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Microfinance combined with health information shows multiple benefits for female sex workers in Tijuana, Mexico

A three-year, university-led study suggests that integrating microfinance with health education promotes economic empowerment and reduces HIV-related risks among women engaging in sex work in Tijuana, Mexico.

The study is among the first to show that this economic empowerment model also helps participants reduce their drug and alcohol use and increase their savings.
The study, Empowerment of Sex Workers to Increase Economic and Social Mobility (ESTIMA), published in Advances in Global Health, was led by Elizabeth Reed, ScD, MPH, Professor of Global Health at San Diego State University, in collaboration with researchers at the University of California San Diego. The intervention was implemented by Los Niños de Baja California, a community development organization serving Tijuana and other border communities in Mexico, under the leadership of Executive Director Elisa Sabatini.

Female sex workers (FSW) participating in the study reported that ESTIMA increased their financial stability, self-appreciation, social support, recognition of their rights as women, and ability to negotiate decreased substance use and increased condom use with their clients.

Reed said, “Our findings from the ESTIMA program are incredibly encouraging. Women not only reported that they valued and enjoyed the intervention, but we also documented meaningful improvements across health, social, and economic outcomes. Perhaps most striking—even after the research funding ended—ESTIMA groups have continued for another eight years and have been managed for over a decade by Los Niños. This is a testament to the study’s real-world relevance and impact.”

Sabatini noted, “The women reported being valued and honored for their contributions in their groups. Truly the program honors the name ESTIMA—Spanish for self-esteem.”

Participants were recruited from Tijuana bars, brothels, hotels, and street venues. Aged eighteen or older, they reported having exchanged sex for money, drugs, shelter or goods within the previous 30 days. One hundred and twenty women were randomly assigned to either receive the intervention or a wait-list control group. Control participants were invited to join ESTIMA groups at the study’s conclusion.

Decreased HIV risk
Alcohol and drug use—often widespread within sex work venues—puts FSW at higher risk for HIV. The study noted, “Our findings highlighted several ways in which ESTIMA may have reduced risk for HIV, including reports of decreased substance use as well as improved condom negotiation with clients.”

Participants reported that improved financial security and greater awareness of their rights increased their ability to negotiate condom use and refuse client demands that heightened the women’s risk of violence.

Members reported “I feel more sure of myself… because I’ve learned a lot of things here about how to take care of myself.” And “It’s not like before, that, well everything was rough, violence, or things like that.”

The study included in-depth interviews with twenty-five participants to assess their program experiences, and how ESTIMA affected their lives. Interviewees were, on average, 37 years old with 2.4 dependent children. Sixty-six percent were single, 21 percent married, and 13 percent separated or divorced.

Importance of access to business loans and training
Because most Tijuana sex workers cannot get commercial business loans, funding from Women’s Empowerment International (WE), enabled the FSW to start or expand businesses such as selling handmade crafts and food, and reselling clothing and jewelry. WE has provided loan support since the program’s inception.
Each ESTIMA member received an initial $200 business or personal loan, which she repaid over four months during weekly group meetings. With each repayment, members became eligible for larger loans, capping at $1,000.

Meeting topics included budgets, savings, credit, investments, and business practices. Topics also included gender equity, and the connection between sex work and HIV, gender-based violence and substance use.

Impact of individual loans and small groups
Traditionally, microfinance participants meet in large groups and are collectively responsible for the group’s loan repayment. This model did not work for FSW participating in the pilot studies. But when the groups were downsized to five, and members became individually responsible for their loans, repayment rates went from 50% to 90%.

Poverty and economic vulnerability among Tijuana’s female sex workers
Launching this study in Tijuana–one of the busiest land border crossings in the world–captured the poverty commonly experienced by sex workers worldwide. Sex tourism from the US and Mexico flourishes in Tijuana’s red-light district, Zonas Rojas, where approximately 9,000 women practice quasi-legal prostitution.
Economic vulnerability stemming from inequitable access to education, employment, and child support, is a major factor contributing to women’s involvement in sex work. FSW are among Tijuana’s highest risk populations for HIV and report high rates of physical and sexual violence perpetrated by clients, police, and male partners.

Link to study: https://doi.org/10.1525/agh.2025.2481129
Contact Information:
Dr. Elizabeth Reed, Principal Investigator
Elisa Sabatini, Executive Director, Los Niños de Baja California | Los Niños is celebrating 50 years of work in the border region: www.losninosdebaja.org
Sarah Adams, Executive Director, Women’s Empowerment International (WE)  |  San Diego-based WE has awarded nearly $3 million in grants to microfinance, business development, financial literacy, and holistic empowerment projects in 10 countries: www.womenempowerment.org.
Media Contact: Winifred Cox