As the CSW continues to debate how to prevent and eliminate violence against women and girls, and as Michel Sidibe and Eric Goosby call for its end, I reflect on my own experiences of these issues. Working with women in sex work for the last 10 years in rural South India has taught me that it is not HIV that is a priority in their lives but issues like violence, stigma and discrimination and uncertainties related to their children’s future. Whilst it was HIV projects which gave me an opportunity to work with the sex workers, the women would always ask me what can be done about the violence they face in their lives. The sex workers that I work with in rural South India are mostly traditional sex workers, dedicated to sex work through a tradition of devadasi. These women begin sex work at a very early age (15 years), are mostly illiterate, belong to the low (schedule) caste and most have a family member who has been or is in sex work. HIV prevalence among sex workers in Northern Karnataka is high at 34.3%. Devadasis are not allowed to marry but 60% of them have an intimate partner who is either the first client or a paid client who, with repeated visits, becomes a lover or an intimate partner. These relationships are very important for them and there is a high degree of emotional dependence involved.  Condom use is low in these relationships (40%) and reported violence is present in 1 out of 4 relationships.

We organised a participatory workshop with sex workers to understand the extent of violence in these intimate relationships, including causes of violence. According to the sex workers, negotiating for using condoms, demanding money from intimate partners or expecting them to take care of the women’s children, and suspicion over soliciting clients were the main causes of violence in their relationships with intimate partners. Violence was often severe and included throwing acid at the sex worker, burning her with cigarette butts, hitting her severely, and so on. Sex workers also shared that violence often took the form of intimate partners demanding to have sex with the daughter or sister of the sex worker. Insecurities, suspicion and jealousies constitute one set of causes of violence in intimate partner relationships of the sex workers. The women shared that intimate partners were suspicious and jealous of other men in their lives. According to the participants, these jealousies and insecurities drove their intimate partners to violence.

“I had gone for training for 3-4 days, he asked me where I had gone, and whom I met and what did I do there. He was not satisfied with my answer so he asked me to prove my love towards him by putting my hand in the boiling oil. He said if my hand does not burn, then only it will mean I truly love him.” - 33-year-old female sex worker

 “I had a major operation sometime back. Doctors had advised abstinence from sex for six months. But he did not pay any attention to doctor’s advice and had sex with me after 3 months. As a result I had infection and had to undergo another operation. He just wants to show off his power over me.” - 35-year-old female sex worker

Sex workers also stated that intimate partners showed their dominance and power over them through violence, using it ‘to win’ or to put the woman down. 

The women shared that they feared the consequences of violence more than the violence itself and they were also fearful of its consequences on their children. They reported that most conflicts ended negatively, creating tension in the relationship. This in turn often led to partners deserting the women, over-consumption of alcohol (by both parties), the women resorting to physical violence towards themselves or towards their lovers, and attempts to kill themselves or to murder their  lover. Emotional violence was also listed as one of the consequences of conflicts.

Gender-based violence in India is common and stems from the low social status of women and girls, undermining their safety and well-being. A WHO multi-country study of domestic violence and women’s health found that partner violence is the most common form of violence. Data from the National Family Health Survey (NFHS)-3 indicates the extent of gender-based domestic violence in India – 35% ever married women aged 15-49 years experienced spousal physical or sexual violence while in Karnataka it is 20%. The situation of sex workers in Northern Karnataka, India makes them vulnerable to violence from clients (56%), intimate partners (23%), police (7%), and “rowdies” (7%). However, most of the interventions to address violence against sex workers are targeted to clients and the police. Addressing intimate partner violence is a challenging programmatic gap. The sex workers’  intimate partner relationships are complex with 98% of the women reporting economic and non-economic support from their main intimate partners, including emotional support, social status, and protection from other men. There are  significant linkages between women who reported violence, low condom usage, and reduced likelihood of accessing HIV services. Our  findings indicate the possibility of addressing the broader structural factors of violence as part of HIV prevention programs.

The dominant notions of femininity in most societies cast women in subordinate, dependent, passive positions and virginity, chastity, motherhood, moral superiority and obedience are ascribed as key virtues of the ideal woman. In sharp contrast, the dominant notions of masculinity characterize men as independent, dominant, invulnerable aggressors and providers with strength, virility and courage as their key virtues. Both notions are found operating in and defining sex workers and their intimate relationships. Though the intimate partners start as clients of the sex workers, their expectations of each other quickly change as the relationship changes from a commercial one to a non-commercial relationship, based on intimacy. The intimate partners begin to expect loyalty and fidelity from their sex worker lovers, since dominant notions of femininity emphasize uncompromising loyalty and fidelity from women partners. The power imbalance that exists between sex workers and their intimate partners, where the latter holds more power than the former, manifests in terms of low decision-making powers and control with sex workers, resulting in low condom use and tolerance of violence.

In the last ten years of interventions with sex workers by  Karnataka Health Promotion Trust  (KHPT) supported by the  Gates Foundation, we have been able to support the sex workers and their collectives to feel empowered to address and undertake collective action against violence perpetrated by clients and police. This has resulted in significant reduction in proportions of sex workers reporting violence by those perpetrators. However it has taken 10 years of support for the sex workers to recognise that intimate partner violence is unacceptable behaviour towards them, and to seek support to design interventions addressing this issue. With the STRIVE consortium, KHPT is now partnering with the districts’ sex workers collective, to address violence in their intimate relationships. We will be using strategies like Stepping Stones to enhance critical thinking, communication and relationship skills, individual/couple counselling to improve communication, respect and intimacy in these relationships, including increasing individual and collective efficacy and action to reduce intimate partner violence and risk of HIV or (other) Sexually Transmitted Infections.

Meanwhile, back in New York, we hear from colleagues that several states will not even acknowledge the existence of intimate partner violence and are resisting this language in the Outcome Document. Given the widespread scientific evidence for intimate partner violence around the world, and echoed in our research, we concur with the views of sex workers that the first priority to address is the violence in their lives, and from that many other good things will flow. We hope and trust that the deliberations at the CSW in New York will conclude likewise.