A community-based qualitative study on the experience and understandings of intimate partner violence and HIV vulnerability from the perspectives of female sex workers and male intimate partners in North Karnataka state, India

Andrea K Blanchard,Chaitanya Aids Tadegattuva Mahila Sangha ,Martine Collumbien,Srikanta Murthy,Priya Pillai,Raghavendra Thalinja,Sharon G Bruce,Lori Heise,Sapna G Nair,Shajy Isac,Prakash Javalkar,Satyanarayana Ramanaik,Parinita Bhattacharjee

doi:10.1186/s12905-018-0554-8

Abstract

BackgroundResearch has increasingly documented the important role that violence by clients and the police play in exacerbating HIV vulnerability for women in sex work. However few studies have examined violence in the intimate relationships of women in sex work, or drawn on community partnerships to explore the social dynamics involved. A community-based participatory research study was undertaken by community and academic partners leading intimate partner violence (IPV) and HIV prevention programs in Bagalkot district, Karnataka state, India. The purpose was to explore the experience and understandings of intimate partner violence and HIV/AIDS among women in sex work and their intimate partners in Bagalkot that would inform both theory and practice.MethodsA community-based, interpretive qualitative methodology was used. Data was collected between July and October 2014 through in-depth interviews with 38 participants, including 10 couples, 13 individual female sex workers, and 5 individual male intimate partners. Purposive sampling was done to maximize variation on socio-demographic characteristics. Thematic content analysis was conducted through coding and categorization for each interview question in NVivo 10.0, followed by collaborative analysis to answer the research questions.ResultsThe results showed that an array of interrelated, multi-level factors underlay the widespread acceptance and perpetuation of violence and lack of condom use in participants’ intimate relationships. These included individual expectations that justified violence and reflected societal gender norms, compounded by stigma, legal and economic constraints relating to sex work. The results demonstrate that structural vulnerability to IPV and HIV must be addressed not only on the individual and relationship levels to resolve relevant triggers of violence and lack of condom use, but also the societal-level to address gender norms and socio-economic constraints among women in sex work and their partners.ConclusionThe study contributes to a better understanding on the interplay of individual agency and structural forces at a time when researchers and program planners are increasingly pondering how best to address complex and intersecting social and health issues. Ongoing research should assess the generalizability of the results and the effectiveness of structural interventions aiming to reduce IPV and HIV vulnerability in other contexts.

Highlights

Research has increasingly documented the important role that violence by clients and the police play in exacerbating Human immunodeficiency virus (HIV) vulnerability for women in sex work
A deeper exploration of how social influences interact to shape the experience of violence among women in sex work and their intimate partners is required if health interventions are to effectively address the underlying processes that heighten intimate partner violence (IPV) and HIV/AIDS vulnerability
Our methods were collaborative in nature, developing questions able to explore experiences from women’s and men’s perspectives in relevant ways by working closely with community partners, and together undertaking analyses that allowed for multidimensional interpretations on how participants conceptualized IPV and low condom use, the root causes, and related ways to address them

Summary

Introduction

Research has increasingly documented the important role that violence by clients and the police play in exacerbating HIV vulnerability for women in sex work. In a study among a representative sample of 1750 FSWs in north Karnataka state, India, 29% of women reported experiencing physical violence from an intimate partner in the last 6 months alone [7]. Research to date has identified a host of important risk factors for partner violence using multivariate analyses Efforts to extend this analysis to the context of sex work have largely focussed on exploring the impact of client violence on women’s health and wellbeing [8,9,10,11]. A deeper exploration of how social influences interact to shape the experience of violence among women in sex work and their intimate partners is required if health interventions are to effectively address the underlying processes that heighten IPV and HIV/AIDS vulnerability

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