ESTIMA: Empowerment of Sex workers To Increase Social and Economic Mobility

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DESCRIPTION (provided by applicant): Given the increasing recognition of the contribution of structural-level factors (e.g. gendered economic and social power imbalances) on both HIV and gender-based violence (GBV) among women, and thereby, the need for interventions that aim to alter such structures within communities, I have developed the proposed training to provide an opportunity for me to expand my work on the intersection of GBV and HIV by: 1) developing new skills related to structural-level interventions that specifically focus on economic promotion among women, and 2) enhancing my expertise related to the implementation and rigorous evaluation of structural interventions to address these issues. Notably, developing new skills and receiving training in methodologies (e.g. evaluation, measurement) related to structural-level interventions that specifically focus on economic promotion among women will provide me with a unique skill set possessed by only a handful of researchers in the field, particularly among researchers focusing on both GBV and HIV. The training aims will be accomplished through a combination of formal and/or informal coursework in economic development strategies and measures, structural interventions, and rigorous evaluation methodologies, as well as practical experience in the implementation and evaluation of a structural intervention. The proposed research aims to pilot a multi-strategy structural intervention combining community mobilization to promote gender equity alongside an economic intervention (microfinance and business training) in order to reduce gender-based violence and HIV risk among female sex workers (FSW) in Tijuana, Mexico. The program will be called ESTIMA: "Empowerment of Sex workers to Increase Social and Economic Mobility. The evaluation will employ a randomized controlled design, recruiting FSW (n=120, 60 in each arm) who will be randomized to: 1) ESTIMA (gender equity/community mobilization program and economic intervention) or 2) a wait-list control group. For this preliminary work, at 12 months follow-up, w hypothesize that compared to control participants, intervention participants will have: 1) significantly greater economic security (e.g. decreased debt, increased income, decreased number of sex trades) and 2) significantly greater perceived collective power (i.e. collective efficacy) to address gendered power imbalances within social structures and the community. The long-term goal of this program, upon future refinement and large scale implementation, is to reduce HIV risk behaviors, STI/HIV, GBV, and ultimately, alleviate a multitude of health burdens among women. Furthermore, we expect that such work will highlight the need for HIV prevention initiatives in Mexico, and elsewhere, to more broadly consider women's 'life contexts' - addressing economic and social burdens in women's lives, to reduce the burden of poverty, gender, and HIV, as well as the intersection of these among women.