India | Karnataka Health Promotion Trust
Samdevena Plus is a multi-level intervention that aims to reduce vulnerability to HIV amongst female sex workers in Karnataka State, India, by reducing partner violence and increasing consistent condom use within their intimate relationships. The Global Programme, in partnership with the Karnataka Health Promotion Trust and STRIVE will evaluate the programme using a Cluster-Randomised Control Trial.
Javalkar, P., Platt, L., Prakash, R., Beattie, T. S., Collumbien, M., Gafos, M., ... & Bhattacharjee, P. (2019). Effectiveness of a multilevel intervention to reduce violence and increase condom use in intimate partnerships among female sex workers: cluster randomised controlled trial in Karnataka, India. BMJ Global Health, 4(6).
Javalkar, P., Platt, L., Prakash, R., Beattie, T., Bhattacharjee, P., Thalinja, R., ... & Davey, C. (2019). What determines violence among female sex workers in an intimate partner relationship? Findings from North Karnataka, south India. BMC Public Health, 19(1), 350.
The response to the HIV epidemic through targeted interventions focused largely on changing individual behaviour and encouraged female sex workers to use condoms correctly, continuously and consistently with their clients. However, subsequent studies reported that although condom usage during sexual interactions with clients increased, their usage was less consistent with intimate partners (also known as lovers and as Hiriya or Malak in the context of Karnataka) of female sex workers. It was also observed that where condom use has been inconsistent, experience of violence has been high.
The influence of structural factors such as poverty, social norms, alcohol abuse, and criminalisation of high-risk behaviours on HIV risk and vulnerability has led scholars and HIV prevention programmers to regard structural intervention as an essential component of an HIV prevention strategy. Structural interventions reduce risk and vulnerability among female sex workers (FSWs) by empowering them with greater control over condom use with clients, and reducing violence and stigma against them.
In response to the HIV epidemic, targeted interventions were initiated which focused on changing individual behaviour and encouraging sex workers to use condoms correctly, continuously and consistently with their clients. However it was observed in subsequent studies that though there was an increase in condom usage among sex workers during their sexual interactions with clients, the usage was less consistent when they were with their intimate partners (termed lovers in some contexts or Hiriya or Malak in the context of Karnataka).
Blanchard, A. K., Nair, S. G., Bruce, S. G., Ramanaik, S., Thalinja, R., Murthy, S., ... & Isac, S. (2018). A community-based qualitative study on the experience and understandings of intimate partner violence and HIV vulnerability from the perspectives of female sex workers and male intimate partners in North Karnataka state, India. BMC women's health, 18(1), 66.
Bhattacharjee, P., Campbell, L., Thalinja, R., Nair, S., Doddamane, M., Ramanaik, S., ... & Beattie, T. S. (2018). Understanding the Relationship Between Female Sex Workers and Their Intimate Partners: Lessons and Initial Findings From Participatory Research in North Karnataka, South India. Health education & behavior, 1090198118763934.
David* is a 25 year old man, who works as driver and is married. He has had an ongoing intimate relationship with a FSW for more than seven years. They have had a difficult relationship for many years, which has often led to him physically abusing her.
Gowri* is a 35-year-old sex worker with a daily clientele. She has two regular intimate partners, with whom she reports being very compatible. As a result, she does not experience violence in intimate relationships. Given the intimacy and trust she enjoys with them, she does not use condoms in their intimate relationships.
Violence persists in sex workers’ relationships with their intimate partners, an intervention and evaluation study, Samvedana Plus, was designed to understand and address violence and HIV risk in the intimate partnerships of female sex workers. Karnataka Health Promotion Trust (KHPT) is implementing Samvedana Plus, in partnership with Chaitanya AIDS Tadegattuwa Mahila Sangha, a communitybased organisation (CBO) of sex workers in northern Karnataka, India. The findings of the report are related to four broad categories: characteristics of the female sex workers and intimate partner relationships; gender attitudes, social norms and violence acceptance; experience of intimate partner violence, solidarity and self-worth; and STI/HIV risk perceptions, skills for self-protection and condom use among female sex workers.