Abstract
Female sex workers (FSW) are a socially and economically marginalized population heavily affected by HIV. Community empowerment approaches focus on FSW taking collective action to address structural barriers to their health and have demonstrated effectiveness in reducing HIV risk. This study examines the potential for community savings groups (locally called michezo) among FSW in Iringa, Tanzania to reduce HIV risk and promote economic and community empowerment. We conducted 27 in-depth interviews (IDIs) with 15 FSW over time and 4 focus group discussions (FGDs) with 35 FSW participating in michezo, and 10 key informant interviews (KIIs) with group collectors. Content analysis was used to identify salient themes around participants’ sex work and financial realities; the role of savings groups in their lives and work; and experiences with social cohesion associated with group participation. Michezo were described as providing a safety net for times of financial need, allowing FSW to create greater financial security for themselves and their families. Participation in the groups was also reported to facilitate both individual agency, resulting in members' ability to negotiate condom use and be selective about clients, and a sense of collective identity and solidarity. Participants described group challenges including high mobility and low income of FSW making it difficult for women to fulfill their financial obligations to the group. As a result, participants reported preferences for joining michezo whose members were perceived as more stable (e.g. older, married, from more established venues). Group collectors and members were eager to have michezo formally registered and become recognized by the broader community. Findings indicate that savings groups promote individual agency to reduce sexual risk behaviors and foster community empowerment among FSW. The groups hold potential as an empowerment strategy to enable sex workers to address structural sources of HIV vulnerability and help them achieve socioeconomic inclusion.
Highlights
Female sex workers (FSW) are a socially and economically marginalized population heavily affected by HIV
Building on prior formative work in Iringa which revealed the use of michezo among FSW in the region [36], the current study clarified savings group structure and operations
The community savings groups explored in this study promote individual agency to reduce sexual risk behaviors and foster community empowerment among FSW in Iringa
Summary
Female sex workers (FSW) are a socially and economically marginalized population heavily affected by HIV. HIV prevalence among FSW in sub-Saharan African countries is significantly higher than in other geographic regions, with an estimated pooled prevalence of 36.9% [2]. In the Iringa region of Tanzania, a recent integrated biobehavioral surveillance survey found that 32.9% of FSW were living with HIV [3]. FSW are a population often living in poverty and balancing competing financial priorities such as food, housing, children’s expenses, and medical costs [4,5,6,7]. Social and structural factors such as financial insecurity, stigma and discrimination, violence, and legal and policy environments surrounding sex work have all been linked to heightened HIV risk of FSW[10]
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