ECONOMIC FACTORS AND HIV RISK AMONG FEMALE SEX WORKERS IN SENEGAL
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Stigma and economic disadvantages have been underscored as structural determinants for HIV acquisition and transmission among female sex workers (FSWs). The objective of this thesis is to explore the economic factors in relation to HIV prevention among FSWs, within the programmatic context where integrated stigma mitigation interventions took place. The integrated stigma mitigation interventions (ISMI) aimed to optimize HIV service delivery through stigma mitigation for FSWs. This thesis firstly documented the implementation of the ISMI through their key stakeholders’ lenses. Experiences and opinions were elicited from interviews with the HIV healthcare providers and from focus group discussions with the FSW peer educators on the acceptability, adoption, etc. of the ISMI. It was found that ISMI were well accepted and adopted among the FSW community. However, various opinions existed among HIV healthcare providers. To explore HIV acquisition and transmission through structural determinants, this dissertation extended its scope to economic disadvantages and its role in potentiating or mitigating HIV risk among FSWs. Firstly, economic factors such as FSWs’ income from sex work, and perceived degree of financial insufficiency were tested in relation to condom use behaviors using the data of 758 FSWs recruited from Dakar and Mbour. Bivariate and multivariate logistic regressions were used, and statistically significant associations were observed between FSWs’ perceived degree of financial insufficiency and condom non-use with regular and new clients during the last sex act. The income measure was not associated with condom use with all types of sexual partners. Next, the role of economic hardship experienced by FSWs and its implications for HIV risk were explored using data from 45 interviews conducted with 15 FSWs from Dakar. FSWs reported pronounced economic hardship during the entry to sex work and around religious events. Most reported no condomless sex with their clients even in economic hardship. As often the sole breadwinners for their households, they reported replying on sex work for a living and supporting kinship. Many FSWs tried to cope with the economic hardship, through seeking additional income-generating opportunities and participating in saving groups. However, there were contextual barriers for them to escape from economic hardship.