Research paper
Intimate partner violence is as important as client violence in increasing street-based female sex workers’ vulnerability to HIV in India

https://doi.org/10.1016/j.drugpo.2007.11.013Get rights and content

Abstract

Objectives

There are no studies that examine street-based female sex workers’ vulnerability to HIV from both clients and intimate partners. This study documents street-based female sex workers’ experiences of client and intimate partners, examines the intersections of violence, alcohol use in condom use, and highlights survival strategies used to avert harm.

Methods

Ethnographic data were collected from 49 female sex workers through focus group discussions and in-depth interviews.

Results

Female sex workers experienced multifarious forms of severe client and intimate partner violence. Sexual coercion and forced group sex in the context of alcohol use posed formidable barriers for condom use negotiation. Further, traditional gender norms dictated women's inabilities to negotiate condom-use with intimate partners. However, there was evidence of adoption of successful survival strategies in the face of danger and women's positive evaluations of the benefits of sex work and their contributions to family well-being.

Conclusions

Harm reduction efforts with female sex workers need to account for their vulnerability to HIV from intimate partners in addition to clients. HIV prevention programmes need to include male clients in order to reduce harm among street-based female sex workers. There is an urgent need to build on sex workers’ strengths and involve them in designing individual level, community, and structural interventions that could help in reducing women's vulnerability to intimate partner violence and HIV in India.

Section snippets

Background

Globally, sex work been recognized as an important factor in the spread of HIV/AIDS (UNAIDS, 2006). Women around the world have resorted to sex work as an income generating activity for centuries (Mulia, 2001) in the face of scarce resources to cope with crises and provide for their families. Financial dependence on men, inequitable power relationships and often violent intimate relationships for women around the world heightens their vulnerability to infection due to constraints in condom

Sample and data collection

This study was nested within a five-country NIMH Collaborative HIV/STD Prevention Trial study that seeks to test the efficacy of HIV prevention messages delivered through community popular opinion leaders (CPOLs). Briefly, CPOLs are individuals whose friends and close associates look to for advice, affirmation and counsel (Kelly, 2004). The considerable formative research that accompanied identifying and recruiting study participants in this trial found that male wine shop patrons and female

Sample profile, marriage, and intimate relationship and entry into sex work

The mean age of women was 35.13 years (S.D. = 4.34, range: 25–42). Years of schooling ranged from none to ten years. All women, except one had been born and raised in Chennai city. All respondents identified themselves as ‘currently married,’ and in most cases, their families had arranged their marriage. Male partners of FSWs in our sample could be classified into 3 types: (1) ‘paying sexual partners’ (one-time clients) with whom women did not have an ongoing relationship, (2) ‘paying regular

Discussion

This is one of the first studies in India to document street-based female sex workers’ multi-faceted vulnerability to HIV that stems from not only their work environment, but also from their intimate relationships. Co-occurring phenomena of violence, sexual coercion and alcohol use posed serious challenges for sex workers to remain safe with clients as well as intimate partners. Findings related to women's entry into sex work precipitated as a result of financial crises and being forced by

Acknowledgements

We are grateful to all the respondents who generously shared their experiences with us. We wish to thank the anonymous reviewers and Dr. Susan Sherman for their helpful comments on earlier drafts of the manuscript.

Funding support acknowledgment: National Institute for Mental Health Grant U10 681543-01 to the last author.

References (50)

  • J.M. Wojcicki et al.

    Condom use, power and HIV/AIDS risk: Sex-workers bargain for survival in Hillbrow/Joubert Park/Berea, Johannesburg

    Social Science & Medicine

    (2001)
  • G. Bhave et al.

    Impact of an intervention on HIV, sexually transmitted diseases, and condom use among sex workers in Bombay, India

    AIDS

    (1995)
  • A. Chattopadhyay et al.

    Social development of commercial sex workers in India: An essential step in HIV/AIDS prevention

    AIDS Patient Care and STDs

    (2004)
  • J. Cohen

    HIV/AIDS in India: Sonagachi sex workers stymie HIV

    Science

    (2004)
  • L. Cusik

    Widening the harm reduction agenda: From drug use to sex work

    International Journal of Drug Policy

    (2006)
  • L. Dandona et al.

    Is the HIV burden in India being overestimated?

    BMC Public Health

    (2006)
  • R. Dandona

    High risk of HIV in non-brothel based female sex workers in India

    BMC Public Health

    (2005)
  • R. Dandona

    Demography and sex work characteristics of female sex workers in India

    BMC International Health and Human Rights

    (2006)
  • N. El-Bassel et al.

    Partner violence and sexual HIV-risk behaviors among women in an inner-city emergency department

    Violence Victims

    (1998)
  • N. El-Bassel et al.

    Designing effective HIV prevention strategies for female street sex workers

    AIDS Patient Care STDS

    (1998)
  • R.R. Gangakhedkar et al.

    Spread of HIV infection in married monogamous women in India

    JAMA

    (1997)
  • V.F. Go et al.

    When HIV-prevention messages and gender norms clash: The impact of domestic violence on women's HIV risk in slums of Chennai, India

    AIDS and Behaviour

    (2003)
  • M. Gossop et al.

    Female prostitutes in south London: Use of heroin, cocaine and alcohol, and their relationship to health risk behaviours

    AIDS Care

    (1995)
  • L.L. Heise

    Reproductive freedom and violence against women: Where are the intersections?

    The Journal of Law, Medicine, and Ethics

    (1993)
  • C. Otutubikey Izugbara

    “Ashawo suppose shine her eyes”: Female sex workers and sex work risks in Nigeria

    Health, Risk & Society

    (2005)
  • Cited by (135)

    View all citing articles on Scopus
    View full text