Reducing violence and increasing condom use in the intimate partnerships of female sex workers: study protocol for Samvedana Plus, a cluster randomised controlled trial in Karnataka state, south India

Abstract

BackgroundFemale sex workers (FSWs) are at increased risk of HIV and STIs compared to women in the general population, and frequently experience violence in their working and domestic lives from a variety of perpetrators, which can enhance this risk. While progress has been made in addressing violence by police and clients, little work has been done to understand and prevent violence by intimate partners (IPs) among FSW populations.MethodsSamvedana Plus is a multi-level intervention programme that works with FSWs, their IPs, the sex worker community, and the general population, and aims to reduce violence and increase consistent condom use within these ‘intimate’ relationships. The programme involves shifting norms around the acceptability of beating as a form of discipline, challenging gender roles that give men authority over women, and working with men and women to encourage new relationship models based on gender equity and respect. The programme will aim to cover 800 FSWs and their IPs living in 47 villages in Bagalkot district, northern Karnataka. The study is designed to assess two primary outcomes: the proportion of FSWs who report: (i) physical or sexual partner violence; and (ii) consistent condom use in their intimate relationship, within the past 6 months. The evaluation will employ a cluster-randomised controlled trial design, with 50 % of the village clusters (n = 24) randomly selected to receive the intervention for the first 24 months and the remaining 50 % (n = 23) receiving the intervention thereafter. Statisticians will be blinded to treatment arm allocation. The evaluation will use an adjusted, cluster-level intention to treat analysis, comparing outcomes in intervention and control villages at midline (12 months) and endline (24 months). The evaluation design will involve quantitative and qualitative assessments with (i) all FSWs who report an IP (ii) IPs; and process/ implementation monitoring. Baseline data collection was completed in April 2015, and endline data collection is anticipated in May 2017.ConclusionsThis is an innovative intervention programme that aims to address violence by IPs as part of HIV prevention programming with FSWs. Reducing violence is expected to reduce vulnerability to HIV acquisition, and help women to work and live without fear of violence.Trial registrationClinical Trials NCT02807259 Jun 24 2016 (retrospectively registered).Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-016-3356-7) contains supplementary material, which is available to authorized users.

Alcohol Use and Experiences of Partner Violence Among Female Sex Workers in Coastal Andhra Pradesh, India

“…There are several public health implications of our findings. As also suggested by others (e.g., Beattie et al, 2010;Beattie et al, 2016;Reza-Paul et al, 2012), interventions should take a multifaceted and multilevel approach to addressing violence prevention in the FSW population. One such intervention took place in Andhra Pradesh in 2011-2012 and aimed to reduce work-related violence against FSWs in an HIV prevention context.…”

“…There was a postintervention reduction in violence, but no control group was available (India HIV/ AIDS Alliance, 2014). A randomized trial evaluating an intervention to reduce violence and increase condom use in FSWs' primary relationships in Karnataka, South India (Beattie et al, 2016), targeted the FSWs (e.g., personal safety plan) and their primary partners (e.g., one-on-one discussions), including couple counseling. It also trained community-based organizations to respond to IPV and aimed to educate the wider community about IPV (e.g., street plays).…”

Do combination HIV prevention programmes result in increased empowerment, inclusion and agency to demand equal rights for marginalised populations in low-income and middle-income countries? A systematic review

“…All studies had quantitative study designs. Four studies employed a cluster or individual-level randomised controlled trial design 37–40. Five studies used a pre/post design,36 41–45 and one reported baseline data from a pre/post study 46.…”

Correlação Entre Marcadores De Vulnerabilidade Social Frente Ao Uso Do Preservativo Por Trabalhadoras Sexuais

“…Em um estudo internacional de revisão de literatura sobre determinantes da prevalência e incidência 16 . É necessário destacar, que para este presente estudo, o nível de escolaridade não apresentou correlação com o uso de preservativo, ou seja, não interferiu na adesão das mulheres profissionais do sexo à camisinha, o que difere de alguns estudos desenvolvidos no Brasil e no mundo 12,14,[16][17] . Porém, esta característica será percebida em diferentes pesquisas, pois os aspectos da prostituição modificam conforme as localidades e o acesso às políticas públicas de saúde 11 .…”

“…Quanto à associação da vulnerabilidade à infecção do vírus HIV/Aids concernente ao nível de escolaridade e pobreza, estudos têm mostrado que, entre o grupo soropositivo, as mulheres apresentam maior frequência em baixa escolaridade e situação de pobreza [12][13]19,22,26 . Este fato torna os grupos sociais menos favorecidos, inclusive as profissionais do sexo, mais vulneráveis à disseminação do vírus do HIV possivelmente por falta de conhecimento, menor acesso aos meios de prevenção e serviços de saúde, em decorrência do preconceito e estigma por parte dos profissionais de saúde, além da dificuldade em dialogar sobre o uso do preservativo [25][26] .…”