1. The document explores the links between intimate partner violence (IPV) and sexually transmitted infections (STIs) among women in India. It presents a situational analysis of 27 studies on the topic and develops a conceptual model. 2. It then analyzes the feasibility of 7 interventions to address IPV and STIs based on criteria like technical effectiveness, organizational feasibility, equity, socio-cultural acceptability, political feasibility and financial feasibility. Short-term feasible interventions included community health workers and women's empowerment programs, while long-term interventions included integrated health services and programs engaging men. 3. Recommendations focused on strengthening government implementation and coordination, supporting more research, and raising community awareness through education and media

1. Exploring the links between
Intimate Partner Violence and
Sexually Transmitted Infections
amongst women in India
AMCCON_SRH_24
Dr. Meera Suresh M.D., MPH
(Day 2: Parallel Session-2-SRH 4)

2. Introduction
• Intimate Partner Violence (IPV)- 35% (WHO, 2014).
• IPV victims- 1.5 times riskier to contract STIs. (WHO,
2014).
Objectives
• To explore different pathways through which IPV
victims acquire STIs.
• To identify the interventions required and to
analyse its feasibility within Indian contexts.

3. Methodology
Situational Analysis
• 27 studies
• Conceptual model based on
three original models
[O’Malley (2012), Devries et
al. (2010) and Coker (2007)]
was developed.
Feasibility of Interventions
• Operation Appraisal Tool of
Walley and Wright (2010).
• 7 interventions.
• 21 studies.
• Criteria:
• Technical Effectiveness (TE)
• Organizational Feasibility (OF)
• Equity: Gender, Socio-
economic
• Socio-cultural Acceptability
(SA)
• Political Feasibility (PF)
• Financial Feasibility (FF)

4. Conceptual model
State
Societal
Health systems
Relationship
Individual
Direct Indirect
Genital
Trauma
Psychological
stress/depression
STIs
Age
Education
Poverty
Place of
residence
Caste
1. High-
risk sex
behaviour
2.
Alcoholic
3.Inability
negotiate
safe sex.
1. Patriarchal
norms
2. Sexual
dominance
of males.
3. ‘Culture of
silence’.
4. Stigma to
STIs
1. DVA
2. Legal age
of marriage.
1.Treatment
seeking
behaviour
2.
Accessibility
availability &
quality of
services.
3. Contact
with HCPs.
Biological
Socio-
ecological
IPV
Figure1: Author's conceptual framework (Source: Modified from O’Malley, 2012; Devries et al., 2010; Coker, 2007)

5. Situational Analysis
Factors Author/Year Finding
1. Biological Winter and Stephenson (2013)
Decker et al. (2009)
Coercive sexual acts →
Trauma→STI
2. Socioecological
2a) Individual: i) Age
Ahmad et al. (2015); Chakraborty et al.
(2014)
Lesser age → More IPV
2b) Relationship
i) High-risk sex
behaviours
a) Decker et al. (2009; Silverman et al.
(2008); Schensul et al. (2006)
b) Martin et al. (1999)
a)Abusive husbands→ Double
risk
b) Conversely, 6 times.
ii) Alcoholism Kishor (2012); Berg et al. (2010) ++++ association
iii) Inability to
negotiate safe sex
a) Ghosh et al. (2011); Solomon et al.
(2009)
b) Varma et al. (2010)
a) Patriarchal norms
b) Infidelity
2c) Health Systems
i) Treatment seeking
behaviour
a) Sabarwal and Santhya (2012)
b) Sudha and Morrison (2011)
a) Ignorance about STIs
b) More violence
c) Stigma to STIs
ii) Accessibility,
availability/quality
services.
a) Sabarwal and Santhya (2012)
b) Coast et al. (2012)
a) Weak association
b) Unaware/less quality
services.

6. Factors Author/Year Finding
iii) Contact with HCPs Sabarwal and Santhya (2012);
Sudha and Morrison (2011)
Consistent ++++ association
2d) Societal
i) Patriarchal norms/
Gender inequality
a) Go et el. (2003)
b) Varma et al. (2010)
a) Manu → Adopt violence
b) Females → Less role in
decision-making
ii) Sexual dominance of
males.
a) Priya et al. (2014)
b) Berg et al. (2010)
a) Tough attitude/ Sole control
b) Not supposed to speak sex
matters
iii) ‘Culture of silence’. a) Priya et al. (2014)
b) Solomon et al. (2009); Go
et al. (2003)
a) Parents advise daughters “to
adjust”.
b) Financial dependence
iv) Stigma to STIs a) Sabarwal and Santhya
(2012); Sudha et al. (2007)
a) STIs → Promiscuity.
3. STIs to IPV Chakraborty et al. (2014);
Patrikar et al. (2012)
STI/HIV+ → Tripled sexual IPV

