Preliminary Effects of a Brief Intervention to Identify and Reduce Gender-Based Violence Among a Sample of Women with a History of Transactional Sex and Substance Use in Kyrgyzstan

Background and Purpose: Women who engage in transactional sex experience high rates of gender-based violence (GBV) perpetrated by intimate partners (IPV) and non-intimate partners (nIPV) such as police and clients, especially if they use drugs or engage in hazardous drinking. There remain few evidence-based GBV screening and brief interventions that have been developed and tested to identify and address different types of GBV among women with a history of transactional sex and substance use. This paper examines the preliminary effects of an adapted two-session evidence-based GBV screening and brief intervention (Wings of Hope) on identifying and reducing IPV and nIPV.

Methods: In partnership with multiple harm reduction organizations in Kyrgyzstan, Central Asia, we conducted a pre-post intervention study from 2013-2016 with 213 women who reported ever using drugs or engaging in hazardous alcohol use. Participants completed a computerized assisted baseline survey, a 2-session individual intervention facilitated by harm reduction staff, and a post-intervention survey after three-months. The core components of the intervention included psycho-education about IPV/nIPV, completion of an IPV/nIPV screener, as well as social support enhancement, safety planning, goal setting and service care coordination, and optional HIV testing. Of the 213 participants included in this study sample, 108 participants reported some history of transactional sex in their lifetime (exchange of sex for money, food, drugs, or other resources). We conducted pre/post-test analyses on primary IPV/nIPV outcomes using random-effect Poisson and logistic regression analyses for continuous and dichotomous outcomes, respectively.

Results: The average age of the participants who reported a history of transactional sex was 38.65 (SD=0.57). At baseline, 92.59%, 83.33%, and 92.59% of the participants who reported a history of transactional sex reported lifetime physical, sexual, and emotional IPV, respectively. 92.59%, 74.07%, and 77.78 % of participants also reported physical, sexual, and emotional nIPV, in their lifetime. Pre/post-test analyses of IPV/nIPV in the 3-months prior to baseline to the 3-month follow-up revealed significant declines in the number of incidents of physical (IRR: 0.22; p<.001), sexual (IRR: 0.44; p<.001), and emotional (IRR: 0.33; p<.001) violence by intimate partners, and a significant decline in the number of incidents of physical (IRR: 0.72; p<.01) and sexual violence (IRR: 0.57; p<.001) by non-intimate partners.

Conclusions and Implications: Findings from this study suggest the promise of this two-session screening and brief intervention to identify and address both IPV and nIPV among women who have both a history of transactional sex and substance use in community-based settings in Kyrgyzstan and the broader Central Asian context. This is particularly salient given extant literature has shown high rates of all types of GBV among women with a history of transactional sex. Findings also suggest the for additional research to better understand which core component(s) of Wings of Hope contributed to the observed changes and any further refinements needed to further improve outcomes.