Jitegemee (Rely on yourself)

Female sex workers (FSW) contribute 12% of new HIV infections in sub-Saharan Africa (SSA) yet comprise only 1.1% of women of childbearing age. In Kenya, HIV prevalence among FSW is about 5-times higher than that of women in the general population. Economic barriers have long been associated with sub-optimal use of available behavioral and biomedical interventions. A large literature has shown that such economic shocks are extremely common in resource-limited settings in SSA, stemming from weather events, family illnesses, or unemployment of male clients. Helping FSW cope with these economic shocks in ways that do not increase their HIV risk is essential for reducing new infections in this priority population, and is an important policy priority. We are proposing a study to design and pilot an intervention known as Jitegemee (rely on yourself) that encourages FSW to use part of their earnings to save and call back when in need. The aims of the study will be to:1. Design the Jitegemee intervention. We will use data collected during 2 previous studies, one on acceptability of the Jitegemee intervention and another on piloting the intervention to see if FSW can save and call back their money. 2. Conduct a pilot study to determine the preliminary impact of Jitegemee intervention on savings and reducing risky sexual behaviors. We will enroll about 405 HIV status neutral FSW from 4 clusters in Kisumu County; 3 large (with 12-16 individual hotspots) and one small (with 6 individual hotspots). We will randomly select 4 hotspots in each of the large clusters and 2 hotspots in the small cluster. 3. Explore experiences of participants on barriers to and facilitators of saving. We will conduct end-line focus group discussions (FGDs) with intervention participants stratified into 6 sub-groups: high, medium, low, and no savers; and those who called back their money and those who did not (6 FGDs in each group). The interviews/discussions will explore their experiences, specifically what made it easy or difficult to save and whether and how the cash call back may have saved situations of potential risk. If preliminary results from the pilot study shows promise, the data will be used to inform the development of a larger effectiveness study to determine if Jitegemee intervention can result in a reduction of risk among FSW in western Kenya.