How can sex workers negotiate condom use with their romantic partners?

Aug 2016 Priya Pillai Photo credit: Priya Pillai

Having a violent partner leads to lower condom use by female sex workers – an initiative in Karnataka, India, aims to address this and reduce their risk of HIV

In early 2016, I met a group of female sex workers (FSWs) in Bagalkot district in Karnataka, India. The campaign statement for their Orange Day event calling for an end to violence against women in December 2015 was “Violence is not love”. I was curious about what this meant because the women had framed it in the context of intimate relationships with their male partners.

Just a year earlier, the results of a formative study by researchers from the Karnataka Health Promotion Trust among 620 female sex workers (FSWs) in the same district had revealed that 51% of them faced emotional, physical or sexual abuse from their intimate partners. Almost half the FSWs reported humiliation, threat of harm or intimidation, 33% were either kicked, choked, burnt on purpose, forced to engage in humiliating sex acts or threatened with a weapon, and 7% were raped by their partners in the six months prior to the survey.

If we don’t beat them, the mistakes done by women will become visible, and then the public will question my manhoodKiranmay, sex worker’s partner

Tara, one of the FSWs I met, shared the story of a long raised scar on her right arm. On a Friday evening in August 2014, her partner came home to find her with a client. She defended herself when he accused her of cheating: “What will happen if I continue sex work? You don’t earn and give me money. How should I earn my livelihood? I need to eat. What do you expect me to do?” Seething with rage, he kicked and pinned her to the ground with his legs on her chest. The pocketknife meant to slit her neck instead slashed her arm raised in an act of self-protection.

A majority (64%) of sex workers surveyed for the study met their current partners as clients. The men, before they transitioned into a lover/partner, were just one of the many clients the women serviced. So there is something deeper than an act of betrayal that triggers violence in these relationships.

In early 2014, a qualitative study with FSWs and their partners quoted Kiranmay, a 24-year-old study participant who justified hitting his lover, saying: “If we don’t beat them, the mistakes done by women will become visible, and then the public will talk about me and question my manhood.”

Men reported using violence to assert dominance, correct perceived transgressions and lack of obedience, and maintain their public image of being in control of the household and family.

5456 (1)
A sex worker gets ready to receive clients in her home. Photograph: Priya Pillai

In a society where roles and expectations from women and men are gendered and fixed, sex workers act out the norms so that they can belong to the mainstream. According to interviews with FSWs, they feel they are more deserving of respect, love and care with a man in their lives and children from him. They expect their partners to treat them as they do their wives, and fear that they are loved less if they are not hit. “Rates of condom use fall further when the relationship is violent”

The norms governing these relationships have significant implications for public health interventions, particularly for HIV/Aids programmes. Women’s unquestioning acceptance of masculinity norms and trust in their partners create barriers to condom use and uptake of health services by both women and men.

An overwhelming 91% of FSWs in the survey reported trust as the main reason for not using condoms with their partners. Unlike with their clients, FSWs hesitate to insist on condom use with their partners for fear of being perceived as disloyal, losing their partners or experiencing violence. Rates of condom use fall further when the relationship is violent. Only 24% of FSWs who had experienced violence reported consistent condom use with their partners, as compared with 49% of sex workers who did not face violence.

Love, loss and unsafe sex

How do they navigate this seemingly impossible matrix of violence, love and loss, and unsafe sex? Samvedana Plus is a violence reduction intervention that aims to reduce the risk of HIV in FSWs by addressing partner violence in their intimate relationships. Since early 2015, a total of 800 FSWs in the district have been learning to better negotiate violence and condom use with their partners.

Individual and group sessions inform FSWs about protective laws and teach them to better communicate with their partners. Peer support groups, outreach workers and a crisis management team from a sex worker’s collective work to guide them about how to better resist violence from their partners. The programme provides access to HIV services and distributes male and female condoms. Outreach workers offer counselling to the FSWs and their partners when there is a fight.

5456 (2)
An outreach worker meets sex workers in the village. Photograph: Priya Pillai

Group sessions with men discuss gender, condom use, HIV/Aids and laws against violence. The sessions are safe spaces for men to open up about the burden of supporting many families, measuring up to society’s expectations of being a man and the fear of being considered weak if they do not keep their women in check. They are seen not just as the aggressors, but also as individuals in equal need of support and potential allies in preventing violence. The FSWs say violence continues to happen but at a lower rate.

5456 (3)
A female condom sachet used by sex workers. Photograph: Priya Pillai

Giving these women and men information, condoms and legal aid doesn’t address the complex drivers of unsafe sex and violence in these relationships – patriarchal gender norms that lead men to believe that women are deserving of violence and that their honour is conditional upon her subservience.

Gender roles need to evolve so that women believe in their right to safe sex and men can define themselves without violence. This is critical not only to the fight against HIV/Aids and violence against women, but to create an equal society.


Additional reporting from Bharathi Gurav, Lata Kulkarni and Kavitha DL.

All names in this article have been changed to protect confidentiality of FSWs and their partners.

Follow @hivdrivers and@WhatWorksVAWG on Twitter.

The article was published in The Join our community of development professionals and humanitarians. Follow@GuardianGDP on Twitter. Join the conversation with the hashtag #SheMatters.