Samvedana Plus: Reducing Violence and Increasing Condom Use in the Intimate Partnerships of Female Sex Workers in Bagalkote District, North Karnataka, South India

STRIVE_evidence brief Samvedana Plus.pdf

Previous interventions in India successfully reduced violence against female sex workers (FSWs) by 'non-intimate' partners such as clients and police, but addressing violence by their non-paying intimate partners (husband, boyfriend) has been challenging. As violence is strongly associated with HIV-infection and risks such as reduced condom use, the Karnataka Health Promotion Trust (KHPT) developed Samvedana Plus, a multi-level structural intervention that aimed to reduce risk and vulnerability among FSWs by reducing partner violence and promoting consistnt condom use within intimate relationships in rural settings in South India.

This is the first cluster randomised controlled trial (cRCT) to evaluate an intervention designed to address the factors that contribute to violence and impede condom use in the relationships of FSWs and their intimate partners (IPs). The trial found no difference in either reports of physical or sexual violence or consistent condom use within the intimate relationship between the trial groups. However, the trial did find lower acceptance of intimate partner violence (IPV), and higher levels of self-protection strategies and solidarity among FSWs around the issue of IPV in the intervention group.

The qualitative study revealed that addressing IPV within the intimate relationships of FSWs is challenging due to complex social norms around intimate relationships and may require a long-term intervention. For a FSW, protecting her relationship is of utmost importance, and so she is unlikely to assert herself against violence and insist on condoms.

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