Mobilising Social Capital in a World with AIDS AIDS2031 Conference 30 March to April 1, 2009 Salzburg, Austria

Effects of micro-enterprise services on HIV risk behaviour among female sex workers in Kenya's urban slums Willis Odek Doctoral Student University of Aberdeen, UK

Background Individual-focused targeted intervention among FSWs Risk/vulnerability reduction outcomes Peer STI/HIV/AIDS education Condom promotion Economic deprivation Fear of health services Gender (regular partnerships)

Intervention strategies STI/HIV/AIDS Education Safer sex negotiation STI counselling Proper & consistent condom use (in both vaginal and anal sex) Reduction of number of partners Increased use of non-penetrative sex Sex avoidance in menses Health provider training STI counselling STI syndromic management Referrals – STI/HIV care and support Credit finance Business training Savings Increase or stabilise income Social capital –credit groups, education & training Control Self-esteem Assertiveness Micro-enterprise support services

Methods Pre-post survey of sexual behaviour among 227 FSWs (18-23 months) Condom use Number of sexual partners Continued involvement in sex work

Findings – participant characteristics Generally older – mean age 41 years Average 4 dependents Education – illiterate (17.3%); primary (55.1%); and secondary (27.6%). Majority have ever been married – 62.6%.

Main outcomes Business survival – 65% Substantial self-reported exit from sex work – (45.4%) Significant reductions in regular partnerships (mean 1.96 B/L to 0.73 E/L); average 1 casual partner. Sustained consistent condom use with casual partners (>90%) and ≈20% improvement within regular partnerships

Main outcomes contd. Business operational status or loan amount received not significantly correlated with sexual behaviour change

Key messages Microfinance for micro-enterprise economic activities appears more appropriate for older women seeking to exit sex work; Younger women (at peak age of HIV vulnerability years) may require a different economic empowerment strategy.

Making a difference by 2031 Promote formal education for girls emphasising progression beyond basic to secondary and tertiary education Continue targeted interventions (HIV and livelihoods) among marginalised women emphasising greater integration with society Move economic support programmes from petty commerce to skills- based, better-paying enterprises for young and older women Strengthen programmes for youth employment both nationally and regionally

Acknowledgements University of Nairobi University of Manitoba Programme participants Wellcome Trust, UK London School of Hygiene and Tropical Medicine