London School of Hygiene & Tropical Medicine

Background:  Female sex workers 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 sex worker populations. Samvedana Plus is a multi-level intervention programme that works with sex workers, their IPs, the sex worker community, and the general population to address intimate partner violence.

The overall aim of SAMVEDANA PLUS is to reduce violence and increase consistent condom use within these ‘intimate’ relationships. The intervention consists of: (i) couples counselling sessions between sex workers and their intimate partners; (ii) separate group work among sex workers and intimate partners to increase self-esteem and encourage reflection about violence; (iii) strengthening supportive crisis management systems that address domestic and sex worker violence; (iv) training male ‘champions’ to encourage action against violence; and (v) training media to promote informed discussions about violence and HIV risk. The program involves changing perceptions on acceptability of physical violence as a form of discipline, challenging assumptions that give men authority over women, and working with men and women to encourage new relationship models based on equality and respect.

Study design: Evaluation of the Samvedana Plus intervention has been through a cluster randomized controlled trial conducted with ~650  female sex workers and their IPs living in 47 villages in Bagalkot district, northern Karnataka. 50% of the village clusters (n=24) were randomly selected to receive the intervention for the first 24 months and the remaining 50% (n=23) will receive the intervention thereafter. The study has been designed to assess two primary outcomes: the proportion of  female sex workers 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 use an adjusted, cluster-level intention to treat analysis, comparing outcomes in intervention and control villages at midline (12 months (September 2016)) and endline (24 months (September 2017)).  The evaluation design will involve quantitative assessments with all sex workers who report an IP and qualitative assessments with sex workers and IPs, as well as and process and implementation monitoring.