Project Nova: A Combination HIV Prevention and Microfinance Intervention for Women Who Engage in Sex Work and Use Drugs in Kazakhstan

Abstract

Innovative combination HIV-prevention and microfinance interventions are needed to address the high incidence of HIV and other STIs among women who use drugs. Project Nova is a cluster-randomized, controlled trial for drug-using female sex workers in two cities in Kazakhstan. The intervention was adapted from prior interventions for women at high risk for HIV and tailored to meet the needs of female sex workers who use injection or noninjection drugs. We describe the development and implementation of the Nova intervention and detail its components: HIV-risk reduction, financial-literacy training, vocational training, and a matched-savings program. We discuss session-attendance rates, barriers to engagement, challenges that arose during the sessions, and the solutions implemented. Our findings show that it is feasible to implement a combination HIV-prevention and microfinance intervention with highly vulnerable women such as these, and to address implementation challenges successfully.

Do combination HIV prevention programmes result in increased empowerment, inclusion and agency to demand equal rights for marginalised populations in low-income and middle-income countries? A systematic review

“…All studies had quantitative study designs. Four studies employed a cluster or individual-level randomised controlled trial design 37–40. Five studies used a pre/post design,36 41–45 and one reported baseline data from a pre/post study 46.…”

“…High risk of bias was found in two domains in two studies: selective reporting and other bias. The research by Mergenova et al had a high reporting bias and other bias given that it did not report the concerned quantitative results, but the study was meant to describe the project execution and its challenges 40. In this regard, the risk assessment of the blinding of outcome assessment was not applicable.…”

“…Behavioural interventions in all studies had similar elements based on a peer outreach and education model, and some included individual and group counselling sessions as well as using different approaches to counselling such as motivational interviewing, integrated behavioural change communication and cognitive behavioural change, development of a personal safety plan for FSWs and sexual negotiation with clients 19 37 41–43. Unique elements of behavioural interventions included texts to promote rights awareness and group solidarity46; a 24-hour crisis management services with an on-call violence response team and links to medical and legal support for FSWs experiencing violence38; financial literacy and vocational training40; and support for alcohol deaddiction and provision of rest place 44…”

“…Structural interventions were more varied but generally included community-wide awareness raising and capacity building components, sensitivity training for stakeholders and support network strengthening activities, and stigma and discrimination reduction activities. Two programmes included microcredit in the forms of a conditional cash transfer and a microfinance with matched-savings programme,40 47 one provided support to access social security grants48 and three programmes offered legal service assistance/support 19 40 44. One programme relied on mass media training in its interventions 19.…”

“…Condom use was measured in a wide variety of ways including frequency of consistent condom use in last relationship,36 consistent condom use in the past 6 months,37 unprotected sex in the past 3 months,39 consistent condom use in the past 30 days per partner type,19 38 46 condom use at last sex,19 36 42 45 condom use at last paid sex44 and a six-item consistent condom use scale 42. Some did not report a time period for their measurement including: number of unprotected sexual acts40 and consistent condom use with occasional and regular clients 49. Other traditional prevention outcomes measures included HIV and STI incidence/rate, testing and treatment, knowledge about HIV and treatment, and prevention adherence.…”