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What determines violence among female sex workers in an intimate partner relationship? Findings from North Karnataka, south India.
BMC Public Health. 2019 Mar 29; 19(1):350.BP

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.

Authors+Show Affiliations

Karnataka Health Promotion Trust (KHPT), IT Park, 5th Floor, #1-4, Rajajinagar Industrial Area, Behind KSSIDC Admin Office, Rajajinagar, Bangalore, Karnataka, 560044, India. prakashj@khpt.org.Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine (LSHTM), 15-17 Tavistock Place, London, WC1H 9SN, UK.Karnataka Health Promotion Trust (KHPT), IT Park, 5th Floor, #1-4, Rajajinagar Industrial Area, Behind KSSIDC Admin Office, Rajajinagar, Bangalore, Karnataka, 560044, India.Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine (LSHTM), 15-17 Tavistock Place, London, WC1H 9SN, UK.Karnataka Health Promotion Trust (KHPT), IT Park, 5th Floor, #1-4, Rajajinagar Industrial Area, Behind KSSIDC Admin Office, Rajajinagar, Bangalore, Karnataka, 560044, India. Center for Global Public Health, University of Manitoba, Winnipeg, Manitoba, R3T 2N2, Canada.Karnataka Health Promotion Trust (KHPT), IT Park, 5th Floor, #1-4, Rajajinagar Industrial Area, Behind KSSIDC Admin Office, Rajajinagar, Bangalore, Karnataka, 560044, India.Karnataka Health Promotion Trust (KHPT), IT Park, 5th Floor, #1-4, Rajajinagar Industrial Area, Behind KSSIDC Admin Office, Rajajinagar, Bangalore, Karnataka, 560044, India.Chaitanya AIDS Tadegattuva Mahila Sangha, Opposite Anupama Hospital, Mallamanagar, Mudhol, Bagalkot, 587313, India.Karnataka Health Promotion Trust (KHPT), IT Park, 5th Floor, #1-4, Rajajinagar Industrial Area, Behind KSSIDC Admin Office, Rajajinagar, Bangalore, Karnataka, 560044, India.Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine (LSHTM), 15-17 Tavistock Place, London, WC1H 9SN, UK.Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine (LSHTM), 15-17 Tavistock Place, London, WC1H 9SN, UK.Center for Global Public Health, University of Manitoba, Winnipeg, Manitoba, R3T 2N2, Canada.South African Medical Research Council, 1 Soutpansberg Road, Pretoria, South Africa.Karnataka Health Promotion Trust (KHPT), IT Park, 5th Floor, #1-4, Rajajinagar Industrial Area, Behind KSSIDC Admin Office, Rajajinagar, Bangalore, Karnataka, 560044, India. Center for Global Public Health, University of Manitoba, Winnipeg, Manitoba, R3T 2N2, Canada.Johns Hopkins University, 3400 N. Charles Street, Baltimore, MD, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

30922283

Citation

Javalkar, Prakash, et al. "What Determines Violence Among Female Sex Workers in an Intimate Partner Relationship? Findings From North Karnataka, South India." BMC Public Health, vol. 19, no. 1, 2019, p. 350.
Javalkar P, Platt L, Prakash R, et al. What determines violence among female sex workers in an intimate partner relationship? Findings from North Karnataka, south India. BMC Public Health. 2019;19(1):350.
Javalkar, P., Platt, L., Prakash, R., Beattie, T., Bhattacharjee, P., Thalinja, R., L, K. D., Sangha, C. A. T. M., Ramanaik, S., Collumbien, M., Davey, C., Moses, S., Jewkes, R., Isac, S., & Heise, L. (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. https://doi.org/10.1186/s12889-019-6673-9
Javalkar P, et al. What Determines Violence Among Female Sex Workers in an Intimate Partner Relationship? Findings From North Karnataka, South India. BMC Public Health. 2019 Mar 29;19(1):350. PubMed PMID: 30922283.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - What determines violence among female sex workers in an intimate partner relationship? Findings from North Karnataka, south India. AU - Javalkar,Prakash, AU - Platt,Lucy, AU - Prakash,Ravi, AU - Beattie,Tara, AU - Bhattacharjee,Parinita, AU - Thalinja,Raghavendra, AU - L,Kavitha D, AU - Sangha,Chaitanya Aids Tadegattuva Mahila, AU - Ramanaik,Satyanarayana, AU - Collumbien,Martine, AU - Davey,Calum, AU - Moses,Stephen, AU - Jewkes,Rachel, AU - Isac,Shajy, AU - Heise,Lori, Y1 - 2019/03/29/ PY - 2018/06/16/received PY - 2019/03/18/accepted PY - 2019/3/30/entrez PY - 2019/3/30/pubmed PY - 2019/5/16/medline KW - Devadasi KW - Domestic violenc KW - Female sex workers KW - India KW - Violence, intimate partner violence SP - 350 EP - 350 JF - BMC public health JO - BMC Public Health VL - 19 IS - 1 N2 - 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. SN - 1471-2458 UR - https://www.unboundmedicine.com/medline/citation/30922283/What_determines_violence_among_female_sex_workers_in_an_intimate_partner_relationship_Findings_from_North_Karnataka_south_India_ L2 - https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-019-6673-9 DB - PRIME DP - Unbound Medicine ER -