Violence against female sex workers in Karnataka state, south India: impact on health, and reductions in violence following an intervention program

BMC Public Health

Research Article

James F Blanchard¹  Stephen Moses¹  Tara SH Beattie²  Aparajita Ramakrishnan³  Tisha Wheeler³  John Anthony⁴  HL Mohan⁵  Vandana Gurnani⁵  Shajy Isac⁵  Parinita Bhattacharjee⁵  BM Ramesh⁶  Janet Bradley⁷ 

[1] Department of Community Health Sciences, University of Manitoba, 750 Bannatyne Avenue, R3E 0W3, Winnipeg, Canada;Department of Medical Microbiology, University of Manitoba, 745 Bannatyne Avenue, R3E 0J9, Winnipeg, Canada;Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, Keppel Street, WC1E 7HT, London, UK;India AIDS Initiative (Avahan), Bill & Melinda Gates Foundation, Sanskrit Bhavan, A-10 Qutb Institutional Area, Aruna Asaf Ali Marg, 110067, New Delhi, India;India Health Action Trust, # 4/13-1, Pisces Building, Crescent Road, High Grounds, 560001, Bangalore, India;Karnataka Health Promotion Trust, Behind KSSIDC Administrative Office, IT/BT Park, 5th Floor, #1-4/ Rajajinagar Industrial Area, , Rajajinagar, 560 044, Bangalore, India;Karnataka Health Promotion Trust, Behind KSSIDC Administrative Office, IT/BT Park, 5th Floor, #1-4/ Rajajinagar Industrial Area, , Rajajinagar, 560 044, Bangalore, India;Department of Community Health Sciences, University of Manitoba, 750 Bannatyne Avenue, R3E 0W3, Winnipeg, Canada;Unité de recherche en santé des populations, Centre hospitalier affilié universitaire de Québec, Hôpital du Saint-Sacrement, Québec, Canada;

关键词: Human Immunodeficiency Virus;    Human Immunodeficiency Virus Prevention;    Regular Partner;    Legal Empowerment;    Karnataka State;   

DOI  :  10.1186/1471-2458-10-476

 received in 2010-02-10, accepted in 2010-08-11,  发布年份 2010

来源: Springer

【 摘 要 】

BackgroundViolence against female sex workers (FSWs) can impede HIV prevention efforts and contravenes their human rights. We developed a multi-layered violence intervention targeting policy makers, secondary stakeholders (police, lawyers, media), and primary stakeholders (FSWs), as part of wider HIV prevention programming involving >60,000 FSWs in Karnataka state. This study examined if violence against FSWs is associated with reduced condom use and increased STI/HIV risk, and if addressing violence against FSWs within a large-scale HIV prevention program can reduce levels of violence against them.MethodsFSWs were randomly selected to participate in polling booth surveys (PBS 2006-2008; short behavioural questionnaires administered anonymously) and integrated behavioural-biological assessments (IBBAs 2005-2009; administered face-to-face).Results3,852 FSWs participated in the IBBAs and 7,638 FSWs participated in the PBS. Overall, 11.0% of FSWs in the IBBAs and 26.4% of FSWs in the PBS reported being beaten or raped in the past year. FSWs who reported violence in the past year were significantly less likely to report condom use with clients (zero unprotected sex acts in previous month, 55.4% vs. 75.5%, adjusted odds ratio (AOR) 0.4, 95% confidence interval (CI) 0.3 to 0.5, p < 0.001); to have accessed the HIV intervention program (ever contacted by peer educator, 84.9% vs. 89.6%, AOR 0.7, 95% CI 0.4 to 1.0, p = 0.04); or to have ever visited the project sexual health clinic (59.0% vs. 68.1%, AOR 0.7, 95% CI 0.6 to 1.0, p = 0.02); and were significantly more likely to be infected with gonorrhea (5.0% vs. 2.6%, AOR 1.9, 95% CI 1.1 to 3.3, p = 0.02). By the follow-up surveys, significant reductions were seen in the proportions of FSWs reporting violence compared with baseline (IBBA 13.0% vs. 9.0%, AOR 0.7, 95% CI 0.5 to 0.9 p = 0.01; PBS 27.3% vs. 18.9%, crude OR 0.5, 95% CI 0.4 to 0.5, p < 0.001).ConclusionsThis program demonstrates that a structural approach to addressing violence can be effectively delivered at scale. Addressing violence against FSWs is important for the success of HIV prevention programs, and for protecting their basic human rights.

【 授权许可】

CC BY   
© Beattie et al; licensee BioMed Central Ltd. 2010