Understanding the Relationship Between Female Sex Workers and Their Intimate Partners: Lessons and Initial Findings From Participatory Research in North Karnataka, South India

Abstract

While traditional HIV prevention programs with female sex workers (FSWs) in Karnataka, India, have focused on reducing HIV transmission between FSWs and clients through increased condom use, these programs have not fully addressed the transmission risk between FSWs and their nonpaying intimate partners (IPs). Condom use is infrequent and violence is recurrent in these relationships: Furthermore, there is little evidence on the precise nature of FSW–IP relationships. Our study addresses this knowledge gap to inform HIV programs targeted at FSWs. A series of workshops, using participatory tools, was held to explore FSW-IP relationships; 31 FSWs and 37 IPs participated. Three aspects of FSW–IP relationships were examined: how FSWs and IPs understand and interpret their relationships, factors influencing condom use, and the role of violence and its consequences. FSWs wish to be perceived as their IPs’ wives, while IPs expect their FSW partners to accept their dominance in the relationship. Nonuse of condoms signals fidelity and elevates the status of the relationship almost to that of marriage, which helps FSWs enter the category of “good” (married) women. Tolerating and accepting violence in these relationships is normative, as in other marital relationships; IPs justify violence as necessary to establish and maintain their power within the relationship. Both FSWs and IPs value their relationships despite the high degree of risk posed by low condom use and high levels of violence. Implications for program design include addressing current norms around masculinity and gender roles, and improving communication within relationships.

The Logic of Condom Use in Female Sex Workers in Bali, Indonesia

“…The power imbalance due to the effect of gender and nature of service also affect consistent condom utilization. Given that men are dominant (patriarchal society), and since they are paying for the service, they are in a position of power to use or not to use a condom [19].…”

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

“…Domestic violence can inhibit women from negotiating condom use [ 15 , 39 , 40 ]. Within FSWs’ intimate partnerships, women’s ability to negotiate condom use is often severely compromised due to norms around female obedience and fidelity, men’s ignorance of her sex work status, men’s expectations that their partner will abandon sex work and are therefore no longer a source of risk, and women’s emotional and sometimes financial dependence on their partners [ 57 – 59 ]. All of these challenges are exacerbated if a male partner is violent.…”

Effectiveness of a multilevel intervention to reduce violence and increase condom use in intimate partnerships among female sex workers: cluster randomised controlled trial in Karnataka, India

“…Condomless sex is also used by sex workers in this setting to demonstrate intimacy and fidelity to their partner, who frequently demand exclusivity as a condition of the relationship. This is particularly relevant here where sex work was often concealed from partners and the lack of condoms used to prove that individuals were not engaging in sex work 29 37. We found some evidence to suggest that the intervention had a small effect in reducing acceptance of violence.…”