Javalkar Prakash, Platt Lucy, Prakash Ravi, Beattie Tara, Bhattacharjee Parinita, Thalinja Raghavendra, L Kavitha D, Sangha Chaitanya Aids Tadegattuva Mahila, Ramanaik Satyanarayana, Collumbien Martine, Davey Calum, Moses Stephen, Jewkes Rachel, Isac Shajy, Heise Lori
Karnataka Health Promotion Trust (KHPT), IT Park, 5th Floor, #1-4, Rajajinagar Industrial Area, Behind KSSIDC Admin Office, Rajajinagar, Bangalore, Karnataka, 560044, India.
Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine (LSHTM), 15-17 Tavistock Place, London, WC1H 9SN, UK.
BMC Public Health. 2019 Mar 29;19(1):350. doi: 10.1186/s12889-019-6673-9.
Like other women in India, female sex workers (FSWs) frequently experience violence from their intimate partners (IPs)-a reality that increases their risk of acquiring HIV or other sexually transmitted infections. Less is known about the nature of these intimate relationships or what aspect of the relationship increases the risk of IP violence (IPV). We measured the prevalence and determinants of IPV on FSWs in the context of north Karnataka, India, characterized by high HIV-prevalence and extreme poverty.
Overall 620 FSWs with an IP participated in a baseline survey conducted for an on-going cluster-randomised controlled trial aiming to evaluate the impact of a multi-level intervention on IPV reduction. We characterize the nature of intimate relationships and explored determinants of severe physical and/or sexual IP violence using univariable and multivariable analyses.
The median age of participants was 35 years with 10 years of duration in an intimate relationship. Though most relationships originated from a sex work encounter, 84% stated that IPs did not know they were currently practicing sex work. In past 6 months, the experience of emotional violence was 49% (95%CI:45.2-53.2), physical 33% (95%CI:29.5-37.1) and sexual violence 7% (95%CI:4.8-8.9), while 24% (95%CI:21.0-27.9) FSWs experienced recent severe physical and/or sexual violence from IPs. Factors associated with recent IPV included experience of physical and/or sexual violence from their clients in last 6 months (AOR 2.20; 95%CI: 1.29-3.75), sexual intercourse in the past 1 month when their IP was under the influence of alcohol (AOR 2.30; 95%CI: 1.47-3.59) and providing financial support to their IP (AOR 2.07; 95%CI: 1.28-3.34).
The association between increased risk of violence and provision of financial support to an IP is indicative of gendered power dynamics as men remain dominant irrespective of their financial dependency on FSWs. Interventions are needed that address inequitable gender norms which makes FSWs tolerate violence even though she is not financially dependent on IP. Higher likelihood of violence in presence of alcohol use and FSWs' previous experience of workplace violence linked to IPV call for strengthening the crisis management systems within community-based organisations that can address all forms of violence and associated risk factors.
Clinical Trials NCT02807259.
与印度其他女性一样，女性性工作者（FSW）经常遭受亲密伴侣（IP）的暴力侵害，这一现实增加了她们感染艾滋病毒或其他性传播感染的风险。人们对这些亲密关系的本质，或者关系中的哪些方面会增加亲密伴侣暴力（IPV）的风险了解较少。我们在印度北卡纳塔克邦的背景下，测量了女性性工作者中亲密伴侣暴力的患病率及其决定因素，该地区艾滋病毒感染率高且极度贫困。
共有620名有亲密伴侣的女性性工作者参与了一项正在进行的整群随机对照试验的基线调查，该试验旨在评估多层次干预对减少亲密伴侣暴力的影响。我们描述了亲密关系的本质，并使用单变量和多变量分析探索了严重身体暴力和/或性暴力的决定因素。
参与者的中位年龄为35岁，亲密关系持续时间为10年。虽然大多数关系始于性工作接触，但84%的人表示其亲密伴侣不知道她们目前从事性工作。在过去6个月中，遭受情感暴力的比例为49%（95%置信区间：45.2 - 53.2），身体暴力为33%（95%置信区间：29.5 - 37.1），性暴力为7%（95%置信区间：4.8 - 8.9），而24%（95%置信区间：21.0 - 27.9）的女性性工作者近期遭受了亲密伴侣的严重身体暴力和/或性暴力。与近期亲密伴侣暴力相关的因素包括过去6个月内遭受客户的身体和/或性暴力（调整后比值比[AOR] 2.20；95%置信区间：1.29 - 3.75）、在其亲密伴侣饮酒时过去1个月内发生性行为（AOR 2.30；95%置信区间：1.47 - 3.59）以及为其亲密伴侣提供经济支持（AOR 2.07；95%置信区间：1.28 - 3.34）。
暴力风险增加与为亲密伴侣提供经济支持之间的关联表明了性别权力动态，即男性即使在经济上依赖女性性工作者，仍占据主导地位。需要开展干预措施，以解决不公平的性别规范，这种规范使女性性工作者即使在经济上不依赖亲密伴侣时也容忍暴力。在亲密伴侣饮酒时暴力可能性更高，以及女性性工作者之前在工作场所遭受的暴力与亲密伴侣暴力相关，这就要求加强社区组织内的危机管理系统，以应对所有形式的暴力及相关风险因素。
临床试验编号NCT02807259 。
