A cluster-randomized controlled trial of a combination HIV risk reduction and economic empowerment intervention for women engaged in sex work in Uganda
An article in Journal of the International AIDS Society, published November 10, 2025.
Authors: Susan S Witte, Fred M Ssewamala, Joshua Kiyingi, Scarlett L Bellamy, Lyla Sunyoung Yang, Proscovia Nabunya, Ozge Sensoy Bahar, Larissa Jennings Mayo-Wilson, Yesim Tozan, Abel Mwebembezi, Joseph Kagaayi
The Kyaterekera Project was a study conducted in Uganda aimed at assessing whether a combination of HIV risk reduction (HIVRR) and economic empowerment interventions could reduce sexually transmitted infections (STIs) and risky behaviors in women engaged in sex work (WESW). The study involved 542 participants who were divided into two groups: one receiving only the HIVRR intervention, and the other receiving HIVRR plus financial literacy training and an unconditional matched savings account. Originally, a third group was intended to include vocational training, but COVID-19 disruptions led to its cancellation. The study measured outcomes such as new HIV infections, STI prevalence, and rates of unprotected sex over a period of up to 24 months.
Results showed that while both groups experienced a reduction in risky sexual behaviors and a shift towards income from non-sex work activities, there were no significant differences between the groups. Both groups exhibited fewer instances of condomless sex with paying partners and reduced dependency on income from sex work. However, the added financial literacy and savings components did not demonstrate extra benefits over the HIVRR intervention alone. Furthermore, despite initial decreases in STI prevalence at 18 months, these reductions were not sustained at 24 months. Researchers highlighted the need for tailored strategies to address persistent condomless sex with regular partners and emphasized that integrating economic empowerment within HIVRR interventions is feasible but may not provide additional biological benefits. The study underscores that strong basic HIVRR interventions can significantly influence economic and behavioral outcomes even without additional economic components.