{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T12:09:32Z","timestamp":1780920572018,"version":"3.54.1"},"reference-count":51,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2023,4,23]],"date-time":"2023-04-23T00:00:00Z","timestamp":1682208000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000025","name":"National Institute of Mental Health","doi-asserted-by":"publisher","award":["R01MH116768"],"award-info":[{"award-number":["R01MH116768"]}],"id":[{"id":"10.13039\/100000025","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Background: Women employed by sex work (WESW) have a high risk of human immunodeficiency virus (HIV) infection and experience economic barriers in accessing care. However, few studies have described their financial lives and the relationship between expenditures and HIV-related behaviors. Methods: This exploratory study used financial diaries to collect expenditure and income data from WESW in Uganda over 6 months. Data were collected as part of a larger trial that tested the efficacy of an HIV prevention intervention method. Descriptive statistics were used to quantify women\u2019s income, relative expenditures, and negative cash balances. Bivariate and multivariate logistic regressions were used to examine the odds of sexual risk behavior or use of HIV medications for several cash scenarios. Results: A total of 163 WESW were enrolled; the participants mean age was 32 years old. Sex work was the sole source of employment for most WESW (99%); their average monthly income was $62.32. Food accounted for the highest proportion of spending (44%) followed by sex work (20%) and housing expenditures (11%). WESW spent the least on health care (5%). Expenditures accounted for a large but variable proportion of these women\u2019s income (56% to 101%). Most WESW (74%) experienced a negative cash balance. Some also reported high sex work (28%), health care (24%), and education (28%) costs. The prevalence of condomless sex (77%) and sex with drugs\/alcohol (70%) was high compared to use of ART\/PrEP (Antiretroviral therapy\/Pre-exposure prophylaxis) medications (45%). Women\u2019s cash expenditures were not statistically significantly associated with HIV-related behaviors. However, the exploratory study observed a consistent null trend of lower odds of condomless sex (adjusted odds ratio (AOR) = 0.70, 95% confidence interval (CI): 0.28\u20131.70), sex with drugs\/alcohol (AOR = 0.93, 95% CI: 0.42\u20132.05), and use of ART\/PrEP (AOR = 0.80, 95% CI: 0.39\u20131.67) among women who experienced a negative cash balance versus those who did not. Similar trends were observed for other cash scenarios. Conclusion: Financial diaries are a feasible tool to assess the economic lives of vulnerable women. Despite having paid work, most WESW encountered a myriad of financial challenges with limited spending on HIV prevention. Financial protections and additional income-generating activities may improve their status. More robust research is needed to understand the potentially complex relationship between income, expenditures, and HIV risk among vulnerable sex workers.<\/jats:p>","DOI":"10.3390\/ijerph20095612","type":"journal-article","created":{"date-parts":[[2023,4,24]],"date-time":"2023-04-24T03:04:08Z","timestamp":1682305448000},"page":"5612","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["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"],"prefix":"10.3390","volume":"20","author":[{"given":"Larissa","family":"Jennings Mayo-Wilson","sequence":"first","affiliation":[{"name":"Department of Health Behavior, Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina, 135 Dauer Drive, Chapel Hill, NC 27599, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Summer K.","family":"Peterson","sequence":"additional","affiliation":[{"name":"Department of Health Behavior, Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina, 135 Dauer Drive, Chapel Hill, NC 27599, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7264-6976","authenticated-orcid":false,"given":"Joshua","family":"Kiyingi","sequence":"additional","affiliation":[{"name":"Brown School, Washington University in St. Louis, One Brookings Drive, St. Louis, MO 63130, USA"},{"name":"International Center for Child Health and Development, Masaka Field Office, Mutuba Ave, Masaka 319, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Proscovia","family":"Nabunya","sequence":"additional","affiliation":[{"name":"Brown School, Washington University in St. Louis, One Brookings Drive, St. Louis, MO 63130, USA"},{"name":"International Center for Child Health and Development, Masaka Field Office, Mutuba Ave, Masaka 319, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ozge","family":"Sensoy Bahar","sequence":"additional","affiliation":[{"name":"Brown School, Washington University in St. Louis, One Brookings Drive, St. Louis, MO 63130, USA"},{"name":"International Center for Child Health and Development, Masaka Field Office, Mutuba Ave, Masaka 319, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lyla S.","family":"Yang","sequence":"additional","affiliation":[{"name":"School of Social Work, Columbia University, 1255 Amsterdam Avenue, New York, NY 10027, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan S.","family":"Witte","sequence":"additional","affiliation":[{"name":"School of Social Work, Columbia University, 1255 Amsterdam Avenue, New York, NY 10027, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fred M.","family":"Ssewamala","sequence":"additional","affiliation":[{"name":"Brown School, Washington University in St. Louis, One Brookings Drive, St. Louis, MO 63130, USA"},{"name":"International Center for Child Health and Development, Masaka Field Office, Mutuba Ave, Masaka 319, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,4,23]]},"reference":[{"key":"ref_1","unstructured":"(2022, December 09). 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