Background: Community-led organizations have been essential part of HIV prevention programs to address the socio-economic and structural vulnerabilities among female sex workers (FSWs). The current study aims to examine whether strengthening of community organizations (COs) have been instrumental in reducing the financial vulnerability among FSWs in India.
Methods: This study used a panel data of 2085 FSWs selected from 30 COs across five states of India. Two rounds of data (baseline in 2015 and end line in 2017) were collected among FSWs. Data were collected both at CO and individual level. CO level data was used to assess the CO strength. Individual level data was used to measure financial security. The financial security measure was measured based on the composite score of having a savings account, investment in schemes, insurance products, had an alternative source of income, and had not taken any loan from informal sources. Descriptive statistics, frequency, bivariate and multilevel logistic regression techniques were used for the analysis.
Results: There was a significant improvement in CO strength from baseline to end-line. High CO strength has led to improved financial security among FSWs (EL: 85% vs. BL: 51%, AOR: 2.5; 95% CI: 1.5-4.1) in end line from baseline. FSWs those associated with COs whom were formed more than 5 years ago, have higher financial security compared to others (EL: 86% vs. BL: 49%, AOR: 2.82). In addition, FSWs those belonged to larger outreach COs (covering >=1200 FSWs) have 2 times higher financial security compared to FSWs belonged to smaller outreach COs (covering < 1200 FSWs). Further, the improvement in financial security in the inter-survey period led to increased or sustained individual empowerment (in terms of self-confidence, self-efficacy and individual agency) among FSWs.
Conclusions: The study concluded that organizational strengthening under the community mobilization interventions are key to address the structural issues and the decrease of financial vulnerability among FSWs. Further attention is needed to sustain the existing community advocacy and engagement systems to address the vulnerabilities faced by marginalized populations and build their empowerment.