Key Social Norms Take-aways The Samvedana Plus reduced the acceptance of intimate partner violence, increased awareness of self-protection strategies, and fostered solidarity among sex workers. These findings highlight the importance of addressing deeply embedded norms that normalize violence in intimate relationships but also emphasize that changing norms may require broader structural and community-level engagement beyond individual and couple-based approaches.
Objectives The study aimed to assess whether Samvedana Plus, a multilevel intervention, could reduce physical and/or sexual violence from intimate partners and increase consistent condom use among female sex workers in Karnataka, India.
Methods A cluster randomized controlled trial was conducted across 47 villages, with 24 receiving the intervention and 23 serving as wait-list controls. Surveys were administered at baseline, midline, and endline to female sex workers with intimate partners. The study measured physical/sexual violence in the last 6 months and consistent condom use in the past 30 days. Secondary outcomes included attitudes towards violence, knowledge of self-protection, and peer solidarity.
Intervention Details Samvedana Plus combined individual counseling, group reflection sessions, and couple counseling with community engagement strategies, including street theatre and training male partners as champions of non-violence. Implemented over 27 months by a local community-based sex worker collective with support from the Karnataka Health Promotion Trust, the intervention addressed power dynamics, gender inequality, and communication within relationships. Outreach workers and peer educators facilitated the intervention and monitored violence through community crisis management systems.
Results The intervention did not significantly reduce reported physical or sexual intimate partner violence or increase consistent condom use at endline. However, it was associated with decreased acceptance of violence, increased awareness of self-protection strategies, and greater solidarity among sex workers. Reported violence increased during the intervention’s early phase, likely reflecting increased awareness and reporting rather than actual increases in violence.
Conclusions Although Samvedana Plus did not achieve reductions in violence or changes in condom use, it shifted attitudes and awareness related to violence. These findings suggest that normative change around intimate partner violence among sex workers requires broader structural interventions and longer-term investment in community empowerment and stigma reduction, particularly in socially marginalized populations like the devadasi community.