Violence experience by perpetrator and associations with HIV/STI risk and infection: a cross-sectional study among female sex workers in Karnataka, south India

Alicja Beksinska, Ravi Prakash, Shajy Isac, H L Mohan, Lucy Platt, James Blanchard, Stephen Moses, Tara S Beattie BMJ Open, 2018; Read the full paper online

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. This paper examines whether HIV/STI risk differs by the perpetrator of violence.

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 were assessed, as was physical and sexual intimate partner violence in the past 12 months.

Of the 1111 FSWs include in the study, 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 botrh both domestic and non-domestic (workplace/community) perpetrators.

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 female sex worker under the influence of alcohol at last sex) than domestic violence. 

The findings reveal that 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.


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