title: Female sex workers use power over their day-to-day lives to meet the condition of a conditional cash transfer intervention to incentivize safe sex.
abstract: Female Sex Workers are a core population in the HIV epidemic, and interventions such as conditional cash transfers (CCTs), effective in other health domains, are a promising new approach to reduce the spread of HIV. Here we investigate how a population of Tanzanian female sex workers, though constrained in many ways, experience and use their power in the context of a CCT intervention that incentivizes safe sex. We analyzed 20 qualitative in-depth interviews with female sex workers enrolled in a randomized-controlled CCT program, the RESPECT II pilot, and found that while such women have limited choices, they do have substantial power over their work logistics that they leveraged to meet the conditions of the CCT and receive the cash award. It was through these decisions over work logistics, such as reducing the number of workdays and clients, that the CCT intervention had its greatest impact on modifying female sex workers' behavior.
authors.affiliation: School of Public Health, 50 University Hall, #7360, University of California Berkeley, Berkeley, CA, 94720-7360, USA. Electronic address: janc@berkeley.edu.
authors.forename: Jan E
authors.initials: JE
authors.lastname: Cooper
authors.affiliation: School of Public Health, 50 University Hall, #7360, University of California Berkeley, Berkeley, CA, 94720-7360, USA. Electronic address: wdow@berkeley.edu.
authors.forename: William H
authors.initials: WH
authors.lastname: Dow
authors.affiliation: Development Research Group, The World Bank, 1818 H Street, NW, Washington, DC, 20433, USA. Electronic address: ddewalque@worldbank.org.
authors.forename: Damien
authors.initials: D
authors.lastname: de Walque
authors.affiliation: School of Public Health, 50 University Hall, #7360, University of California Berkeley, Berkeley, CA, 94720-7360, USA. Electronic address: annk@berkeley.edu.
authors.forename: Ann C
authors.initials: AC
authors.lastname: Keller
authors.affiliation: School of Public Health, 50 University Hall, #7360, University of California Berkeley, Berkeley, CA, 94720-7360, USA. Electronic address: smccoy@berkeley.edu.
authors.forename: Sandra I
authors.initials: SI
authors.lastname: McCoy
authors.affiliation: School of Public Health, 50 University Hall, #7360, University of California Berkeley, Berkeley, CA, 94720-7360, USA. Electronic address: fernald@berkeley.edu.
authors.forename: Lia C H
authors.initials: LCH
authors.lastname: Fernald
authors.affiliation: Independent, Dar es Salaam, Tanzania. Electronic address: m_balampama@yahoo.com.
authors.forename: Marianna P
authors.initials: MP
authors.lastname: Balampama
authors.affiliation: Ifakara Health Institute, Plot 463, Kiko Avenue, Mikocheni, Dar es Salaam, P.O. Box 78373, Tanzania. Electronic address: akalolella@ihi.or.tz.
authors.forename: Admirabilis
authors.initials: A
authors.lastname: Kalolella
authors.affiliation: Office of the President, University of California, 1111 Franklin Street, Oakland, CA, 94607, USA. Electronic address: ljpackel@gmail.com.
authors.forename: Laura J
authors.initials: LJ
authors.lastname: Packel
authors.affiliation: Global Gender Center, RTI International, East Cornwallis Road, P.O. Box 12194, Research Triangle Park, NC, 27709-2194, USA. Electronic address: wmw@rti.org.
authors.forename: Wendee M
authors.initials: WM
authors.lastname: Wechsberg
authors.affiliation: School of Public Health, 50 University Hall, #7360, University of California Berkeley, Berkeley, CA, 94720-7360, USA. Electronic address: eozer@berkeley.edu.
authors.forename: Emily J
authors.initials: EJ
authors.lastname: Ozer
mesh_terms: D000328:Adult; D018588:Fee-for-Service Plans; D005260:Female; D015658:HIV Infections / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control*; D006801:Humans; D036301:Qualitative Research; D021841:Safe Sex / Q000523:psychology*; D060386:Sex Workers / Q000523:psychology*; D013636:Tanzania / Q000453:epidemiology
keywords: Core populations; Empowerment; Gender; Incentives; Sexually transmitted infections; Sub-Saharan Africa; Tanzania