India - Samvedana Plus: Reducing Violence and Increasing Condom Use in the Intimate Partnerships of female Sex Workers in Bagalkote District, North Karnataka, South India

Samvedana Plus is a three-year multilevel intervention working with sex workers, their intimate partners (IPs) and communities to reduce intimate partner violence (IPV) and to increase condom use within intimate relationships of sex workers. The primary objective of the intervention is to support women to achieve three key outcomes: decreased experience of reported physical or sexual violence in intimate relationships, decreased experience of reported severe physical and/or sexual violence in intimate relationships, increased reported consistent condom use in intimate relationships. This multilevel programme intervened with FSWs, their intimate partners, community-based organisations of FSWs and the wider society. The intervention consists of several strategies at each level such as:

i) Individual FSWs and their IPs: Includes participatory reflection sessions, develop practical safety plans, counselling support, linkages to services and commodities, leadership trainings and special solidarity events to build self-worth and collective efficacy, develop skills to change norms around tolerance of violence, inform FSWs about protective laws, empower FSWs to identify solutions and support mechanisms and take action against violent and risky relationships.

ii) Board members, staff, and crisis management teams of FSW CBOs: Capacity building activities to strengthen CBO to understand and address IPV.

iii) The wider community where FSWs and their partners live: Includes sensitizing the community through community dialogue, street plays and folk shows to address issues of domestic violence, improve understanding of the general community on the rights and IPV related laws and challenge social norms around these issues

The program is being evaluated through cluster randomised control trial design with waitlist control, using the village as the unit of randomisation in Bagalkote district. 47 villages were randomly allocated (1:1) to the intervention or control group using a computer-generated sequence in Stata 15 using two village-level stratification factors: village population size (<2638, 2639-4604 and >4604) and the number of sex workers with IPs (above 12 or 12 and below). 24 villages were allocated to the intervention arm and 23 to the wait-list control arm. The primary outcome for the Cluster Randomised Control Trial was a reduction in experience of intimate partner violence among FSWs and increase in consistent condom use in the intimate partnerships of FSWs. Secondary outcomes include reduced acceptance of IPV, increased disclosure of IPV, improved knowledge of self-protection strategies, improved self-efficacy to negotiate condom use with IPs and improved solidarity among FSWs around issues of IPV. The study population were female sex workers who engage in commercial sex work, aged over 18, and either have an IP or have had an IP within the last 6 months from selected 47 villages of Bagalkot district. All eligible female sex workers listed from the 47 villages were approached for a face-to-face interview, and those who consented to participate (verbal or written) were interviewed. The study protocol provides further details on the study:- rationale, randomization, sample size and data collection (https://dx.doi.org/10.1186/s12889-016-3356-7).