Background: Historically and socially sex work in India has been considered as immoral and put female sex workers (FSWs) at risk of violence of different sort i.e. physical, sexual, verbal. Avahan (a large-scale HIV-prevention program in India for high-risk groups) in each of its three phases (2003-17) implemented multiple strategies to address crisis (violence) through legal aid to FSW''s, providing support to incidents reporting, and reducing episodes of violence through building a community organisation. Evidences from two phases of the program noticed decline in violence incidents. The present study is conducted to present an update on the changes in crisis redressal efforts of the program among FSWs in context of the concluding phase (2014-17).
Methods: A panel data of 2085 FSWs selected across five states of India was used for the study. Both bivariate and multivariate analyses were performed. A series of multiple logistic regression models were fitted to understand the adjusted relationship between outcome measures and key predictors.
Results: On average FSWs were 35 years old, slightly over half of them having formal education and nearly two-thirds were currently married. A significant improvement was observed in overall crisis response index from baseline to end line (62% vs 87%, Adjusted Odds Ratio (AOR): 3.95, 95% CI: 3.36-4.65). Similarly, reporting of violence episodes (48% vs 96%, AOR: 29.25 95%CI:9.66-88.51) and redressal of cases in a day (19% vs 60%, AOR: 7.90 (8.86-9.94) were ameliorated significantly from baseline to end line. The average time to redress violence cases reduced from 257 minutes/case to 88 minutes/case from 2015 to 2017. Compared to 2015, FSWs in 2017 perceived nine times safer to practice sex work (14% vs 51%, AOR: 9.16, 95% CI: 7.74-10.80) and reported to have received four times higher support from community (37% to 7%, AOR: 4:00 (3.58-4.47) during crisis.
Conclusions: Crisis control efforts through community mobilisation, as discussed in the paper, offer a promising violence reduction strategy for proving enabling environment for FSWs.