THE ROLE OF COMMUNITY SAVINGS GROUPS IN ADDRESSING HIV AMONG FEMALE SEX WORKERS IN IRINGA, TANZANIA
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Background: Financial insecurity has been linked to heightened HIV risk among female sex workers (FSW). Community empowerment (CE) approaches have demonstrated effectiveness in reducing HIV risk and vulnerability through FSW taking collective action to address structural barriers to their health and human rights. This study examines organically formed community savings groups among FSW in Iringa, Tanzania for their potential role within a CE approach to addressing HIV among FSW. Methods: Logistic regression was used to determine the associations between financial security, community savings group participation, and consistent condom use (CCU) among a cohort of 496 FSW in Iringa. Mediation analysis was used to assess whether community savings group participation mediates the relationship between financial security and CCU. Qualitative methods included 27 in-depth interviews with 15 FSW and 4 focus group discussions with 35 FSW who participate in community savings groups as well as 10 key informant interviews with group collectors. Content analysis was conducted to identify salient themes including those related to the dynamic nature of participants’ sex work and financial realities, the meaning and importance of community savings groups to the women, and overall group operations and functioning. Results: In quantitative analysis, FSW who participated in community savings groups had nearly two times greater odds of CCU in the last 30 days with new clients than women who did not participate in the groups (aOR: 1.80; 95% CI: 1.08, 2.97). Higher financial security (i.e. monthly income) was positively associated with CCU (aOR: 1.54; 95% CI: 0.94, 2.53) and mediation analysis suggested that community savings group participation partially mediates the relationship between financial security and CCU. Qualitatively, women described savings groups as an important addition to their often unsteady income, which can leave them vulnerable to high-risk sex with clients. Savings groups were described as providing a safety net women utilized in times of financial need, making them less likely to engage in high-risk sex with clients. Women described a sense of agency resulting from group participation playing out in their ability to negotiate condom use and be more selective about clients. Savings groups helped participants afford health care and HIV-infected participants described saving from the groups enabled them to cover the costs of eating healthy foods, medications, and transportation for clinic appointments. Beyond the individual level, groups were seen as fostering a sense of solidarity and collective identity. Participants expressed their desires to formally register their groups and be recognized by the larger community. Conclusion: Findings suggest that community savings groups may improve financial security and enhance individual agency in decision making influencing sexual risk behaviors among FSW. They may also impact the overall health and well-being of FSW and help HIV-infected FSW achieve improved HIV treatment and care outcomes. Through greater social cohesion and collective action among FSW the groups further efforts for their social and economic inclusion. Community savings groups may be an important economic empowerment strategy within a CE framework for FSW communities and enable sex workers to intervene on structural factors contributing to their HIV vulnerability and ultimately to gain more equal access to resources.