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Study Overview

Evaluation of Samvedana Plus: An intervention with female sex workers (FSWs) and their intimate partners to reduce partner violence and increase consistent condom use within intimate relationships
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Female sex workers (FSWs) frequently experience violence from their intimate partners (non-paying lovers), which compromises their health and increases their vulnerability to STIs/HIV. Samdevena Plus is a multi-level intervention that works with FSWs, their IPs, the sex worker community and the general population, and aims to reduce partner violence and increase consistent condom use within these relationships. The program involves shifting norms around the acceptability of beating as a form of discipline, challenging gender roles that give men authority over women, and working with men and women to encourage new relationship models based on gender equity and respect. The intervention will cover 800 FSWs and their IPs living in 47 villages in north Karnataka, India. The evaluation will employ a cluster-randomized control trial design with 50% of villages receiving the intervention for the first 24 months and the remaining 50% receiving the intervention thereafter. The primary outcomes of the trial will be: the proportion of FSWs who report i) consistent condom use in their intimate relationship, and ii) experiencing partner violence within the past 6 months.
Health, Nutrition, and Population
Additional Keywords:
female sex work, violence, hiv, intimate partners, vulnerability, HIV, condom use
Secondary ID Number(s):

Principal Investigator(s)

Name of First PI:
Lori Heise
London School of Hygiene and Tropical Medicine
Name of Second PI:
Shajy Isac
Karnataka Health Promotion Trust

Research Partner

Name of Partner Institution:
Karnataka Health Promotion Trust
Type of Organization:
NGO (local) or other civil society organization

Intervention Overview

A Theory of Change model was developed which guided the choice of intervention components. At the individual level, the intervention program will work with FSWs and their IPs, both separately, as well as together in couples’ counselling sessions. The intervention will focus on: (i) the formation of structured reflection groups for FSWs, designed to enhance self-esteem, encourage critical reflection around gender norms and violence, and build individual and collective efficacy among FSWs; (ii) the hosting of separate sessions for IPs to discuss issues around violence and condom use as well as gender, equity, respect and responsibility; (iii) skills building around female condoms (iv) access to individual and couples-based counselling. At the FSW Community Based Organization level, the intervention will focus on strengthening the supportive crisis management systems so that they are able to address 'domestic' as well as 'work-place' violence. At the community level, the intervention will build an environment that encourages action against IPV by training male champions and developing folk media troops to create dialogue around gender, masculinity, violence and HIV risk.
Theory of Change:
Multiple Treatment Arms Evaluated?

Intervention Timing

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Evaluation Method

Evaluation Method Overview

Primary (or First) Evaluation Method:
Randomized control trial
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Method Details

Details of Evaluation Approach:
The study will employ a Cluster-Randomized Trial with wait-list control, using the village as the unit of randomization. 50% of the village clusters (n=24) (‘Group 1’) will receive the intervention for the first 24 months. The remaining 50% of the village clusters (n=23) (‘Group 2’) will receive the intervention thereafter. All FSWs with a current or recent (past 6 months) IP will be enrolled into the study. The proposed impact evaluation has three main components: 1) Quantitative Assessment consisting of baseline, midline and endline surveys among FSWs and their intimate partners 2) Qualitative Assessment consisting of longitudinal case studies with FSWs and their intimate partners and in-depth interviews with facilitators of the program. 3) Implementation Monitoring wherein we measure the exposure of each target group to various components of the intervention, using operational records and logs.
Outcomes (Endpoints):
Primary outcomes: 1.Proportion of FSWs who report consistent condom use in their intimate relationship at endline; 2.Proportion of FSWs who report experiencing intimate partner violence in the past six months at endline. Secondary outcomes will assess the impact of the intervention on the pathways hypothesized in the Theory of Change model as potentially affecting IPV and condom use levels, including the proportion of FSWs who report: 1. Increased self-efficacy to negotiate condom use and HIV/STI testing by their IP; 2. Reduced acceptance of violence by their IPs; 3. Increased disclosure of IPV; 4. Increased solidarity among FSWs around issues of IPV; 5. Increased knowledge of self-protection strategies and sources of support for IPV. The study will aim to assess the proportion of intimate partners who report (i) perpetrating violence; and (ii) consistent condom use in the past 6 months with their FSW, as well as the secondary outcomes detailed above for FSWs. We have not included data from IPs in the main trial outcomes as it is uncertain how many IPs will agree to participate, and thus it is not possible to power the study based on anticipated IP uptake or response rates.
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Number of Individuals in Sample:
800 female sex workers and their intimate partners
Size of Treatment, Control, or Comparison Subsamples:
24 intervention villages and 23 control villages

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Outcomes Data

Cross sectional quantitative surveys will be conducted in both cohorts of villages by means of face-to-face interviews using an interviewer-administered questionnaire among FSWs and their IPs at baseline, mid-line (12 months) and following the intervention (24 months).
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Treatment Assignment Data

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Data Analysis

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Study Materials

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Registration Category

Registration Category:
Prospective, Category 1: Data for measuring impacts have not been collected

Completion Overview

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Preliminary Report:
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Data Availability

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Other Materials

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Study Stopped