{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,26]],"date-time":"2025-11-26T16:36:17Z","timestamp":1764174977849,"version":"3.41.2"},"reference-count":29,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2021,5,5]],"date-time":"2021-05-05T00:00:00Z","timestamp":1620172800000},"content-version":"vor","delay-in-days":4,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000026","name":"National Institute on Drug Abuse","doi-asserted-by":"publisher","award":["R01DA036514"],"award-info":[{"award-number":["R01DA036514"]}],"id":[{"id":"10.13039\/100000026","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Int AIDS Soc"],"published-print":{"date-parts":[[2021,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Female sex workers (FSW) who use drugs are a key population at risk of HIV in Kazakhstan, and face multiple structural barriers to HIV prevention. More research is needed on the role of structural interventions such as microfinance (MF) in reducing HIV risk. This paper describes the results of a cluster\u2010randomized controlled trial to test the efficacy of a combination HIVRR\u00a0+\u00a0MF intervention in reducing biologically confirmed STIs and HIV risk behaviours.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This study took place from May 2015 to October 2018 in two cities in Kazakhstan. We screened 763 participants for eligibility and enrolled 354 FSW who use drugs. Participants were randomized in cohorts to receive either a four\u2010session HIVRR intervention, or that same intervention plus 30 additional sessions of financial literacy training, vocational training and asset\u2010building through a matched\u2010savings programme. Repeated behavioural and biological assessments were conducted at baseline, 3\u2010, 6\u2010 and 12\u2010months post\u2010intervention. Biological and behavioural primary outcomes included HIV\/STI incidence, sexual risk behaviours and drug use risk behaviours, evaluated over the 12\u2010month period.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Over the 12\u2010month follow\u2010up period, few differences in study outcomes were noted between arms. There was only one newly\u2010detected HIV case, and study arms did not significantly differ on any STI incidence. At post\u2010intervention assessments compared to baseline, both HIVRR and HIVRR\u00a0+\u00a0MF participants significantly reduced sexual and drug use risk behaviours, and showed improvements in financial outcomes, condom use attitudes and self\u2010efficacy, social support, and access to medical care. In addition, HIVRR\u00a0+\u00a0MF participants showed a 72% greater reduction in the number of unprotected sex acts with paying partners at the six\u2010month assessment (IRR\u00a0=\u00a0IRR\u00a0=\u00a00.28, 95% CI\u00a0=\u00a00.08, 0.92), and a 10% greater reduction in the proportion of income from sex work at the three\u2010month assessment (b\u00a0=\u00a0\u22120.10, 95% CI\u00a0=\u00a0\u22120.17, \u22120.02) than HIVRR participants did. HIVRR\u00a0+\u00a0MF participants also showed significantly improved performance on financial self\u2010efficacy compared to HIVRR over the 12\u2010month follow\u2010up period.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Compared to a combination HIVRR\u00a0+\u00a0MF intervention, a robust HIVRR intervention alone may be sufficient to reduce sexual and drug risk behaviours among FSW who use drugs. There may be structural limitations to the promise of microfinance for HIV risk reduction among this population.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jia2.25682","type":"journal-article","created":{"date-parts":[[2021,5,6]],"date-time":"2021-05-06T19:14:28Z","timestamp":1620328468000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["A cluster\u2010randomized controlled trial of a combination HIV risk reduction and microfinance intervention for female sex workers who use drugs in Kazakhstan"],"prefix":"10.1002","volume":"24","author":[{"given":"Nabila","family":"El\u2010Bassel","sequence":"first","affiliation":[{"name":"Global Health Research Center of Central Asia Columbia University School of Social Work  New York NY 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