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Violence experience by perpetrator and associations with HIV/STI risk and infection: a cross-sectional study among female sex workers in Karnataka, south India.
BMJ Open. 2018 09 11; 8(9):e021389.BO

Abstract

OBJECTIVES

Female sex workers (FSWs) experience violence from a range of perpetrators, but little is known about how violence experience across multiple settings (workplace, community, domestic) impacts on HIV/sexually transmitted infection (STI) risk. We examined whether HIV/STI risk differs by the perpetrator of violence.

METHODS

An Integrated Biological and Behavioural Assessment survey was conducted among random samples of FSWs in two districts (Bangalore and Shimoga) in Karnataka state, south India, in 2011. Physical and sexual violence in the past six months, by workplace (client, police, coworker, pimp) or community (stranger, rowdy, neighbour, auto-driver) perpetrators was assessed, as was physical and sexual intimate partner violence in the past 12 months. Weighted, bivariate and multivariate analyses were used to examine associations between violence by perpetrator and HIV/STI risk.

RESULTS

1111 FSWs were included (Bangalore=718, Shimoga=393). Overall, 34.9% reported recent physical and/or sexual violence. Violence was experienced from domestic (27.1%), workplace (11.1%) and community (4.2%) perpetrators, with 6.2% of participants reporting recent violence from both domestic and non-domestic (workplace/community) perpetrators. Adjusted analysis suggests that experience of violence by workplace/community perpetrators is more important in increasing HIV/STI risk during sex work (lower condom use with clients; client or FSW under the influence of alcohol at last sex) than domestic violence. However, women who reported recent violence by domestic and workplace/community perpetrators had the highest odds of high-titre syphilis infection, recent STI symptoms and condom breakage at last sex, and the lowest odds of condom use at last sex with regular clients compared with women who reported violence by domestic or workplace/community perpetrators only.

CONCLUSION

HIV/STI risk differs by the perpetrator of violence and is highest among FSWs experiencing violence in the workplace/community and at home. Effective HIV/STI prevention programmes with FSWs need to include violence interventions that address violence across both their personal and working lives.

Authors+Show Affiliations

Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK.Karnataka Health Promotion Trust, Bengaluru, Karnataka, India.Karnataka Health Promotion Trust, Bengaluru, Karnataka, India.Karnataka Health Promotion Trust, Bengaluru, Karnataka, India.Department of Social and Environmental Health, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK.Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada. Department of Medical Microbiology, University of Manitoba, Winnipeg, Manitoba, Canada.Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada. Department of Medical Microbiology, University of Manitoba, Winnipeg, Manitoba, Canada.Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

30206080

Citation

Beksinska, Alicja, et al. "Violence Experience By Perpetrator and Associations With HIV/STI Risk and Infection: a Cross-sectional Study Among Female Sex Workers in Karnataka, South India." BMJ Open, vol. 8, no. 9, 2018, pp. e021389.
Beksinska A, Prakash R, Isac S, et al. Violence experience by perpetrator and associations with HIV/STI risk and infection: a cross-sectional study among female sex workers in Karnataka, south India. BMJ Open. 2018;8(9):e021389.
Beksinska, A., Prakash, R., Isac, S., Mohan, H. L., Platt, L., Blanchard, J., Moses, S., & Beattie, T. S. (2018). Violence experience by perpetrator and associations with HIV/STI risk and infection: a cross-sectional study among female sex workers in Karnataka, south India. BMJ Open, 8(9), e021389. https://doi.org/10.1136/bmjopen-2017-021389
Beksinska A, et al. Violence Experience By Perpetrator and Associations With HIV/STI Risk and Infection: a Cross-sectional Study Among Female Sex Workers in Karnataka, South India. BMJ Open. 2018 09 11;8(9):e021389. PubMed PMID: 30206080.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Violence experience by perpetrator and associations with HIV/STI risk and infection: a cross-sectional study among female sex workers in Karnataka, south India. AU - Beksinska,Alicja, AU - Prakash,Ravi, AU - Isac,Shajy, AU - Mohan,H L, AU - Platt,Lucy, AU - Blanchard,James, AU - Moses,Stephen, AU - Beattie,Tara S, Y1 - 2018/09/11/ PY - 2018/9/13/entrez PY - 2018/9/13/pubmed PY - 2019/10/28/medline KW - female sex workers KW - sexually transmitted infections KW - violence SP - e021389 EP - e021389 JF - BMJ open JO - BMJ Open VL - 8 IS - 9 N2 - OBJECTIVES: Female sex workers (FSWs) experience violence from a range of perpetrators, but little is known about how violence experience across multiple settings (workplace, community, domestic) impacts on HIV/sexually transmitted infection (STI) risk. We examined whether HIV/STI risk differs by the perpetrator of violence. METHODS: An Integrated Biological and Behavioural Assessment survey was conducted among random samples of FSWs in two districts (Bangalore and Shimoga) in Karnataka state, south India, in 2011. Physical and sexual violence in the past six months, by workplace (client, police, coworker, pimp) or community (stranger, rowdy, neighbour, auto-driver) perpetrators was assessed, as was physical and sexual intimate partner violence in the past 12 months. Weighted, bivariate and multivariate analyses were used to examine associations between violence by perpetrator and HIV/STI risk. RESULTS: 1111 FSWs were included (Bangalore=718, Shimoga=393). Overall, 34.9% reported recent physical and/or sexual violence. Violence was experienced from domestic (27.1%), workplace (11.1%) and community (4.2%) perpetrators, with 6.2% of participants reporting recent violence from both domestic and non-domestic (workplace/community) perpetrators. Adjusted analysis suggests that experience of violence by workplace/community perpetrators is more important in increasing HIV/STI risk during sex work (lower condom use with clients; client or FSW under the influence of alcohol at last sex) than domestic violence. However, women who reported recent violence by domestic and workplace/community perpetrators had the highest odds of high-titre syphilis infection, recent STI symptoms and condom breakage at last sex, and the lowest odds of condom use at last sex with regular clients compared with women who reported violence by domestic or workplace/community perpetrators only. CONCLUSION: HIV/STI risk differs by the perpetrator of violence and is highest among FSWs experiencing violence in the workplace/community and at home. Effective HIV/STI prevention programmes with FSWs need to include violence interventions that address violence across both their personal and working lives. SN - 2044-6055 UR - https://www.unboundmedicine.com/medline/citation/30206080/Violence_experience_by_perpetrator_and_associations_with_HIV/STI_risk_and_infection:_a_cross_sectional_study_among_female_sex_workers_in_Karnataka_south_India_ L2 - http://bmjopen.bmj.com/cgi/pmidlookup?view=long&pmid=30206080 DB - PRIME DP - Unbound Medicine ER -