Intimate partner violence is as important as client violence in increasing street-based female sex workers' vulnerability to HIV in India.
OBJECTIVE
There are no studies that examine street-based female sex workers' vulnerability to HIV from both clients and intimate partners. This study documents street-based female sex workers' experiences of client and intimate partners, examines the intersections of violence, alcohol use in condom use, and highlights survival strategies used to avert harm.


METHODS
Ethnographic data were collected from 49 female sex workers through focus group discussions and in-depth interviews.


RESULTS
Female sex workers experienced multifarious forms of severe client and intimate partner violence. Sexual coercion and forced group sex in the context of alcohol use posed formidable barriers for condom use negotiation. Further, traditional gender norms dictated women's inabilities to negotiate condom-use with intimate partners. However, there was evidence of adoption of successful survival strategies in the face of danger and women's positive evaluations of the benefits of sex work and their contributions to family well-being.


CONCLUSIONS
Harm reduction efforts with female sex workers need to account for their vulnerability to HIV from intimate partners in addition to clients. HIV prevention programmes need to include male clients in order to reduce harm among street-based female sex workers. There is an urgent need to build on sex workers' strengths and involve them in designing individual level, community, and structural interventions that could help in reducing women's vulnerability to intimate partner violence and HIV in India.
Panchanadeswaran
Subadra
S
Adelphi University School of Social Work, Garden City, New York, NY, USA. panchanadeswara@adelphi.edu
Johnson
Sethulakshmi C
SC
Sivaram
Sudha
S
Srikrishnan
A K
AK
Latkin
Carl
C
Bentley
Margaret E
ME
Solomon
Suniti
S
Go
Vivian F
VF
Celentano
David
D
D000328:Adult; D000428:Alcohol Drinking; D003068:Coercion; D017280:Condoms / Q000706:statistics & numerical data; D003625:Data Collection; D017579:Domestic Violence; D005260:Female; D017144:Focus Groups; D015658:HIV Infections / Q000517:prevention & control / Q000635:transmission*; D040261:Harm Reduction; D006801:Humans; D007194:India / Q000453:epidemiology; D008297:Male; D012307:Risk Factors; D012309:Risk-Taking; D012737:Sex Factors; D011477:Sex Work; D012747:Sexual Partners; D047568:Unsafe Sex; D014754:Violence