Understanding the financial lives of female sex workers in Abidjan, Côte d’Ivoire: implications for economic strengthening interventions for HIV prevention

Abstract

Many women's decisions about whether and how to participate in sex work are driven by financial considerations. Despite the recognized importance of economic factors in HIV risk among female sex workers (FSWs), many HIV prevention programs focus narrowly on sexual risk behaviors. We collected data on the financial practices of FSWs in Abidjan, Côte d'Ivoire, to better inform economic strengthening programs for HIV risk reduction with this population. We conducted "walk-along" participant observations (N = 74) during FSWs' daily non-working routines and analyzed resultant notes using qualitative thematic analysis. We used a financial diary methodology to collect detailed quantitative data on income, spending, savings and lending from a sub-sample of participants (n = 33) over six weeks; these data were analyzed using descriptive statistics. All women in our sample reported sex work as their primary source of earned income. Median weekly income was roughly US $114, with a wide range across the sample and from week to week. Cash expenses related primarily to routine needs (e.g., food, housing, transportation) and accounted, on average, for approximately 90% of weekly spending. Around one-quarter of weekly expenses were directly associated with sex work (e.g., clothing, beauty products, and alcohol). FSWs held "savings" in boxes, mobile money platforms, informal savings groups, or banks, though most withdrew cash from these funds frequently. These findings suggest that this group of FSWs in Abidjan, Côte d'Ivoire, are not cashpoor: median weekly income is greater than the estimated Ivoirian weekly per capita gross national income. Yet the erratic nature of income alongside routine spending needs suggests that effective economic strengthening programs in this context should include financial management education, group-based savings and lending, and links to formal financial institutions. These economic strengthening activities hold promise to empower FSWs financially for downstream HIV-risk reduction benefits by building economic resilience to reduce financially-driven sexual risk decisions.

Mental health challenges and perceived risks among female sex workers in Nairobi, Kenya

“…The distress of food insecurity and women’s desire to provide for their children’s basic needs consistently emerged as a driver into sex work and has been reported elsewhere [ 41 – 43 ]. Loss of financial support due to the death of a close family member such as a parent, a partner or after a divorce is a stressful event that not only mentally affects women but also a push factor into sex work commencement to cover household needs [ 44 ]. Poverty is the main driver pushing women into sex work across the globe, particularly in SSA [ 41 , 45 , 46 ].…”

HIV prevalence and risk behaviors among female sex workers in Togo in 2017: a cross-sectional national study

“…Despite behavioral interventions and HIV prevention programs whose main message is the importance of wearing condoms to avoid HIV, the proportion of unprotected sexual acts, especially with clients remains high. This could imply that in the processes influencing condom use, including negotiation and consistent use, structural factors such as economic factors could have more weight in the balance than knowledge and risk perception [26,27]. A study in South Africa among FSW reported that the main reason for engaging in condomless sex for FSW is to increase earnings, demonstrating the interaction between the economics of sex work and risky sexual behaviors [28].…”

“…A total of 1,036 FSW were recruited for this study. Median age was 26 years old [IQR: [22][23][24][25][26][27][28][29][30][31][32][33] with almost half of them having reached secondary school (n = 510; 49.2%). Most FSW were single (n = 839; 81.0%) among which 105 (12.5%) were living with a partner.…”

"I expected little, although I learned a lot": perceived benefits of participating in HIV risk reduction sessions among women engaged in sex work in Uganda

“…4 Columbia University School of Social Work, New York City, NY, USA. 5 School of Global Public Health, University of Carolina Chapel Hill, Chapel Hill, NC, USA. 6 College of Health Sciences, Makerere University, Kampala, Uganda.…”

“…Various social, cultural, political, and economic factors influence WESW's heightened risk for contracting HIV. WESW may have limited bargaining power to negotiate safe sex practices due to higher premiums offered for unprotected sexual acts, increasing their vulnerability to HIV infection [4][5][6][7]. Studies from SSA show that WESW experience intense stigma, discrimination, and consequent social marginalization, which in turn deepens their vulnerability to HIV infection [8][9][10] and interferes with their ability to engage with HIV and sexually transmitted infections (STIs) prevention and treatment services [8,11].…”