Understanding Risk for HIV/STI Transmission and Acquisition within Non-Paying Partnerships of Female Sex Workers in Southern India

Understanding Risk within Non-Paying Partnerships.pdf

Known informally as the Lovers Study, this pilot investigates HIV risk within the complex relationships between female sex workers (FSW) and their non-paying partners (NPP). Interventions have been found to increase condom use between FSW and their paying clients, but much less is known about the risk of HIV acquisition or transmission in sex workers' intimate partnerships. Karnataka Health Promotion Trust (KHPT) was well placed to address this research gap, building on several years of multifaceted programming with sex workers.

The pilot study found that sex workers' non-paying partnerships:

  • are complex
  • endure and evolve over time
  • often (majority) begin through commercial sexwork
  • often (over half) exist for over five years
  • involve physical, emotional and economic support by NPP and dependence by FSW
  • also involve high levels of physical violence

The report concludes that:

  • risk behaviours are difficult to modify within intimate and non-paying partnerships
  • fertility desires are a factor in low condom use, and so reproductive health focus should be included in prevention programmes
  • power disparities lower women's social status, reduce economic opportunities and therefore limit women's abilities to negotiate safer sex behaviour, testing and/or treatment
  • dependence on male partners for social acceptance and economic security continues to act as a barrier to addressing violence and HIV prevention

The report recommends the implementation and evaluation of de-stigmatising structural and community-led responses that focus on increasing empowerment and education of FSW to reduce their economic and social vulnerability.


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