Economic hardship is a driver of entry into sex work, which is associated with high HIV risk. Yet, little is known about economic abuse in women employed by sex work (WESW) and its relationship to uptake of HIV prevention and financial support services. This study used cross-sectional baseline data from a multisite, longitudinal clinical trial that tests the efficacy of adding economic empowerment to traditional HIV risk reduction education on HIV incidence in 542 WESW. Mixed effects logistic and linear regressions were used to examine associations in reported economic abuse by demographic characteristics, sexual behaviors, HIV care-seeking, and financial care-seeking. Mean age was 31.4 years. Most WESW were unmarried (74%) and had less than primary school education (64%). 48% had savings, and 72% had debt. 93% reported at least one economic abuse incident. Common incidents included being forced to ask for money (80%), having financial information kept from them (61%), and being forced to disclose how money was spent (56%). WESW also reported partners/relatives spending money needed for bills (45%), not paying bills (38%), threatening them to quit their job(s) (38%), and using physical violence when earning income (24%). Married/partnered WESW (OR = 2.68, 95% CI:1.60–4.48), those with debt (OR = 1.70, 95% CI:1.04–2.77), and those with sex-work bosses (OR = 1.90, 95% CI:1.07–3.38) had higher economic abuse. Condomless sex (β = +4.43, p < .05) was higher among WESW experiencing economic abuse, who also had lower odds of initiating PrEP (OR = .39, 95% CI:.17–.89). WESW experiencing economic abuse were also more likely to ask for cash among relatives (OR = 2.36, 95% CI:1.13–4.94) or banks (OR = 2.12, 95% CI:1.11–4.03). The high prevalence of HIV and economic abuse in WESW underscores the importance of integrating financial empowerment in HIV risk reduction interventions for WESW, including education about economic abuse and strategies to address it. Programs focusing on violence against women should also consider economic barriers to accessing HIV prevention services.

中文翻译：

---

从事性工作的女性的艾滋病毒和经济支持服务的经济虐待和寻求护理实践：乌干达临床试验队列的跨部门基线评估

经济困难是从事性工作的驱动因素，而性工作与艾滋病毒高风险相关。然而，人们对性工作女性的经济虐待（WESW）及其与接受艾滋病毒预防和经济支持服务的关系知之甚少。这项研究使用了来自多地点、纵向临床试验的横断面基线数据，该试验测试了在 542 WESW 中将经济赋权添加到传统 HIV 风险降低教育对 HIV 发病率的有效性。使用混合效应逻辑回归和线性回归来检查所报告的经济虐待与人口特征、性行为、艾滋病毒就医和经济就医之间的关联。平均年龄为 31.4 岁。大多数 WESW 未婚 (74%) 且未受过小学教育 (64%)。48% 有储蓄，72% 有债务。93% 的人报告了至少一起经济虐待事件。常见的事件包括被迫要钱（80%），财务信息被隐瞒（61%），以及被迫透露钱是怎么花的（56%）。WESW 还报告了伴侣/亲戚花钱支付账单 (45%)、不支付账单 (38%)、威胁他们辞职 (38%) 以及在赚取收入时使用身体暴力 (24%)。已婚/合伙 WESW (OR = 2.68, 95% CI:1.60–4.48)、有债务的人 (OR = 1.70, 95% CI:1.04–2.77) 和有性工作老板的人 (OR = 1.90, 95% CI :1.07–3.38) 有更高的经济滥用。无套性行为（WESW 还报告了伴侣/亲戚花钱支付账单 (45%)、不支付账单 (38%)、威胁他们辞职 (38%) 以及在赚取收入时使用身体暴力 (24%)。已婚/合伙 WESW (OR = 2.68, 95% CI:1.60–4.48)、有债务的人 (OR = 1.70, 95% CI:1.04–2.77) 和有性工作老板的人 (OR = 1.90, 95% CI :1.07–3.38) 有更高的经济滥用。无套性行为（WESW 还报告了伴侣/亲戚花钱支付账单 (45%)、不支付账单 (38%)、威胁他们辞职 (38%) 以及在赚取收入时使用身体暴力 (24%)。已婚/合伙 WESW (OR = 2.68, 95% CI:1.60–4.48)、有债务的人 (OR = 1.70, 95% CI:1.04–2.77) 和有性工作老板的人 (OR = 1.90, 95% CI :1.07–3.38) 有更高的经济滥用。无套性行为（β = +4.43, p < .05) 在遭受经济虐待的 WESW 中较高，他们启动 PrEP 的几率也较低 (OR = .39, 95% CI:.17–.89)。遭受经济虐待的 WESW 也更有可能向亲属（OR = 2.36，95% CI：1.13-4.94）或银行（OR = 2.12，95% CI：1.11-4.03）索要现金。WESW 中 HIV 和经济虐待的高流行率强调了将金融赋权纳入 WESW 降低 HIV 风险干预措施的重要性，包括有关经济虐待的教育和解决策略。以暴力侵害妇女行为为重点的项目还应考虑获得艾滋病毒预防服务的经济障碍。