Title

Spreading WINGS (Women Initiating New Goals of Safety): Cross-cultural adaptation, feasibility and preliminary effects of an intervention to address gender-based violence among women who use drugs in India

Presenter

Pemu Bhutia

Authors

P. Bhutia¹, M. Pantelic², L. Gilbert³, S. Mehta⁴

Institutions

¹India HIV/AIDS Alliance, Technical Support, Drug Use and Harm Reduction, New Delhi, India, ²International HIV/AIDS Alliance, Research and Evaluation, Hove, United Kingdom, ³Columbia University School of Social Work, Social Intervention Group, New York City, United States, ⁴India HIV/AIDS Alliance, Program and Policy, New Delhi, India

Background: Rates of gender-based violence (GBV) against women who use drugs (WUDs) are 3-5 times higher than among other women, elevating their HIV risks. Asia is home to the largest population of WUDs but has no well-established programs to address GBV in this population. We aimed to address this gap by implementing and testing an intervention to address GBV among WUDs in India.
Methods: We cross-culturally adapted WINGS, a Columbia University-licensed evidence-based GBV screening, brief Intervention and referral to treatment model for WUDs. 48 WUDs were recruited from Sahara Aalhad, an NGO in Pune and 36 completed a 3-month post-intervention follow-up. Between baseline and follow-up, WUDs received two one-on-one psycho-educational sessions on safety planning skills to reduce their risks for GBV. WUDs were also linked to HIV testing and treatment and GBV-related services as needed. Generalised linear models estimated changes in study outcomes between baseline and 3-month post-intervention assessment. Random-effect Poisson and logistic regressions were used for continuous and dichotomous measures, respectively.
Results: At baseline, the mean age of WUDs was 30, 45.8% were married and 75% had children. 25% had an education higher than primary school. 22.9% had been employed in the past year and 20.8% had experienced homelessness in the past 3 months. 54.2% had engaged in sex work, 20.1% had been arrested and 31.3% used heroin in the past 90 days. Prevalence of any GBV was 97.7%, of which 85.4% was verbal, 83.3% was injurious physical violence and 79.2% was sexual violence. Effects of WINGS on incidents of GBV are presented in Table 1. WUDs reported significantly fewer incidents of verbal and physical GBV post intervention, both from intimate partners and others. There were also significant increases in linkages to GBV services over the 3-month follow-up period. No significant differences were observed on sexual violence. 39.5% were provided referrals for HIV testing. 10% registered for ART at Government health cares.
Conclusions:

	Sample No.(%) or mean, SD		Relative Risk ratio or odds ratio- change from baseline to 3-months follow-up
	Baseline	3 months	Unadjusted	Adjusted
Intimate Partner Violence
No. of verbal incidents: IRR	43.4, 39.5	40.1, 40.8	0.93 [0.86-0.99] p = 0.032 *	0.93 [0.86-0.99] p = 0.032 *
No. of physical incidents: IRR	81.6, 74.0	54.75, 61.7	0.67 [0.63-0.71] p < 0.001 ***	0.67 [0.63-0.71] p < 0.001 ***
No. of sexual incidents: IRR	98.5, 100.1	96.6, 94.5	0.98 [0.94-1.03] p = 0.423	0.98 [0.94-1.03] p = 0.423
Non intimate partner gender-based violence
No. of verbal incidents: IRR	22.3, 32.9	14.8, 25.4	0.66 [0.59-0.74] p < 0.001***	0.66 [0.59-0.74] p < 0.001 ***
No. of physical incidents: IRR	28.1, 45.8	14.0, 28.1	0.50 [0.45-0.56] p < 0.001 ***	0.50 [0.45-0.56] p < 0.001 ***
No. of sexual incidents: IRR	11.6, 25.2	11.5, 35.1	0.99 [0.86-1.13] p = 0.203	0.99 [0.86-1.13] p = 0.203

[Effects of WINGS on incidents of IPV, GBV, substance use and linkage to services in the past 90 days (n = 36 women who completed 3-month follow-up)]

Study findings suggest the feasibility and promise for community-based implementation of a peer-delivered intervention for addressing GBV among WUDs in resource-constrained settings. Evidence on larger samples and across cultural contexts is urgently needed to meet needs of WUDs in Asia.

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