7. Appraisal of Interventions
Level Interventi
on
TE OF Equity SA PF FF
Relationship
RHANI
wives
(Mumbai
slums)
1. 20% ↑ in
condom
use.
2. Sexual
coercive
acts ↓ from
36 to 9%
(Saggurti et
al., 2014).
Not feasible
infrastructur
ally or by
work force.
Illiterate,
urban
slum-
dwellers
targeted.
But not
rural
areas.
Acceptable
only if all
counsellors
are females
and with
family
involvement
Not
feasible
.
Difficult
EBAN
CONNECT
(US)
1. Increased
condom use
to the
baseline (El-
Bassel et
al., 2010)
Not feasible High
cost
deman
ding

8. Level Interventi
on
TE OF Equity SA PF FF
Health
Systems
Integrated
services
[Namibia,
B’desh,
Brazil,
Honduras,
Thailand
&
Malaysia]
↓ IPV
and STIs
(Chibber
and
Krishnan,
2011).
Feasible in
multi-
phases.
Targets
rural,
young and
pregnant
women.
Increases
if support
services
are also
available.
Feasible
(NACO,
2012;
NHP,
2002;
HRLN,
2013)
Possible
from Health
Budget
(multi-
phases)
CHWs
(ASHA/JP
HN/ANM)
↓ IPV
↑
condom
use [Sub-
Saharan
Africa
(Jones et
al., 2013)]
Easily
feasible
with
institution
supports
and IPV
training
Hard-to-
reach
women
easily
approach
ed.
Highly
acceptabl
e.
Easily
feasible.
(NHM,
2014;
CLRA,
2010)
Readily
possible→
honorarium
on case-
basis

9. Level Interventi
on
TE OF Equity SA PF FF
Societal
Men-peer
groups
↓ high-
risk sex
behaviour
(Verma et
al., 2006).
Feasible only
in long-run
with better
coordination
of NGOs
Only if
women
are
involved
Yes but
with out-
reach
clinics
Feasible
(CEDAW,
1980;
ICRW,
2015)
Depend on
external
donors.
Women
empower-
ment
↓ HSV-2
infection
by 33%.
IPV ↓
38%
(Jewkes et
al, 2008)
Easily
feasible with
govt’s self-
help groups
(KS)
Male +
Prefer
unemploy
ed, semi-
urban/rur
al, BPL,
SC/ST
women.
Yes
Locally-
suited
resources
(regional
languages
) &
support
services
Feasible
(Govt.)
Govt.
budget
allocations

10. Findings
1. Situational analysis
• 3 interrelationships
2. Appraisal of interventions
• Short-term: CHWs
Women empowerment programmes.
• Long-term: Integrated health services.
Men-peer groups

11. Recommendations
• Government:
1. M/E cell.
2. Integrated health services in multiple phases
3. Inter-ministerial collaboration
• Academic Institutions, Researchers:
1. More evidence-based research
2. Include IPV topics in medical schools
• Media:
1. Community mobilisation

12. Thank you

13. References
Ahmad, J. et al. 2015. Gender-Based Violence in Rural Uttar Pradesh, India: Prevalence and Association With
Reproductive Health Behaviors. Journal of Interpersonal Violence. [Online]. [Accessed 10 May 2015]. Avaialble from:
http://jiv.sagepub.com/content/early/2015/05/05/0886260515584341.full.pdf
Berg, M.J. et al. 2010. The effects of husband's alcohol consumption on married women in three low-income areas of
Greater Mumbai. AIDS and Behaviours.14 Suppl 1, pp.S126-135
Centre for Legislative Research and Advocacy (CLRA). 2010. Sexual and Reproductive Health Rights under the
Reproductive and Child Health Policy – Compromising Women's Dignity. [Online]. [Accessed 4 June 2015]. Available
from: http://www.clraindia.org/include/CLRA%20RCH%20Booklet-1.pdf
Chakraborty, H. et al. 2014. Determinants of Intimate Partner Violence Among HIV-Positive and HIV-Negative Women
in India. Journal of Interpersonal Violence. [Online]. [Accessed 15 May 2015]. Available from:
http://jiv.sagepub.com/content/early/2014/11/04/0886260514555867.abstract
Chibber, K.S and Krishnan, S. 2011. Confronting Intimate Partner Violence, A Global Health Care Priotity. The Mount
Sinai journal of medicine, New York. 78(3):449-457. doi:10.1002/msj.20259.
Coast, E. et al. 2012. Gender-based violence and reproductive health in five Indian states. [Online]. [Accessed 22 May
2015].
Coker, A.L. 2007. Does physical intimate partner violence affect sexual health? A systematic review. Trauma Violence
Abuse.8(2), pp.149-177
CREA. [no date]. home. [Online]. [Accessed 7 June 2015]. Available from: http://www.creaworld.org/
Decker, M.R. et al. 2009. Intimate partner violence functions as both a risk marker and risk factor for women's HIV
infection: findings from Indian husband-wife dyads. Journal of Acquired Immune Deficiency Syndrome.51(5), pp.593-
600.
Devries, K. et al. 2010. Preventing HIV by preventing violence: the global prevalence of intimate partner violence
against women and its links with HIV infection. [Online]. [Accessed 26 May 2015]. Available from:
http://www.salamandertrust.net/resources/WattsGBDVAWHIVOralAIDS2010Vienna.pdf
El-Bassel, N. et al. 2010. Couple-based HIV prevention in the United States: advantages, gaps, and future directions.
Journal of Acquired Immune Deficiency Syndrome.55 Suppl 2, pp.S98-101
Ghosh, P. et al. 2011. Factors associated with HIV infection among Indian women. International Journal of STD and
AIDS.22(3), pp.140-145

