There is a growing recognition that social and structural factors increase HIV risk for vulnerable groups including female sex workers (FSWs). In order to find out what is driving the spread of India’s HIV epidemic into rural areas and low-prevalence states, researchers at Karnataka Health Promotion Trust (KHPT) conducted a survey with FSWs and intimate partners (IPs) in Bagalkot District, northern Karnataka.

As this evidence brief explains, qualitative inquiry is important for Samvedana Plus as it seeks to collect evidence of gender norms and intimate partner violence (IPV) as possible drivers of HIV transmission in order to reduce the HIV vulnerability of the women and their partners.

Study 

17 FSWs and 34 IPs were interviewed in this survey to explore the impact of norms around masculinity, gender and violence on the dynamics of IPV among FSWs. It investigated how IPs used their support to FSWs to justify their acts of violence and the IPs’ perceptions of the causes and effects of violence. The following questions were addressed:

• Does gender inequality increase HIV vulnerability of FSWs?
• What harmful gender norms sanction violence against these women?
• How does IPV increase the risk of HIV for FSWs?

Findings

• Existing norms such as male dominance, infidelity, violence as a legitimate form of discipline increase sex workers’ risk of contracting HIV while in intimate relationships
• For IPs, the construct of the ideal woman did not differ substantially between their lovers and wives
• IPs believed that their relationship with FSW lovers is expendable
• IPs use violence against their FSW lovers to assert control over women and to correct their transgressions and lack of obedience
• IPs feel entitled to unprotected sex with their FSW lovers

Call to Action

The findings indicate that it is unlikely that IPs will listen to, learn from or comply with FSWs who attempt to negotiate condom use. For this reason, it is important that programmes work with IPs of FSWs to reduce the HIV vulnerability of the women and their partners. This study calls for:

• increased outreach to the IPs of FSWs, to educate them about HIV prevention and promote a resilient concept of masculinity that supports women’s liberty and equality
• the creation of collectives/forums to discuss relationship challenges and form positive norms based on love, respect and equality
• the promotion of awareness of why and how to eliminate violence against women
• the promotion of understanding and stricter enforcement of laws that protect women
• the engagement of leaders and role models among the IPs to speak against IPV and male supremacy