Women engaged in sex work (WESW) in sub-Saharan Africa remain at highest risk for HIV, and a critical target for innovations such as interventions combining HIV risk reduction with economic empowerment. While evidence suggests such interventions may reduce HIV risk, their mechanisms for change remain unclear. Further, interventions tested have used conditional asset-based components, e.g. matched savings, which restrict participant spending. Needed are studies that both examine unconditional asset accumulation and the financial lives of WESW to tailor economic strengthening programs to address financial determinants of HIV risk. Financial diaries studies provide detailed data on how people manage their finances, but are rarely implemented with WESW. This study examines feasibility and preliminary findings of using financial diaries within a larger combination intervention trial testing the use of unconditional matched savings among WESW in Uganda.
This financial diaries study was conducted among a sub-sample of WESW randomized to the treatment condition of a larger, longitudinal randomized controlled trial, Kyaterakera. The trial is evaluating the efficacy of adding economic empowerment components (financial literacy and unconditional matched savings) to traditional HIV risk reduction among 540 WESW in Uganda. Unconditional matched savings means that participants control spending of funds they receive. Beginning October 2019, at their third of six financial literacy sessions, 150 women from eight sites were trained in how to complete financial diary booklets and asked to record daily household expenditures over 6 months’ time. Prior to COVID-19 restrictions, team members met participants on a monthly basis to review diary entries. Following lockdown, diaries data were collected more intermittently during scheduled field visits for the parent study. Demographic and expenditures data were summarized.
The mean age of participants was 32 years (range 18-55); and over half (58.7%) completed primary school. The majority of participants (68.7%) were primary income earners in households with an average of 4 people. While few participants recorded expenses for the first month, the number and quality of entries grew over time, with participant practice and as the team employed strategies to increase entries and accuracy. Women reported average monthly expenses of 170,213 shillings (47.66 USD), (range 2,616 shillings (.73 USD) to 835,783 shillings (234 USD)). The range illustrates how widely expenses fluctuated, which may also indicate financial impact from the pandemic. The largest average monthly expenses were purchasing food and beverages (43%), housing (10%), clothing (9%), education (6%), and medical (5%). Only 2% of the total expenditure was spent on leisure and entertainment.
To the best of our knowledge, this is the first and largest financial diaries study among WESW. Preliminary findings demonstrate the feasibility of diaries data collection among WESW despite pandemic challenges, and offer a window into their household spending patterns. Unconditional matched savings allow WESW the choice and flexibility of allocating resources to meet their most pressing needs. This autonomy may be particularly important during unforeseen financial shocks like a pandemic. Diaries data may also help unpack if/whether unconditional savings is an active ingredient in economic empowerment to reduce HIV risk.