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      Acceptability of a microfinance-based empowerment intervention for transgender and cisgender women sex workers in Greater Kuala Lumpur, Malaysia

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          Abstract

          Introduction: Cisgender and transgender woman sex workers (CWSWs and TWSWs, respectively) are key populations in Malaysia with higher HIV-prevalence than that of the general population. Given the impact economic instability can have on HIV transmission in these populations, novel HIV prevention interventions that reduce poverty may reduce HIV incidence and improve linkage and retention to care for those already living with HIV. We examine the feasibility of a microfinance-based HIV prevention intervention among CWSW and TWSWs in Greater Kuala Lumpur, Malaysia.

          Methods: We conducted 35 in-depth interviews to examine the acceptability of a microfinance-based HIV prevention intervention, focusing on: (1) participants’ readiness to engage in other occupations and the types of jobs in which they were interested in; (2) their level of interest in the components of the potential intervention, including training on financial literacy and vocational education; and (3) possible barriers and facilitators to the successful completion of the intervention. Using grounded theory as a framework of analysis, transcripts were analysed through Nvivo 11.

          Results: Participants were on average 41 years old, slightly less than half (48%) were married, and more than half (52%) identified as Muslim. Participants express high motivation to seek employment in other professions as they perceived sex work as not a “proper job” with opportunities for career growth but rather as a short-term option offering an unstable form of income. Participants wanted to develop their own small enterprise. Most participants expressed a high level of interest in microfinance intervention and training to enable them to enter a new profession. Possible barriers to intervention participation included time, stigma, and a lack of resources.

          Conclusion: Findings indicate that a microfinance intervention is acceptable and desirable for CWSWs and TWSWs in urban Malaysian contexts as participants reported that they were ready to engage in alternative forms of income generation.

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          Most cited references 39

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          Qualitative research and evaluation methods

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            Effect of a structural intervention for the prevention of intimate-partner violence and HIV in rural South Africa: a cluster randomised trial.

            HIV infection and intimate-partner violence share a common risk environment in much of southern Africa. The aim of the Intervention with Microfinance for AIDS and Gender Equity (IMAGE) study was to assess a structural intervention that combined a microfinance programme with a gender and HIV training curriculum. Villages in the rural Limpopo province of South Africa were pair-matched and randomly allocated to receive the intervention at study onset (intervention group, n=4) or 3 years later (comparison group, n=4). Loans were provided to poor women who enrolled in the intervention group. A participatory learning and action curriculum was integrated into loan meetings, which took place every 2 weeks. Both arms of the trial were divided into three groups: direct programme participants or matched controls (cohort one), randomly selected 14-35-year-old household co-residents (cohort two), and randomly selected community members (cohort three). Primary outcomes were experience of intimate-partner violence--either physical or sexual--in the past 12 months by a spouse or other sexual intimate (cohort one), unprotected sexual intercourse at last occurrence with a non-spousal partner in the past 12 months (cohorts two and three), and HIV incidence (cohort three). Analyses were done on a per-protocol basis. This trial is registered with ClinicalTrials.gov, number NCT00242957. In cohort one, experience of intimate-partner violence was reduced by 55% (adjusted risk ratio [aRR] 0.45, 95% CI 0.23-0.91; adjusted risk difference -7.3%, -16.2 to 1.5). The intervention did not affect the rate of unprotected sexual intercourse with a non-spousal partner in cohort two (aRR 1.02, 0.85-1.23), and there was no effect on the rate of unprotected sexual intercourse at last occurrence with a non-spousal partner (0.89, 0.66-1.19) or HIV incidence (1.06, 0.66-1.69) in cohort three. A combined microfinance and training intervention can lead to reductions in levels of intimate-partner violence in programme participants. Social and economic development interventions have the potential to alter risk environments for HIV and intimate-partner violence in southern Africa.
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              Structural interventions: concepts, challenges and opportunities for research.

              Structural interventions refer to public health interventions that promote health by altering the structural context within which health is produced and reproduced. They draw on concepts from multiple disciplines, including public health, psychiatry, and psychology, in which attention to interventions is common, and sociology and political economy, where structure is a familiar, if contested, concept. This has meant that even as discussions of structural interventions bring together researchers from various fields, they can get stalled in debates over definitions. In this paper, we seek to move these discussions forward by highlighting a number of critical issues raised by structural interventions, and the subsequent implications of these for research.
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                Author and article information

                Journal
                J Int AIDS Soc
                J Int AIDS Soc
                ZIAS
                zias20
                Journal of the International AIDS Society
                Taylor & Francis
                1758-2652
                2017
                2 August 2017
                : 20
                : 1
                Affiliations
                [ a ] Faculty of Medicine, Department of Medicine, Centre of Excellence for Research in AIDS, University of Malaya , Kuala Lumpur, Malaysia
                [ b ] Department of Social Work, Brigham Young University, Provo , USA
                [ c ] Department of Health, Behavior and Society, Johns Hopkins University School of Public Health , Baltimore, MD, USA
                [ d ] Social Intervention Group, School of Social Work, Columbia University , New York, NY, USA
                [ e ] Yale University School of Medicine, Department of Internal Medicine, Section of Infectious Diseases, AIDS Program , New Haven, CT, USA
                Author notes
                [ § ]Corresponding author: Jeffrey A. Wickersham, Yale University School of Medicine, Department of Internal Medicine, Section of Infectious Diseases , AIDS Program, New Haven, CT, USA. ( jeffrey.wickersham@ 123456yale.edu )
                [*]

                These authors have contributed equally to the work.

                Article
                1355617
                10.7448/IAS.20.1.21723
                5577685
                28782331
                © 2017 Lall P et al; licensee International AIDS Society

                This is an Open Access article distributed under the terms of the Creative Commons Attribution 3.0 Unported (CC BY 3.0) License http://creativecommons.org/licenses/by/3.0/, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                Page count
                Tables: 4, References: 47, Pages: 11
                Product
                Funding
                Funded by: Ministry of Higher Education, Malaysia 10.13039/501100003093
                Award ID: E-000001-20001
                Award ID: AK
                Funded by: National Institute on Drug Abuse 10.13039/100000026
                Award ID: K01 DA038529
                Award ID: JAW
                Research for this paper was supported by a grant from the National Institute on Drug Abuse (K01 DA038529, JAW) and a Ministry of Education, University Malaya High Impact Research Grant (E-000001-20001, AK).
                Categories
                Article
                Research Article

                Infectious disease & Microbiology

                microfinance, sex work, cisgender women, transgender women, hiv

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