Long before I was introduced to the world of savings groups, I worked on the socio-behavioral side of HIV prevention research for several years in the early 2000s. During that time, I read hundreds of transcripts from interviews our field teams had conducted with female sex workers (FSWs) in various countries for different studies. Given the sexual transmission of HIV, these interviews invariably included many questions on the sexual risk behaviors of FSWs. We were interested in condom use - how often women used them and with whom. But during those years of the Bush administration and the Abstinence, Be Faithful, Condoms (ABC) campaign, when we asked about condoms, we also had to ask sex workers about being faithful and abstinence! This seemed disrespectful and completely ignored the context of these women’s lives. But it wasn’t just the questions about abstinence that bothered me.

In reading the interviews of these women, what nagged at me was that while we were busy drilling away at condom use and sexual behavior, we were missing out on the hows and whys of these women’s decisions to enter sex work. It was clear that economic factors were motivating behavior and that knowledge, attitudes, and beliefs about HIV - however aligned they were with good HIV prevention practices - could not override a woman’s need to feed herself and her family. And, in an environment of limited economic opportunities, especially for women, ignoring this driving motivation did little to change women’s circumstances.

Fast-forward a decade and by the 2010s, growing numbers of people working in the field had also identified this as an issue and multinational organizations were urging attention to the structural drivers of HIV. A handful of projects and programs had tried different approaches to economic empowerment for FSWs, including skills training and microfinance. The evidence on the effectiveness and sustainability of these approaches was mixed (also see here), particularly for programs in Sub-Saharan Africa (SSA) where sex work is illegal.

Through a project called ASPIRES, FHI 360 had an opportunity to develop a pilot economic strengthening program for FSWs, but we wanted to make sure that what we designed would meet the needs of the women it was intended to serve. Despite knowing a lot about the sex lives of FSWs we knew virtually nothing about their financial lives, so that’s where we decided to start. With funding from USAID and PEPFAR, we carried out a rapid study in Abidjan, Côte d’Ivoire, using participant observations to get at context and financial diaries to gather detailed information on cash inflows and outflows. The findings (and the process) were fascinating, and pointed to some clear ideas for economic strengthening activities for this population of FSWs.

"…This project is an opportunity for us. This is the first time they did not come to talk about AIDS with us, but to help us manage our money. Thank you very much."

Advance Your Learning at SG2018!

I will talk about our findings (including women’s use of tontines as informal savings groups) and the pilot project we designed for FSWs at the SG2018 session entitled, Reaching the Hard to Reach: Insights for Working with Female Sex Workers. Joining me to present real-world experience with an economic strengthening program for FSWs will be Sitholubuhle Zitha. Sitholubuhle will share learning from a project implemented by WorldEducation/Bantwana in Zimbabwe that has used savings groups and a work readiness program to build financial and employability skills among FSWs, promote alternative livelihood pathways for them, and create platforms of service delivery for the provision of wrap-around services.

“From my savings, I started cross-border trading, buying and selling clothes. I have not left sex work. But I now have more control over where I go and with whom I play with.”

How do our experiences in Zimbabwe and Côte d’Ivoire compare? What lessons can we draw from the similarities - and differences? And what role did savings groups play in both? Our intrepid moderator Mbonisi Tshuma of WorldEducation/Bantwana will lead a discussion of these and other questions (all of which promise to be more interesting and relevant than asking questions about abstinence!). We would love to have you join this conversation in Kigali on May 23, 2018 at 2:00 pm to share your comments, experiences, and ideas for innovations.

Emily Namey is the Associate Director of the Behavioral, Epidemiological, and Clinical Sciences division for Global Health, Population and Nutrition at FHI 360, where she facilitates and conducts social science research related to public health and development. She has implemented qualitative and mixed-methods research in a dozen countries, on issues including HIV prevention, maternal and reproductive health, economic strengthening, child protection, and bioethics. Additionally, Emily has an interest in and works on improving the evidence base for qualitative research methodology. She is the co-author or -editor of five books on research methods and has led dozens of research-related trainings domestically and internationally.