organizations (COs) have been an integral part of HIV prevention programs to address the socio-economic and structural vulnerabilities faced by female sex workers (FSWs). The current study examines whether strengthening of community-led organizations and community collectivization have been instrumental in reducing the financial vulnerability and empowering FSWs in terms of their self-efficacy, confidence, and individual agency in India.

Data and methods

This study used a panel data of 2085 FSWs selected from 38 COs across five states of India. Two rounds of data (Round 1 in 2015 and Round 2 in 2017) were collected among FSWs. Data were collected both at CO and individual level. CO level data was used to assess the CO strength. Individual level data was used to measure financial security, community collectivization, and individual empowerment.


There was a significant improvement in CO strength and community collectivization from Round 1 to Round 2. High CO strength has led to improved financial security among FSWs (R2: 85% vs. R1: 51%, AOR: 2.5; 95% CI: 1.5–4.1) from Round 1 to Round 2. High collective efficacy and community ownership have improved the financial security of FSWs during the inter-survey period. Further, the improvement in financial security in the inter-survey period led to increased or sustained individual empowerment (in terms of self-confidence, self-efficacy, and individual agency) among FSWs.


Institutional strengthening and community mobilization programs are key to address the structural issues and the decrease of financial vulnerability among FSWs. In addition, enhanced financial security is very important to sustain or improve the individual empowerment of FSWs. Further attention is needed to sustain the existing community advocacy and engagement systems to address the vulnerabilities faced by marginalized populations and build their empowerment.

Klíčová slova:

Finance – HIV – HIV prevention – India – Money supply and banking – Sex work – Female sex workers – Sex workers


1. Blanchard AK, Mohan HL, Shahmanesh M, Prakash R, Isac S, Ramesh BM, et al. Community mobilization, empowerment and HIV prevention among female sex workers in South India. BMC Public Health. 2013; 13: 234. doi: 10.1186/1471-2458-13-234 23496972

2. de Souza R. Creating “communicative spaces”: A case of NGO community organizing for HIV/AIDS prevention. Health Communication. 2009; 24: 692–702. doi: 10.1080/10410230903264006 20183378

3. Greener R, Sarkar S. Risk and vulnerability: Do socioeconomic factors influence the risk of acquiring HIV in Asia? AIDS. 2010; 24: S3–S11. doi: 10.1097/01.aids.0000390084.37812.30 20926925

4. Wheeler T, Kiran U, Dallabetta G, Jayaram M, Chandrasekaran P, Tangri A, et al. Learning about scale, measurement and community mobilisation: Reflections on the implementation of the Avahan HIV/AIDS initiative in India. J Epidemiol Community Health. 2012; 66: ii16–ii25. doi: 10.1136/jech-2012-201081 22945907

5. Mainkar MM, Pardeshi DB, Dale J, Deshpande S, Khazi S, Gautam A, et al. Targeted interventions of the Avahan program and their association with intermediate outcomes among female sex workers in Maharashtra, India. BMC Public Health, 2011; 11: S2.

6. Lippman SA, Chinaglia M, Donini AA, Diaz J, Reingold A, Kerrigan DL. Findings from Encontros: a multi-level STI/HIV intervention to increase condom use, reduce STI, and change the social environment among sex workers in Brazil. Sexually Transmitted Diseases. 2012; 39: 209. doi: 10.1097/OLQ.0b013e31823b1937 22337108

7. Saggurti N, Mishra RM, Proddutoor L, Tucker S, Kovvali D, Parimi P, Wheeler T. Community collectivization and its association with consistent condom use and STI treatment-seeking behaviors among female sex workers and high-risk men who have sex with men/transgenders in Andhra Pradesh, India. AIDS Care. 2013; 25: S55–S66. doi: 10.1080/09540121.2012.749334 23745631

