Does asset ownership influence sexual risk-taking behaviors among women engaged in sex work in Southern Uganda? A mediation analysis.

Economic vulnerability influences women engaged in commercial sex work (WESW) to further engage in sexual risk behaviors, as they often have multiple customers and engage in unprotected sex for financial gains. This study examined asset ownership's direct and indirect impact on sexual risk-taking behaviors among WESW in Southern Uganda, a very vulnerable group of women at high risk for contracting HIV and other STIs. We used baseline data from the Kyaterekera study, an NIH-funded study among WESW aged 18-55 across 19 HIV hotspots in Southern Uganda. Structural equation modeling was used to examine the direct, indirect, and total effects of assets-defined as ownership of physical and financial resources-on sexual risk-taking behaviors among WESW. Results showed that asset ownership was associated with a decrease in depression (β =  - 0.096 [95% CI - 0.191, - 0.001], p = 0.050) and increased access to medical care (β = 0.174 [95% CI 0.072, 0.275], p = 0.001).We also found that an increase in access to medical care was associated with decreased sexual risk-taking behaviors (β =  - 0.107 [95% CI - 0.210, - 0.004], p = 0.041). We observed a specific indirect effect between assets and sexual risk-taking behaviors through access to medical care (β =  - 0.019 [95% CI - 0.040, - 0.002], p = 0.05). Mediation contributed 31% of the total effects of asset ownership on sexual risk-taking behaviors. To our knowledge, this is among the few studies to examine the impact of asset ownership on sexual risk-taking behaviors among WESW in Southern Uganda. Findings from this study indicate that increasing access to economic resources may reduce the risk of WESW engaging in unprotected sex for higher income, which limits the spread of HIV among this population. The results also indicate that asset ownership may allow women to access healthcare services.

Nabayinda J ，Kiyingi J ，Kizito S ，Nsubuga E ，Nabunya P ，Bahar OS ，Magorokosho N ，Nattabi J ，Witte S ，Fred Melch S ... -  《BMC Womens Health》

A combination intervention addressing sexual risk-taking behaviors among vulnerable women in Uganda: study protocol for a cluster randomized clinical trial.

Ssewamala FM ，Sensoy Bahar O ，Tozan Y ，Nabunya P ，Mayo-Wilson LJ ，Kiyingi J ，Kagaayi J ，Bellamy S ，McKay MM ，Witte SS ... -  《BMC Womens Health》

Correlates of Intimate Partner Violence Among Young Women Engaged in Sex Work in Southern Uganda.

Nabayinda J ，Namirembe R ，Kizito S ，Nsubuga E ，Nabunya P ，Sensoy Bahar O ，Magorokosho N ，Kiyingi J ，Nattabi J ，Tozan Y ，Jennings Mayo-Wilson L ，Mwebembezi A ，Witte SS ，Ssewamala FM ... -  《-》

Examining the Intrapersonal, Interpersonal and Community Level Correlates of Access to Medical Care Among Women Employed by Sex Work in Southern Uganda: A cross-sectional Analysis of the Kyaterekera Study.

Women employed by sex work (WESW) experience significant gaps in accessing necessary healthcare services, leading to unmet health needs. Yet, there is a dearth of literature on the barriers to medical care access among WESW in Uganda. We used data from the Kyaterekera baseline to examine the correlates of access to medical care among WESW, defined as the ability of individuals to obtain the necessary healthcare services they require in a timely, affordable, and equitable manner. The Kyaterekera study recruited 542 WESW aged 18-58 years from Southern Uganda. We conducted a multilevel linear regression model to determine the intrapersonal (age, education level, marital status, HIV knowledge, and asset ownership), interpersonal (family cohesion and domestic violence attitudes), and community (community satisfaction, sex work stigma and distance to health facility) level correlates of access to medical care among WESW. Intrapersonal and interpersonal factors were associated with access to medical care among WESW. There was no significant association between community level factors and access to medical care. WESW with secondary education (β = 0.928, 95% CI = 0.007, 1.849) were associated with increased access to medical care. WESW with high asset ownership (β = -1.154, 95% CI= -1.903, -0.405), high family cohesion (β = -0.069, 95% CI= -0.106, -0.031), and high domestic violence attitudes (β = -0.253, 95% CI= -0.438, -0.068) were associated with decreased access to medical care. The findings emphasize the critical need for targeted family strengthening interventions to enhance family support for WESW and address domestic violence.

Kiyingi J ，Mayo-Wilson LJ ，Nabunya P ，Kizito S ，Nabayinda J ，Nattabi J ，Nsubuga E ，Bahar OS ，Namuwonge F ，Nakabuye F ，Nanteza F ，Filippone PL ，Mukasa D ，Witte SS ，Ssewamala FM ... -  《-》

Examining Cash Expenditures and Associated HIV-Related Behaviors Using Financial Diaries in Women Employed by Sex Work in Rural Uganda: Findings from the Kyaterekera Study.

Jennings Mayo-Wilson L ，Peterson SK ，Kiyingi J ，Nabunya P ，Sensoy Bahar O ，Yang LS ，Witte SS ，Ssewamala FM ... -  《-》