Despite the multitude of risks experienced by women who exchange sex, few psychosocial, health or economic support services exist in Mongolia to help women who exchange sex for money (Witte et al. 2010). To reduce women’s sexual health risks, alcohol dependency, risk of violence and economic challenges, our team began working with women who exchange sex in Ulaanbaatar in 2007. Over the past five years, we have implemented two interventions which successfully improved women’s physical, social and financial health. The first of these programmes, Women’s Wellness, sought to test the efficacy and compare the results of three skills-based inter­ventions: a sexual risk reduction intervention, a sexual risk reduction intervention combined with motivational interviewing and a women’s wellness control group. As a result of this trial with 166 women, participants in each group reduced rates of sexual risk taking (such as number of acts of unprotected sex), experiences of violence from intimate and paying partners and harmful alcohol use (Carlson et al. 2012; Witte et al. 2011). A shared component in these interventions was the group format of the sessions, providing women with a social support network of peers and reducing isolation and shame. Findings from this initial study indicate the effectiveness of minimal intervention with a highly stigmatised group of women at improving their health and safety and the importance of women’s informal social support systems.

Most recently, in response to requests by women in our first study, our team is implementing a combined microfinance and sexual risk reduction intervention. The goal of the intervention is for women to learn financial literacy, business development knowledge and skills and to be mentored in the establishment of a small business start-up. Additionally, women are given the opportunity to receive two to one matching funds in savings they contribute to their own savings account, which they may use to purchase materials and required supplies or equipment for a new business. Based on results of a pilot study, women demonstrated increases in knowledge of banking services, savings, financial negotiations, and small business development, in addition to increased enfranchisement through the use of banks (Tsai et al. 2011). Additionally, as a result of participation, women reported increased self-confidence, future orientation and goal setting. While some women have left sex work as a result of participating in the microfinance intervention, others have learned how to better mitigate potential health risks while continuing to engage in sex work. The women in this study demonstrate great resilience while balancing numerous financial challenges and providing support to their families.

There are many challenges related to the implementation of interventions seeking to create alternative income sources for women engaged in sex work and reduce health risks. As we note in this chapter, women sex workers face multiple kinds of adversity and traumas, past and present, and carry significant responsibility for care of dependent children, parents and sometimes also intimate partners. Interventions that require attendance over time at multiple sessions present a barrier in terms of time and travel for many women. Additionally, although women expressed a preference to start businesses in small groups rather than independently, they acknowledged they had difficulty finding common agreement with others regarding business ideas. Although some women would like to leave sex work in favour of their new business ventures, the rates of reimbursement for sex work have been increasing. To shift to a new business means accepting a lower income and less assurance of long term stability and sustainability of income. Regardless, many women have found ways of overcoming these challenges such as joining with family members to start new business ventures or have succeeded on their own.