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Trials volume 19 , Article number: Cite this article. Among women at high risk for HIV and other sexually transmitted diseases STIs , gender and economic issues limit the impact of behavioral prevention strategies. Women in Kazakhstan with dual risks of sex trading and drug use face elevated risk for HIV and STIs and may benefit from an economic empowerment intervention which combines HIV-risk reduction HIVRR education with financial skills-building and asset-building to promote reduced reliance on sex trading for income.

The study employs a two-arm, cluster-randomized controlled trial c-RCT design. This study responds to an identified need in the academic literature for rigorous testing of structural interventions, including combination microfinance and HIV-prevention interventions. Registered on 30 March Peer Review reports. While the HIV epidemic in Kazakhstan has remained concentrated among high-risk populations since its beginnings, a recent shift from parenteral to heterosexual transmission highlights the increased risk of HIV transmission to, and by, female sex workers FSW.

HIV prevalence continues to rise among FSW throughout the Central Asian region, yet there has been limited research and exposure to evidence-based HIV-prevention interventions for this population [ 1 ]. One systematic review and meta-analysis has estimated that in low- and middle-income countries like Kazakhstan, sex workers have Drug-using female sex workers are at the greatest HIV risk and the least likely to have access to testing, care or treatment services — they operate at the lower end of the market, are more often street-based, and are typically much poorer than non-drug-using FSW [ 2 ].

Stigma against both sex work and drug use and aggressive policing may limit their access to health services including drug treatment as well as legal recourse, and may subject them to sexual coercion and violence from police themselves [ 6 , 8 ]. Furthermore, in Central Asia, few women who use drugs have been reached through evidence-based HIV or harm-reduction interventions, and most local HIV or drug treatment programming has not met their unique needs [ 9 ]. Structural approaches to HIV prevention are characterized by Gupta et al.