Understanding the Relationship Between Female Sex Workers and Their Intimate Partners: Lessons and Initial Findings From Participatory Research in North Karnataka, South India

Parinita Bhattacharjee, Linda Campbell, Raghavendra Thalinja, Sapna Nair, Mahesh Doddamane, Satyanarayana Ramanaik, Shajy Isac and Tara S. Beattie Health Education & Behaviour, 2018; Read the full paper online

While traditional HIV prevention programs with female sex workers (FSWs) in Karnataka, India, have focused on reducing HIV transmission between FSWs and clients through increased condom use, these programs have not fully addressed the transmission risk between FSWs and their non-paying intimate partners (IPs). Condom use is infrequent and violence is recurrent in these relationships and there is little evidence on the precise nature of FSW–IP relationships.

This study addresses this knowledge gap to inform HIV programs targeted at FSWs. A series of workshops, using participatory tools, were held to explore FSW-IP relationships. Three aspects of FSW–IP relationships were examined:

  1. how FSWs and IPs understand and interpret their relationships,
  2. factors influencing condom use, and
  3. the role of violence and its consequences.

Key findings

  • FSWs wish to be perceived as their IPs’ wives, while IPs expect their FSW partners to accept their dominance in the relationship.
  • Non-use of condoms is seen as a signal of fidelity and elevates the status of the relationship almost to that of marriage, which helps FSWs enter the category of “good” (married) women.
  • Tolerating and accepting violence in these relationships is normative, as in other marital relationships; IPs justify violence as necessary to establish and maintain their power within the relationship.
  • Both FSWs and IPs value their relationships despite the high degree of risk posed by low condom use and high levels of violence.

Implications for program design include addressing current norms around masculinity and gender roles, and improving communication within relationships.

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