14. Go, V.F. et al. 2003. When HIV-prevention messages and gender norms clash: the impact of domestic violence on
women's HIV risk in slums of Chennai, India. AIDS and Behaviours.7(3), pp.263-272.
Human Right Law Network (HRLN). 2013. Women's justice. [Online]. [Accessed 4 June 2015]. Available from:
http://www.hrln.org/hrln/womens-justice-.html
International Center for Research on Women (ICRW). 2015. ICRW Parivartan: Coaching Boys into Men. [Online].
[Accessed 4 June 2015]. Available from: http://www.icrw.org/media/multimedia/icrw-parivartan-coaching-boys-
men
Jewkes, R. et al. 2008. Impact of stepping stones on incidence of HIV and HSV-2 and sexual behaviour in rural South
Africa: cluster randomised controlled trial. BMJ.337, pa506
Jones, D. et al. 2014. Implementation of HIV prevention interventions in resource limited settings: the partner
project. Journal of Community Health.39(1), pp.151-158
Kishor, S. 2012. Married women's risk of STIs in developing countries: the role of intimate partner violence and
partner's infection status. Violence Against Women.18(7), pp.829-853.
Martin, S.L. et al. 1999. Sexual behaviors and reproductive health outcomes: associations with wife abuse in India.
JAMA.282(20), pp.1967-1972
National AIDS Control Organization. 2012. National AIDS Control Programme Phase-IV (2012-2017). [Online].
[Accessed 18 June 2015]. Available from: http://naco.gov.in/upload/NACP%20-%20IV/NACP-
IV%20Strategy%20Document%20.pdf
National Health Mission (NHM). 2014. About Accredited Social Health Activist (ASHA). [Online]. [Accessed 10 May
2015]. Available from: http://nrhm.gov.in/communitisation/asha/about-asha.html
O’Malley, T.L. 2012. The intersection of intimate partner violence and hiv/aids among women in India: moving
beyond the individual. MPH dissertation. University of Pittsburgh. [Online]. [Accessed 28 May 2015]. Available from:
http://d-scholarship.pitt.edu/11644/1/omalleytl_etd2012.pdf
Patrikar, S. et al. 2012. Measuring domestic violence in human immunodeficiency virus-positive women. Medical
Journal of Armed Forces India.68(2), pp.136-141.

15. Priya, N. et al. 2014. Study on Masculinity, Intimate Partner Violence and Son Preference in India. New Delhi:
International Center for Research on Women. [Online]. [Accessed 1 June 2015]. Available from:
http://www.icrw.org/sites/default/files/publications/Masculinity%20Book_Inside_final_6th%20Nov.pdf
Sabarwal, S. and Santhya, K.G. 2012. Treatment-seeking for symptoms of reproductive tract infections among young
women in India. International Perspective of Sexual and Reproductive Health.38(2), pp.90-98.
Saggurti, N. et al. 2014. Impact of the RHANI Wives intervention on marital conflict and sexual coercion. International
Journal of Gynaecological Obstetrics.126(1), pp.18-22.
Schensul, S.L. et al. 2006. Men's extramarital sex, marital relationships and sexual risk in urban poor communities in
India. Journal of Urban Health.83(4), pp.614-624.
Silverman, J.G. et al. 2008. Intimate partner violence and HIV infection among married Indian women. JAMA.300(6),
pp.703-710.
Solomon, S. 2009. Domestic violence and forced sex among the urban poor in South India: implications for HIV
prevention. Violence Against Women.15(7), pp.753-773.
Sudha, S. and Morrison, S. 2011. Marital violence and women's reproductive health care in Uttar Pradesh, India.
Womens Health Issues.21(3), pp.214-221.
Sudha, S. et al. 2007. Violence against women, symptom reporting, and treatment for reproductive tract infections in
Kerala state, Southern India. Health Care for Women International.28(3), pp.268-284.
Varma, D.S. et al. 2010. Perceptions of HIV risk among monogamous wives of alcoholic men in South India: a
qualitative study. Journal of Womens Health (Larchmt).19(4), pp.815-821.
Verma, R.K. et al. 2006. Challenging and changing gender attitudes among young men in Mumbai, India. Reproductive
Health Matters.14(28), pp.135-143.
Walley, J. and Wright, J. 2010. Public Health : An action guide to improving health: An action guide to improving
health. Oxford University Press - Special.
Winter, A. and Stephenson, R. 2013. Intimate partner violence and symptoms of reproductive tract infections among
married Indian women. International Journal of Gynaecological Obstetrics.121(3), pp.218-223.
World Health Organization. 2014. Violence against women: Intimate partner and sexual violence against women.
[Online]. [Accessed 2 May 2015]. Available from: http://www.who.int/mediacentre/factsheets/fs239/en/