A global comparative study on empowering women: Key strategy for preventing HIV among most at risk populations

Background/significance: Too often, public health strategies overlook underlying gender and power inequalities, which are often key drivers for HIV transmission. To test this claim, CARE conducted comparative research in Bangladesh, Cambodia, India, and Peru to explore whether the use of empowerment strategies (vis a vis solidarity groups) reduced HIV risk among sex workers.

Methods: 1500 women were purposively sampled for interviews; focus groups, and semi-structured questionnaires. The participatory research explored women's definitions of empowerment, gender norms, and associations between measures of empowerment (e.g. agency, decision-making) and risk factors (e.g. condom use, HIV knowledge, access to and utilization of services). SPSS, STATA, and AtlasTi were used for quantitative and manual coding for qualitative analysis.

Results: Women who participated in CARE's programs reported higher self-esteem, overall condom use, and greater utilization of STI and HIV services, and efforts to combat institutional violence than women who did not participate in programs. Findings also show that programmatic impact did not translate to private spheres of women's lives. For example, sex workers reported high, consistent use of condoms with clients, but comparatively lower use with intimate partners due to love, trust and familiarity. Yet, women simultaneously reported violence and infidelity in their intimate relationships.

Discussion/conclusions: Solidarity groups can empower sex workers in ways which reduce their vulnerability to HIV. However, programs targeting sex workers often overlook vulnerabilities that they face outside of their sex work. To enhance impact of our interventions, it is essential to address dynamics of intimate relationships.