![[ Visit Client Website ]](images/banner.gif)
Globally, only one in two women are in paid employment compared to about three in four men, and the disparity is more marked in low-income settings. The economic vulnerabities among women are strong predictors for women to engage in sex work. Women’s engagement in sex work increases their risk of acquiring HIV, as their ability to negotiate safe sex is limited in fear of losing additional earnings. This study assessed the direct effect and mediators of asset ownership on sexual risk taking behaviors among women engaged in sex work in southern Uganda. Using the asset theory, we hypothesize that, accumulation of assets helps women to earn associated positive economic, social, psychological and behavioral benefits which could reduce the likelihood of engaging in sexual risk taking behaviors.
Methodology
We used baseline data from the Kyaterekera study, a 5-year NIH-funded longitudinal study (Grant#R01MH116768) among 542 women aged 18-55 engaged in sex work from 19 hotspots in southern Uganda. Women were eligible to participate in the study if they fulfilled the following inclusion criteria. 1.) at least 18 years of age, 2.) engaged in transactional sex, defined as having vaginal or anal sexual intercourse in exchange for money, alcohol, or other goods in the last 30 days, 3.) engaged in at least one episode of unprotected sexual intercourse in the preceding 30 days. Upon consenting, the women completed an interviewer-administered questionnaire, which lasted an average of one hour and a half. We used structural equation modeling (SEM) in MPlus to assess the direct, indirect and total effects of assets on sexual risk taking behaviors. The mediators included in our analysis are perceived social support, depression and Intimate partner violence. We generated a latent variable for sexual risk taking behaviors using four variables including total customers- participants had sex with in the past 30 days, number of times they had vaginal sex with these customers, number times a condom was used and whether participants were offered more money, good or extra services not to use a condom.
Results
The average age was 31.4 years (SD=7.18). The results show that asset ownership was significantly associated with a decrease in depression (b = -0.164 [95% CI: -0.260, - 0.068], p=0.001). Also, depression was significantly associated with higher likelihood of engaging in sexual risk behaviors (b = 0.168 [95% CI: 0.054, 0.282], p<0.001). We observed a significant specific indirect effect between assets and sexual risk taking behaviors through depression (b = -0.028 [95% CI: -0.057, -0.003], p=0.050). The total effect (b = -0.110 [95% CI: -0.219, -0.001], p=0.048) and total indirect effects (b = -0.043 [95% CI: -0.079, -0.006], p=0.021) were all significant. However, the direct effect was not significant. Overall, the mediation contributed 64.2% of the total effects.
Conclusion
Our results have implications for policy and programs intended for women engaged in sex work. Such programs need to include economic empowerment strategies and interventions to mitigate psychological distress like depression. Economic empowerment programs through provision of assets could address the financial pressure faced by women.