Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America.
Department of Psychiatry and Mental Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
PLoS One. 2018 Jul 5;13(7):e0199583. doi: 10.1371/journal.pone.0199583. eCollection 2018.
Female sex workers (FSW) are a socially and economically marginalized population heavily affected by HIV. Community empowerment approaches focus on FSW taking collective action to address structural barriers to their health and have demonstrated effectiveness in reducing HIV risk. This study examines the potential for community savings groups (locally called michezo) among FSW in Iringa, Tanzania to reduce HIV risk and promote economic and community empowerment. We conducted 27 in-depth interviews (IDIs) with 15 FSW over time and 4 focus group discussions (FGDs) with 35 FSW participating in michezo, and 10 key informant interviews (KIIs) with group collectors. Content analysis was used to identify salient themes around participants' sex work and financial realities; the role of savings groups in their lives and work; and experiences with social cohesion associated with group participation. Michezo were described as providing a safety net for times of financial need, allowing FSW to create greater financial security for themselves and their families. Participation in the groups was also reported to facilitate both individual agency, resulting in members' ability to negotiate condom use and be selective about clients, and a sense of collective identity and solidarity. Participants described group challenges including high mobility and low income of FSW making it difficult for women to fulfill their financial obligations to the group. As a result, participants reported preferences for joining michezo whose members were perceived as more stable (e.g. older, married, from more established venues). Group collectors and members were eager to have michezo formally registered and become recognized by the broader community. Findings indicate that savings groups promote individual agency to reduce sexual risk behaviors and foster community empowerment among FSW. The groups hold potential as an empowerment strategy to enable sex workers to address structural sources of HIV vulnerability and help them achieve socioeconomic inclusion.
性工作者（FSW）是一个社会和经济上处于边缘地位的群体，深受 HIV 的影响。社区赋权方法侧重于 FSW 采取集体行动，以解决对其健康的结构性障碍，并已证明在降低 HIV 风险方面具有有效性。本研究考察了坦桑尼亚伊林加的 FSW 建立社区储蓄小组（当地称为 michezo）的潜力，以降低 HIV 风险并促进经济和社区赋权。我们对 15 名 FSW 进行了 27 次深入访谈（IDIs），并随着时间的推移对 35 名参与 michezo 的 FSW 进行了 4 次焦点小组讨论（FGDs），并对 10 名小组收集者进行了 10 次关键知情人访谈（KIIs）。内容分析用于确定参与者性工作和财务现实、储蓄小组在他们生活和工作中的作用以及与小组参与相关的社会凝聚力体验方面的突出主题。michezo 被描述为在经济需求时提供安全网，使 FSW 能够为自己和家人创造更大的财务安全。还报告称，参与小组活动有助于个人代理，使成员能够协商使用避孕套并对客户进行选择，以及集体认同感和团结感。参与者描述了小组面临的挑战，包括 FSW 的高流动性和低收入，这使得女性难以履行对小组的财务义务。因此，参与者报告说，他们更喜欢加入被认为更稳定（例如年龄较大、已婚、来自更成熟场所）的 michezo。小组收集者和成员渴望使 michezo 正式注册并得到更广泛社区的认可。研究结果表明，储蓄小组促进个人代理，以减少性风险行为，并促进 FSW 的社区赋权。这些小组具有作为赋权策略的潜力，可以使性工作者能够解决 HIV 脆弱性的结构性根源，并帮助他们实现社会经济包容。
