Background: Many women''s decisions about whether and how to participate in sex work are driven by financial considerations, yet HIV prevention interventions rarely consider the economic rationale or financial practices of female sex workers (FSWs) when designing programs for this group. Understanding the financial context of FSWs'' lives is essential for providing programming that addresses relevant structural drivers of HIV.
Methods: To inform development of a curriculum on economic strengthening for FSWs, we collected quantitative financial diary data from a stratified purposive sample (n=35) of FSWs in Addis Ababa, Ethiopia. Women kept financial diaries daily for six weeks, meeting each week with researchers to systematically discuss and record eight data points per financial transaction. Women also reported experiences of gender-based violence and condom use, to facilitate assessments of HIV-risks relative to financial status. At exit, women were qualitatively interviewed about their financial service needs. Data from financial diaries were descriptively analyzed in R, disaggregated by workplace. Exit interview data were coded and analyzed in NVivo.
Results: All women reported sex work as their primary source of income, accounting for, on average, 85% of weekly income. Food, housing, and clothing represented the largest expenditures. Around 19% of expenses were reported as costs of sex work (e.g., chat/tobacco, alcohol, room rental). Street-based sex workers reported the least income but high condom use; bar/brothel-based sex workers reported the highest incomes and lowest level of consistent condom use. FSWs described saving money in their homes, formal accounts, or equibs (social savings). Qualitatively, FSWs described barriers to inclusion in the formal financial system, including banks and regulated markets, that prevented them from saving or starting new businesses to reduce or leave sex work. Women proposed peer-led financial literacy and savings activities to build their capacity to pursue new livelihoods.
Conclusions: Economic strengthening interventions have potential to lower FSWs'' risks of HIV by lessening the financial drivers of sex work. Our findings offer a rare glimpse into the earning, spending, saving, and borrowing practices of FSWs, providing evidence on which to base decisions about how best to design and implement economic strengthening elements of HIV prevention for FSWs.