Community-Led Economic Initiatives with Sex Workers: Establishing a Conceptual Framework for a Multidimensional Structural Intervention

Commercial sex workers are at significant risk of contracting HIV. Scholars have identified economic insecurity and the exploitation resulting from it as structural vectors of HIV risk for this community. While community-led structural interventions have successfully reduced HIV risk with sex workers, economic structural interventions remain under-utilized and under-studied in this population. The few existing economic interventions described in the literature are limited to individual interventions and do not adopt a community-led structural intervention approach. We conduct a literature review to examine the connections between economic insecurity and sex worker HIV risk, the limitations of existing economic interventions with sex workers, and the evidence in support of HIV structural interventions with sex workers. We then develop a conceptual framework for a community-led structural economic intervention model that would enable sex workers to negotiate the socio-political and economic barriers that increase their HIV vulnerability. Specifically, we articulate an economic structural intervention model which stands on three pillars: (1) a meaningful community ownership, (2) a multilevel (individual, community, socio-political) intervention approach, and (3) a commitment to empowering sex workers as workers, rather than an orientation that seeks to rescue them from sex work through alternative income generation.