Given the increasing recognition of the contribution of structural-level factors (e.g. gendered economic and social power imbalances) on both HIV and gender-based violence (GBV) among women, and thereby, the need for interventions that aim to alter such structures within communities, I have developed the proposed training to provide an opportunity for me to expand my work on the intersection of GBV and HIV by: 1) developing new skills related to structural-level interventions that specifically focus on economic promotion among women, and 2) enhancing my expertise related to the implementation and rigorous evaluation of structural interventions to address these issues. Notably, developing new skills and receiving training in methodologies (e.g. evaluation, measurement) related to structural-level interventions that specifically focus on economic promotion among women will provide me with a unique skill set possessed by only a handful of researchers in the field, particularly among researchers focusing on both GBV and HIV. The training aims will be accomplished through a combination of formal and/or informal coursework in economic development strategies and measures, structural interventions, and rigorous evaluation methodologies, as well as practical experience in the implementation and evaluation of a structural intervention. The proposed research aims to pilot a multi-strategy structural intervention combining community mobilization to promote gender equity alongside an economic intervention (microfinance and business training) in order to reduce gender-based violence and HIV risk among female sex workers (FSW) in Tijuana, Mexico. The program will be called ESTIMA: """"""""Empowerment of Sex workers to Increase Social and Economic Mobility. The evaluation will employ a randomized controlled design, recruiting FSW (n=120, 60 in each arm) who will be randomized to: 1) ESTIMA (gender equity/community mobilization program and economic intervention) or 2) a wait-list control group. For this preliminary work, at 12 months follow-up, w hypothesize that compared to control participants, intervention participants will have: 1) significantly greater economic security (e.g. decreased debt, increased income, decreased number of sex trades) and 2) significantly greater perceived collective power (i.e. collective efficacy) to address gendered power imbalances within social structures and the community. The long-term goal of this program, upon future refinement and large scale implementation, is to reduce HIV risk behaviors, STI/HIV, GBV, and ultimately, alleviate a multitude of health burdens among women. Furthermore, we expect that such work will highlight the need for HIV prevention initiatives in Mexico, and elsewhere, to more broadly consider women's 'life contexts'- addressing economic and social burdens in women's lives, to reduce the burden of poverty, gender, and HIV, as well as the intersection of these among women.

Public Health Relevance

The proposed research aims to pilot a multi-strategy structural intervention combining community mobilization to promote gender equity alongside an economic intervention (microfinance and business training) in order to reduce gender-based violence and HIV risk among female sex workers (FSW) in Tijuana, Mexico. Testing a combined program, for the first time among FSW, could have global implications, particularly in developing regions where poverty, gender inequity, and HIV converge. Furthermore, the proposed training on economic interventions will allow the candidate to obtain a unique combination of skills possessed by only a handful of researchers in the field globally, particularly among researchers focusing on both GBV and HIV.

Agency
National Institute of Health (NIH)
Institute
National Institute of Mental Health (NIMH)
Type
Research Scientist Development Award - Research & Training (K01)
Project #
1K01MH099969-01A1
Application #
8790331
Study Section
Behavioral and Social Consequences of HIV/AIDS Study Section (BSCH)
Program Officer
Allison, Susannah
Project Start
2014-08-19
Project End
2018-07-31
Budget Start
2014-08-19
Budget End
2015-07-31
Support Year
1
Fiscal Year
2014
Total Cost
$188,719
Indirect Cost
$13,979
Name
University of California San Diego
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
804355790
City
La Jolla
State
CA
Country
United States
Zip Code
92093
Reed, Elizabeth; Donta, Balaiah; Dasgupta, Anindita et al. (2016) Access to Money and Relation to Women's Use of Family Planning Methods Among Young Married Women in Rural India. Matern Child Health J 20:1203-10
Reed, Elizabeth; Erausquin, J T; Groves, Allison K et al. (2016) Client-perpetrated and husband-perpetrated violence among female sex workers in Andhra Pradesh, India: HIV/STI risk across personal and work contexts. Sex Transm Infect 92:424-9
Reed, Elizabeth; Saggurti, Niranjan; Donta, Balaiah et al. (2016) Intimate partner violence among married couples in India and contraceptive use reported by women but not husbands. Int J Gynaecol Obstet 133:22-5
Gaines, Tommi L; Urada, Lianne A; Martinez, Gustavo et al. (2015) Short-term cessation of sex work and injection drug use: evidence from a recurrent event survival analysis. Addict Behav 45:63-9
Erausquin, Jennifer Toller; Reed, Elizabeth; Blankenship, Kim M (2015) Change over Time in Police Interactions and HIV Risk Behavior Among Female Sex Workers in Andhra Pradesh, India. AIDS Behav 19:1108-15
Reed, Elizabeth; Myers, Bronwyn; Novak, Scott P et al. (2015) Experiences of violence and association with decreased drug abstinence among women in Cape Town, South Africa. AIDS Behav 19:192-8
Strathdee, Steffanie A; West, Brooke S; Reed, Elizabeth et al. (2015) Substance Use and HIV Among Female Sex Workers and Female Prisoners: Risk Environments and Implications for Prevention, Treatment, and Policies. J Acquir Immune Defic Syndr 69 Suppl 2:S110-7
Raj, Anita; McDougal, Lotus; Reed, Elizabeth et al. (2015) Associations of marital violence with different forms of contraception: cross-sectional findings from South Asia. Int J Gynaecol Obstet 130 Suppl 3:E56-61
Reed, Elizabeth; Donta, Balaiah; Dasgupta, Anindita et al. (2015) Household Debt and Relation to Intimate Partner Violence and Husbands' Attitudes Toward Gender Norms: A Study Among Young Married Couples in Rural Maharashtra, India. Public Health Rep 130:664-71
Bingenheimer, Jeffrey B; Reed, Elizabeth (2014) Risk for coerced sex among female youth in Ghana: roles of family context, school enrollment and relationship experience. Int Perspect Sex Reprod Health 40:184-95