Bhattacharjee Parinita, Isac Shajy, McClarty Leigh M, Mohan Haranahalli L, Maddur Srinath, Jagannath Sunitha B, Venkataramaiah Balasubramanya K, Moses Stephen, Blanchard James F, Gurnani Vandana
Karnataka Health Promotion Trust, Bangalore, India.
Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada.
J Int AIDS Soc. 2016 Jul 18;19(4 Suppl 3):20856. doi: 10.7448/IAS.19.4.20856. eCollection 2016.
Female sex workers (FSWs) frequently experience violence in their work environments, violating their basic rights and increasing their vulnerability to HIV infection. Structural interventions addressing such violence are critical components of comprehensive HIV prevention programmes. We describe structural interventions developed to address violence against FSWs in the form of police arrest, in the context of the Bill and Melinda Gates Foundation's India AIDS Initiative (Avahan) in Karnataka, South India. We examine changes in FSW arrest between two consecutive time points during the intervention and identify characteristics that may increase FSW vulnerability to arrest in Karnataka.
Structural interventions with police involved advocacy work with senior police officials, sensitization workshops, and integration of HIV and human rights topics in pre-service curricula. Programmes for FSWs aimed to enhance collectivization, empowerment and awareness about human rights and to introduce crisis response mechanisms. Three rounds of integrated behavioural and biological assessment surveys were conducted among FSWs from 2004 to 2011. We conducted bivariate and multivariate analyses using data from the second (R2) and third (R3) survey rounds to examine changes in arrests among FSWs over time and to assess associations between police arrest, and the sociodemographic and sex work-related characteristics of FSWs.
Among 4110 FSWs surveyed, rates of ever being arrested by the police significantly decreased over time, from 9.9% in R2 to 6.1% in R3 (adjusted odds ratio (AOR) [95% CI]=0.63 [0.48 to 0.83]). Arrests in the preceding year significantly decreased, from 5.5% in R2 to 2.8% in R3 (AOR [95% CI]=0.59 [0.41 to 0.86]). FSWs arrested as part of arbitrary police raids also decreased from 49.6 to 19.5% (AOR [95% CI]=0.21 [0.11 to 0.42]). Certain characteristics, including financial dependency on sex work, street- or brothel-based solicitation and high client volumes, were found to significantly increase the odds of arrest for participants.
Structural interventions addressing police arrest of FSWs are feasible to implement. Based on our findings, the design of violence prevention and response interventions in Karnataka can be tailored to focus on FSWs, who are disproportionately vulnerable to arrest by police. Context-specific structural interventions can reduce police arrests, create a safer work environment for FSWs and protect fundamental human rights.
女性性工作者（FSW）在其工作环境中经常遭受暴力，这侵犯了她们的基本权利，并增加了她们感染艾滋病毒的易感性。针对此类暴力的结构性干预措施是全面艾滋病毒预防计划的关键组成部分。我们描述了在印度南部卡纳塔克邦比尔及梅琳达·盖茨基金会的印度艾滋病倡议（阿瓦汉）背景下，以警方逮捕形式开展的旨在解决针对女性性工作者暴力行为的结构性干预措施。我们研究了干预期间两个连续时间点之间女性性工作者被捕情况的变化，并确定了可能增加卡纳塔克邦女性性工作者被捕易感性的特征。
与警方开展的结构性干预措施包括与高级警官进行宣传工作、举办提高认识研讨会以及将艾滋病毒和人权主题纳入职前课程。针对女性性工作者的项目旨在加强集体化、增强权能以及提高人权意识，并引入危机应对机制。2004年至2011年期间，对女性性工作者进行了三轮综合行为和生物学评估调查。我们使用第二轮（R2）和第三轮（R3）调查的数据进行双变量和多变量分析，以研究女性性工作者随时间被捕情况的变化，并评估警方逮捕与女性性工作者的社会人口学特征及与性工作相关特征之间的关联。
在接受调查的4110名女性性工作者中，曾被警方逮捕的比例随时间显著下降，从R2时的9.9%降至R3时的6.1%（调整优势比（AOR）[95%置信区间]=0.63[0.48至0.83]）。前一年的逮捕率显著下降，从R2时的5.5%降至R3时的2.8%（AOR[95%置信区间]=0.59[0.41至0.86]）。作为任意警方突袭一部分而被捕的女性性工作者也从49.6%降至19.5%（AOR[95%置信区间]=0.21[0.11至0.42]）。发现某些特征，包括对性工作的经济依赖、在街头或妓院拉客以及客户数量多，会显著增加参与者被捕的几率。
针对警方逮捕女性性工作者的结构性干预措施在实施上是可行的。根据我们的研究结果，卡纳塔克邦预防和应对暴力干预措施的设计可以进行调整，以关注那些特别容易被警方逮捕的女性性工作者。因地制宜的结构性干预措施可以减少警方逮捕，为女性性工作者创造更安全的工作环境，并保护基本人权。
