What determines violence among female sex workers in an intimate partner relationship? Findings from North Karnataka, south India

Abstract

Background: Like other women in India, female sex workers (FSWs) frequently experience violence from their intimate partners (IPs)-a reality that increases their risk of acquiring HIV or other sexually transmitted infections. Less is known about the nature of these intimate relationships or what aspect of the relationship increases the risk of IP violence (IPV). We measured the prevalence and determinants of IPV on FSWs in the context of north Karnataka, India, characterized by high HIV-prevalence and extreme poverty.

Methods: Overall 620 FSWs with an IP participated in a baseline survey conducted for an on-going cluster-randomised controlled trial aiming to evaluate the impact of a multi-level intervention on IPV reduction. We characterize the nature of intimate relationships and explored determinants of severe physical and/or sexual IP violence using univariable and multivariable analyses.

Results: The median age of participants was 35 years with 10 years of duration in an intimate relationship. Though most relationships originated from a sex work encounter, 84% stated that IPs did not know they were currently practicing sex work. In past 6 months, the experience of emotional violence was 49% (95%CI:45.2-53.2), physical 33% (95%CI:29.5-37.1) and sexual violence 7% (95%CI:4.8-8.9), while 24% (95%CI:21.0-27.9) FSWs experienced recent severe physical and/or sexual violence from IPs. Factors associated with recent IPV included experience of physical and/or sexual violence from their clients in last 6 months (AOR 2.20; 95%CI: 1.29-3.75), sexual intercourse in the past 1 month when their IP was under the influence of alcohol (AOR 2.30; 95%CI: 1.47-3.59) and providing financial support to their IP (AOR 2.07; 95%CI: 1.28-3.34).

Conclusions: The association between increased risk of violence and provision of financial support to an IP is indicative of gendered power dynamics as men remain dominant irrespective of their financial dependency on FSWs. Interventions are needed that address inequitable gender norms which makes FSWs tolerate violence even though she is not financially dependent on IP. Higher likelihood of violence in presence of alcohol use and FSWs' previous experience of workplace violence linked to IPV call for strengthening the crisis management systems within community-based organisations that can address all forms of violence and associated risk factors.

Trial registration: Clinical Trials NCT02807259.

Keywords: Devadasi; Domestic violenc; Female sex workers; India; Violence, intimate partner violence.

Conflict of interest statement

Ethics approval and consent to participate

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed verbal consent witnessed by counsellors supporting the intervention and researchers involved in data collection was obtained from all individual participants included in the study about their participation in the study. The study protocol, consent forms and study tools were approved by the Institutional Ethics Committee of St. John’s Medical College and Hospital, Bangalore, India, (Reference number:110/2013) and the Observational/Interventions Research Ethics Committee of the London School of Hygiene and Tropical Medicine (Reference number:8658).

Consent for publication

Informed consent to publish the research findings was obtained with an assurance to maintain the confidentiality of the information provided by the participants.

Competing interests

The authors declare that they have no competing interests.

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Figures

Fig. 1

Proportional Venn diagram illustrating the overlapping between the different forms of violence