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Examining Cash Expenditures and Associated HIV-Related Behaviors Using Financial Diaries in Women Employed by Sex Work in Rural Uganda: Findings from the Kyaterekera Study

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  • Larissa Jennings Mayo-Wilson

    (Department of Health Behavior, Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina, 135 Dauer Drive, Chapel Hill, NC 27599, USA)

  • Summer K. Peterson

    (Department of Health Behavior, Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina, 135 Dauer Drive, Chapel Hill, NC 27599, USA)

  • Joshua Kiyingi

    (Brown School, Washington University in St. Louis, One Brookings Drive, St. Louis, MO 63130, USA
    International Center for Child Health and Development, Masaka Field Office, Mutuba Ave, Masaka 319, Uganda)

  • Proscovia Nabunya

    (Brown School, Washington University in St. Louis, One Brookings Drive, St. Louis, MO 63130, USA
    International Center for Child Health and Development, Masaka Field Office, Mutuba Ave, Masaka 319, Uganda)

  • Ozge Sensoy Bahar

    (Brown School, Washington University in St. Louis, One Brookings Drive, St. Louis, MO 63130, USA
    International Center for Child Health and Development, Masaka Field Office, Mutuba Ave, Masaka 319, Uganda)

  • Lyla S. Yang

    (School of Social Work, Columbia University, 1255 Amsterdam Avenue, New York, NY 10027, USA)

  • Susan S. Witte

    (School of Social Work, Columbia University, 1255 Amsterdam Avenue, New York, NY 10027, USA)

  • Fred M. Ssewamala

    (Brown School, Washington University in St. Louis, One Brookings Drive, St. Louis, MO 63130, USA
    International Center for Child Health and Development, Masaka Field Office, Mutuba Ave, Masaka 319, Uganda)

Abstract

Background: Women employed by sex work (WESW) have a high risk of human immunodeficiency virus (HIV) infection and experience economic barriers in accessing care. However, few studies have described their financial lives and the relationship between expenditures and HIV-related behaviors. Methods: This exploratory study used financial diaries to collect expenditure and income data from WESW in Uganda over 6 months. Data were collected as part of a larger trial that tested the efficacy of an HIV prevention intervention method. Descriptive statistics were used to quantify women’s income, relative expenditures, and negative cash balances. Bivariate and multivariate logistic regressions were used to examine the odds of sexual risk behavior or use of HIV medications for several cash scenarios. Results: A total of 163 WESW were enrolled; the participants mean age was 32 years old. Sex work was the sole source of employment for most WESW (99%); their average monthly income was $62.32. Food accounted for the highest proportion of spending (44%) followed by sex work (20%) and housing expenditures (11%). WESW spent the least on health care (5%). Expenditures accounted for a large but variable proportion of these women’s income (56% to 101%). Most WESW (74%) experienced a negative cash balance. Some also reported high sex work (28%), health care (24%), and education (28%) costs. The prevalence of condomless sex (77%) and sex with drugs/alcohol (70%) was high compared to use of ART/PrEP (Antiretroviral therapy/Pre-exposure prophylaxis) medications (45%). Women’s cash expenditures were not statistically significantly associated with HIV-related behaviors. However, the exploratory study observed a consistent null trend of lower odds of condomless sex (adjusted odds ratio (AOR) = 0.70, 95% confidence interval (CI): 0.28–1.70), sex with drugs/alcohol (AOR = 0.93, 95% CI: 0.42–2.05), and use of ART/PrEP (AOR = 0.80, 95% CI: 0.39–1.67) among women who experienced a negative cash balance versus those who did not. Similar trends were observed for other cash scenarios. Conclusion: Financial diaries are a feasible tool to assess the economic lives of vulnerable women. Despite having paid work, most WESW encountered a myriad of financial challenges with limited spending on HIV prevention. Financial protections and additional income-generating activities may improve their status. More robust research is needed to understand the potentially complex relationship between income, expenditures, and HIV risk among vulnerable sex workers.

Suggested Citation

  • Larissa Jennings Mayo-Wilson & Summer K. Peterson & Joshua Kiyingi & Proscovia Nabunya & Ozge Sensoy Bahar & Lyla S. Yang & Susan S. Witte & Fred M. Ssewamala, 2023. "Examining Cash Expenditures and Associated HIV-Related Behaviors Using Financial Diaries in Women Employed by Sex Work in Rural Uganda: Findings from the Kyaterekera Study," IJERPH, MDPI, vol. 20(9), pages 1-14, April.
    • Handle: RePEc:gam:jijerp:v:20:y:2023:i:9:p:5612-:d:1130530
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    References listed on IDEAS

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    1. Daryl Collins, 2005. "Financial instruments of the poor: Initial findings from the financial diaries study," SALDRU/CSSR Working Papers 130, Southern Africa Labour and Development Research Unit, University of Cape Town.
    2. Daryl Collins, 2005. "Financial instruments of the poor: initial findings from the South African Financial Diaries study," Development Southern Africa, Taylor & Francis Journals, vol. 22(5), pages 717-728.
    3. Paul Gertler & Manisha Shah & Stefano M. Bertozzi, 2005. "Risky Business: The Market for Unprotected Commercial Sex," Journal of Political Economy, University of Chicago Press, vol. 113(3), pages 518-550, June.
    4. Rao, Vijayendra & Gupta, Indrani & Lokshin, Michael & Jana, Smarajit, 2003. "Sex workers and the cost of safe sex: the compensating differential for condom use among Calcutta prostitutes," Journal of Development Economics, Elsevier, vol. 71(2), pages 585-603, August.
    5. Daryl Collins, 2008. "Debt and household finance: evidence from the Financial Diaries," Development Southern Africa, Taylor & Francis Journals, vol. 25(4), pages 469-479.
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