8. Vejella S, Patel SK, Saggurti N, Prabhakar P. Community collectivization and consistent condom use among female sex workers in southern India: Evidence from two rounds of behavioral tracking surveys. AIDS and Behavior. 2016; 20: 776–787. doi: 10.1007/s10461-015-1171-2 26286343

9. Jana S, Basu I, Rotheram-Borus MJ, Newman PA. The Sonagachi Project: A sustainable community intervention program. AIDS Education and Prevention. 2004; 16: 405–414. doi: 10.1521/aeap.16.5.405.48734 15491952

10. Ramesh BM, Beattie TS, Shajy I, Washington R, Jagannathan L, Reza-Paul S, et al. Changes in risk behaviours and prevalence of sexually transmitted infections following HIV preventive interventions among female sex workers in five districts in Karnataka state, South India. Sexually Transmitted Infections. 2010; 86: i17–i24. doi: 10.1136/sti.2009.038513 20167725

11. Parimi P, Mishra RM, Tucker S, Saggurti N. Mobilising community collectivisation among female sex workers to promote STI service utilisation from the government healthcare system in Andhra Pradesh, India. J Epidemiol Community Health. 2012; jech-2011-200832.

12. Sweat M, Morin S, Celentano D, Mulawa M, Singh B, Mbwambo J, et al. Community-based intervention to increase HIV testing and case detection in people aged 16–32 years in Tanzania, Zimbabwe, and Thailand (NIMH Project Accept, HPTN 043): A randomised study. The Lancet infectious diseases. 2011; 11: 525–532. doi: 10.1016/S1473-3099(11)70060-3 21546309

13. Global Fund. Community systems strengthening framework. The Global Fund. Geneva; 2010.

14. Mburu G, Oxenham D, Hodgson I, Nakiyemba A, Seeley J, Bermejo A. Community systems strengthening for HIV care: Experiences from Uganda. Journal of Social Work in End-of-Life & Palliative Care. 2013; 9: 343–368.

15. Basu I, Jana S, Rotheram-Borus MJ, Swendeman D, Lee SJ, Newman P, Weiss R. HIV prevention among sex workers in India. J Acquir Immune Defic Syndr. 2004; 36(3): 845–52. doi: 10.1097/00126334-200407010-00012 15213569

16. Evans C, Jana S, Lambert H. What makes a structural intervention? Reducing vulnerability to HIV in community settings, with particular reference to sex work. Global Public Health. 2010; 5: 449–461. doi: 10.1080/17441690902942472 19507079

17. Mahapatra B, Bhattacharya R, Atmavilas Y, Saggurti N. (2018) Measuring vulnerability among female sex workers in India using a multidimensional framework. PLoS One. 2018; 13: e0204055. doi: 10.1371/journal.pone.0204055 30252879

18. Odek WO, Busza J, Morris CN, Cleland J, Ngugi EN, Ferguson AG. Effects of micro-enterprise services on HIV risk behaviour among female sex workers in Kenya’s urban slums. AIDS and Behavior. 2009; 13: 449. doi: 10.1007/s10461-008-9485-y 18998204

19. Sherman SG, Srikrishnan A, Rivett KA, Liu SH, Solomon S, Celentano DD. (2010) Acceptability of a microenterprise intervention among female sex workers in Chennai, India. AIDS and Behavior. 2010; 14: 649–657. doi: 10.1007/s10461-010-9686-z 20352320

20. Patel SK, Prabhakar P, Jain AK, Saggurti N, Adhikary R. Relationship between community collectivization and financial vulnerability of female sex workers in southern India. PloS One. 2016; 11: e0156060. doi: 10.1371/journal.pone.0156060 27227998

21. Tanwar S, Rewari BB, Dharma Rao CV, Joint Secretary, Seguy N. India’s HIV programme: Successes and challenges. J Virus Erad. 2016; 2(Suppl 4): 15–19.

