Sherman SG, German D, Cheng Y, Marks M, Bailey-Kloche M. The evaluation of the JEWEL project: an innovative economic enhancement and HIV prevention intervention study targeting drug using women involved in prostitution

Department of epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
AIDS Care (Impact Factor: 1.6). 02/2006; 18(1):1-11. DOI: 10.1080/09540120600838480
Source: PubMed


The JEWEL (Jewellery Education for Women Empowering Their Lives) pilot study examined the efficacy of an economic empowerment and HIV prevention intervention targeting illicit drug-using women (n=50) who were involved in prostitution in Baltimore, Maryland. The intervention was comprised of six 2-hour sessions that taught HIV prevention risk reduction and the making, marketing and selling of jewellery. Bivariate comparisons examined behaviour change pre- and 3-months post-intervention. The intervention's effect on the change in the number of sex trade partners from baseline to follow-up was explored with multiple linear regression. Participants were 62.0% African American, 5.0% were currently employed, and the median age was 39 years old (Inter Quartile Range [IQR]: 34-45). Women attended an average of six (IQR: 4.5-6.0) sessions. The women sold over $7,000 worth of jewellery in eleven sales. In comparing self-reported risk behaviours pre and 3-month post intervention participation, we found significant reductions in: receiving drugs or money for sex (100% versus 71.0%, p<0.0005); the median number of sex trade partners per month (9 versus 3, p=0.02); daily drug use (76.0% vs. 55.0%, p=0.003); the amount of money spent on drugs daily (US$52.57 versus US$46.71, p = 0.01); and daily crack use (27.3% versus 13.1.0%, p = 0.014). In the presence of other variables in a multivariate linear model, income from the jewelry sale was associated with a reduction in the number of sex trade partners at follow-up. The pilot indicated effectiveness of a novel, HIV prevention, economic enhancement intervention upon HIV sexual risk behaviours and drug utilization patterns.

Download full-text


Available from: Marie Bailey-kloch, Jul 10, 2014
  • Source
    • "Session Three. Stress Management Compared to men, low-income African American women have reported greater levels of physiological and psychological stress as they are confronted with " triple oppression associated with discriminations based on race, sex, and class " (Bova, et al. 2008; Sherman, et al. 2006; Braxton, et al. 2007; Williams & Williams-Morris, 2000; Hooks, 1993). This in turn, resulted in several exaggerated and negative coping mechanisms, including the tendency to engage in highrisk behaviors, and the reluctance to seek help and treatment (Murry, et al. 2003). "
    [Show abstract] [Hide abstract]
    ABSTRACT: HIV-positive individuals are living longer today as a result of continuing advances in treatment but are also facing an increased risk for chronic diseases such as diabetes, and hypertension. These conditions result in a larger burden of hospitalization, outpatient, and emergency room visits. Impoverished African American women may represent an especially high-risk group due to disparities in health care, racial discrimination, and limited resources. This article describes an intervention that is based on the conceptual framework of the socio-ecological model. Project THANKS uses a community-based participatory, and empowerment building approach to target the unique personal, social, and environmental needs of African American women faced with the dual diagnosis of HIV and one or more chronic diseases. The long-term goal of this project is to identify features in the social and cultural milieu of these women that if integrated into existing harm reduction services can reduce poor health outcomes among them.
  • Source
    • "Secondly, female drug users who exchange sex for drugs or cash may not identify themselves at risk of HIV infection because they do not consider themselves as sex workers [15]. Thirdly, condom use can be infrequent among them because drug dependency and financial problems may impair their judgment and power to negotiate for condom use with their sex partners [16-19]. Fourthly, female drug users depend in many cases on male partners for drugs and injections, leading them to an elevated risk of equipment sharing practice [20,21]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Women who use drugs are extremely vulnerable to HIV and sexually transmitted infections (STIs), but studies on risk behaviours and HIV infection among female drug users are limited in Nepal. In this cross-sectional study conducted between September 2010 and May 2011, HIV prevalence and risk factors for HIV infection were investigated among female drug users recruited in drop-in centres, parks and streets in the Kathmandu Valley. The participants completed face-to-face interviews for a structured questionnaire, HIV pre-test counselling, specimen collection for HIV test and they were provided with their results at post-test counselling. A total of 269 female drug users were recruited, of whom 28% (n = 77) were found HIV positive; the majority (78%, n = 211) being injecting drug users and aged below 25 years (57%, n = 155). Nearly half (n = 137) of the total participants had shared needles or syringes in the past month, and 131 and 102 participants were involved in commercial or casual sex respectively with only half or less of them having had used condoms in the last 12 months. In multivariate analysis the variables associated with HIV infection included: (a) older age; (b) history of school attendance; (c) frequency of sharing of injection instruments; and (d) unsafe sex with commercial or casual partners. HIV was highly prevalent among female drug users in the Kathmandu Valley, with its risk being strongly associated not only with unsafe injection practice but also with unsafe sexual behaviours. Awareness raising programmes and preventive measures such as condom distribution, needle or syringe exchange or methadone maintenance therapy should be urgently introduced in this neglected subpopulation.
    BMC Public Health 12/2013; 13(1):1238. DOI:10.1186/1471-2458-13-1238 · 2.26 Impact Factor
  • Source
    • "Economic vulnerability is not only a push factor which may impel people to enter sex work, but may also impact the risk behavior of people who engage in sex work as a means of economic support (Odek et al., 2009; Kim et al., 2008; Busza, 2005; Manopaiboon et al., 2003; Tan Minh et al., 2004; Wojcicki & Malala, 2001). Individuals exchanging sex for money or goods may have limited power to negotiate safe sex practices with paying partners due to higher premiums gained through unprotected sex, the price of condoms, and/or the urgent need for income in times of crisis or immediate need (Odek et al., 2009; Stratford, Mizuno, Williams, Courtenay-Quirk, & O'Leary, 2008; Sherman et al., 2006). Women engaging in sex work who report having debt or other economic hardships have been more likely to report unsafe sex practices and have STI symptoms (Reed, Gupta, Biradavolu, Devireddy, & Blankenship, 2010; Ngo et al., 2007). "
    [Show abstract] [Hide abstract]
    ABSTRACT: This article provides an overview of the financial lives of women (n = 204) engaging in sex work in Ulaanbaatar, Mongolia. This paper presents findings from a computer-based, interviewer-administered baseline assessment administered with women recruited for participation in a randomized controlled trial testing the feasibility of a combined HIV risk reduction and savings-led microfinance intervention for women engaging in sex work in Mongolia. Findings demonstrate that most women are the primary financial providers for their households, using an array of earning strategies to provide for themselves and other dependents, with sex work often constituting the primary household income source. Financial instability in the lives of people engaging in sex work may increase their risk for HIV and STIs due to a compromised ability to negotiate safer sex with partners in times of economic crisis or need. High levels of financial responsibility for household welfare, when combined with low reported savings, the presence of debt, higher premiums offered for sex without a condom, and high levels of harmful alcohol use, may heighten women's risk for HIV and other STIs. Further research that documents the financial lives of people working in sex work is needed in order to understand the complex relationship between financial stability and engagement in sex work, and to inform the development and testing of structural HIV prevention interventions which target the economic determinants of risk. These findings highlight the importance of economic support programming for women engaged in sex work in Mongolia at a time of rapid economic change in Mongolia.
    Global journal of health science 09/2013; 5(5):41-50. DOI:10.5539/gjhs.v5n5p41
Show more