Working with economically vulnerable women engaged in sex work: Collaborating with community stakeholders in Southern Uganda

ABSTRACT

Economically vulnerable women engaged in sex work (WESW) comprise one of the key populations with higher prevalence of HIV globally. In Uganda, HIV prevalence among WESW is estimated at 37% and accounts for 18% of all new infections in the country. This paper describes the strategies by which we have engaged community stakeholders in a randomised clinical trial aimed at evaluating the efficacy of adding economic empowerment components to traditional HIV risk reduction to reduce the incidence of STIs and HIV among WESW in Uganda. We demonstrate that stakeholder engagement, including the engagement of WESW themselves, plays a critical role in the adaptation, implementation, uptake, and potential sustainability of evidence-based interventions. To our knowledge, this is the first study to utilise stakeholder engagement involving WESW in Uganda. Researchers working with hard-to-reach populations, such as WESW, are encouraged to invest time and resources to engage key stakeholders through a full range of collaborative activities; and ensure that research is culturally appropriate and meets the needs of all stakeholders involved.

Clinical trial registration

ClinicalTrials.gov identifier: NCT03583541.

KEYWORDS:

• Sex work
• stakeholder engagement
• community collaboration
• HIV risk reduction
• Uganda

Acknowledgements

Our special thanks go to the women engaged in sex work (WESW) who have agreed to participate in the study and made this work possible. We are also grateful to the staff and volunteers at the International Center for Child Health and Development (ICHAD) Field Office in Masaka, Uganda for coordinating the project activities; the research teams at Columbia University in New York, specifically, Prema Filippone, Lyla Yang and Marion Riedel, PhD; New York University, and Indiana University; our implementing and collaborating partners, including Reach the Youth Uganda, TASO Masaka, Rakai Health Science Program, Kitovu Mobile, and Masaka Catholic Diocese; the Community Collaborative Board; and the Data and Safety Monitoring Board for their respective contributions to the study design and implementation. In addition, we are grateful to the financial institutions that agreed to work with our study participants to open up savings accounts, as well as the community health workers who facilitate intervention delivery. All study procedures were approved by the Washington University in St. Louis Institutional Review Board (#201811106), Columbia University Institutional Review Board (#AAAR9804) and the in-country local IRBs in Uganda: Uganda Virus Research Institute (UVRI) Research Ethics Committee (#GC/127/18/10/690), and the Uganda National Council of Science and Technology (UNCST –SS4828). Informed written consent was obtained from all study participants prior to participation. Full study protocol: https://bmcwomenshealth.biomedcentral.com/track/pdf/10.1186/s12905-019-0807-1.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This work was supported by the National Institute of Mental Health (NIMH) under award number R01MH116768 (MPIs: Fred M. Ssewamala, PhD & Susan S. Witte, PhD). NIMH had no role in the study design, data collection, analysis, interpretation of findings and preparing this manuscript. The content is solely the responsibility of the authors and does not necessarily represent the official views of NIMH or the National Institutes of Health.