22. Sgaier SK, Ramakrishnan A, Wadhwani A, Bhalla A, Menon H, Baer J, Alexander A. Achieving scale rapidly in public health: Applying business management principles to scale up an HIV prevention program in India. Healthc (Amst). 2018; 6(3): 210–217. doi: 10.1016/j.hjdsi.2017.09.002 28943225

23. Bennett S, Singh S, Rodriguez D, Ozawa S, Singh K, Chhabra V, et al. Transitioning a large-scale HIV/AIDS prevention program to local stakeholders: Findings from the Avahan transition evaluation. PLoS One. 2015; 10(9): e0136177. doi: 10.1371/journal.pone.0136177 26327591

24. Boily M-C, Pickles M, Lowndes CM, Ramesh BM, Washington R, Moses S, et al. Positive impact of a large-scale HIV prevention programme among female sex workers and clients in South India. AIDS (London, England). 2013; 27(9): 1449–60.

25. Gaikwad SS, Bhende A, Nidhi G, Saggurti N, Ranebennur V. How effective is community mobilisation in HIV prevention among highly diverse sex workers in urban settings? The Aastha intervention experience in Mumbai and Thane districts. India Journal of Epidemiology and Community Health. 2012; 66: ii 69.

26. McCullagh P. Regression models for ordinal data. Journal of the Royal Statistical Society. Series B (Methodological). 1980; 42 (2): 109–142. JSTOR 2984952.

27. Suryawanshi D, Patel SK, Sharma V, Adhikary R, Bharat S. Association between community collectivization and mental depression among men who have sex with men in Andhra Pradesh, India. Health Care Current Reviews. 2016; 4: 176.

28. Moore L, Chersich MF, Steen R, Reza-Paul S, Dhana A, Vuylsteke B, Lafort Y, Scorgie F. Community empowerment and involvement of female sex workers in targeted sexual and reproductive health interventions in Africa: a systematic review. Globalization and health. 2014; 10, 47. doi: 10.1186/1744-8603-10-47 24916108

29. Mantsios A, Shembilu C, Mbwambo J, Likindikoki S, Sherman S, Kennedy C and Kerrigan D. ‘That’s how we help each other’: Community savings groups, economic empowerment and HIV risk among female sex workers in Iringa, Tanzania. PloS one. 2018; 13(7): e0199583. doi: 10.1371/journal.pone.0199583 29975737

30. Patel SK, Jain A, Batalla M, Mahapatra B, Saggurti N. Community organization membership, financial security, and social protection among female sex workers in India. Journal of the International Association of Providers of AIDS Care. 2018; 17: 1–8. doi: 10.1177/2325958218811640 30444156

31. Mahapatra B, Walia M, Patel SK, Battala M, Mukherjee S, et al. (2019). Sustaining safe sex behavior among female sex workers by addressing their vulnerabilities and strengthening community-led organizations in India. Poster presentation, WEPEC523, 10th IAS conference on HIV science (IAS 2019), 21–24 July 2019, Mexico City, Mexico. http://programme.ias2019.org/Abstract/Abstract/3052.

32. Benoit C, Smith M, Jansson M, Magnus S, Flagg J, Maurice R. Sex work and three dimensions of self-esteem: self-worth, authenticity and self-efficacy. Culture, Health & Sexuality: An International Journal for Research, Intervention and Care. 2017; 20(1): 69–83. doi: 10.1080/13691058.2017.1328075 28548011

33. Morton M., Montgomery P. Youth empowerment programs for improving self-efficacy and self-esteem of adolescents. Campbell Systematic Reviews, 2011:5 doi: 10.4073/csr.2011.5

34. Farrell L, Fry TRL, Risse L. The significance of financial self-efficacy in explaining women’s personal finance behaviour. Journal of Economic Psychology. 2016; 54: 85–99.

35. Rothwell DW, Khan MN and Cherney K. Building financial knowledge is not enough: Financial self-efficacy as a mediator in the financial capability of low-income families. Journal of Community Practice. 2016. 24 (4): 368–388.

Článek vyšel v časopise


2019 Číslo 10