Establishing the health and wellbeing needs of mining host community in Brazil, Chile and Peru: a mixed-method approach to identify priority areas for action to help communities meet their SDG3 targets.

BACKGROUND: The global mining industry is an important partner in advancing the 2030 Agenda for Sustainable Development. In 2018, Anglo American plc published their Sustainable Mining Plan, containing a goal for improving health and wellbeing aligned with the Sustainable Development Goal 3 (SDG3) targets. Having formed an independent multidisciplinary research consortium, we designed and implemented a mixed-methods approach to attain a deeper understanding of SDG3 priorities within the local context of communities hosting Anglo American mining operations located in Latin America. METHODS: In 2019, within the host communities of three mining operations in Chile, three in Brazil, and one in Peru, we conducted a qualitative study which included stakeholder workshops and key informant interviews. We also quantitatively appraised existing health data. Findings emerging from the qualitative and quantitative assessments were compared to identify health and wellbeing priority areas for action relevant to each community. RESULTS: Across the three countries, 120 people took part in workshops and 35 in interviews. In these workshops and interviews, non-communicable diseases (SDG3.4), harmful alcohol consumption (SDG3.5), and pollution, particularly air pollution (SDG3.9), were consistently identified as areas for priority action. There were similarities in the reporting of individual, interpersonal, community, societal, and structural factors underlying these priority areas across the different communities. The availability of quantitative data was generally good at the state level, becoming increasing sparse as we focused on smaller geographies. The priorities identified in the quantitative assessments generally aligned with those highlighted in the qualitative data. CONCLUSIONS: We highlight the importance of engaging with local populations to understand and address health needs. To address the priorities identified, intervention packages tailored to the specific needs of host communities, that tackle associated upstream societal level factors, are required. To facilitate this, appropriate monitoring systems and epidemiological investigations should be implemented to better understand the local context and quantify health issues. In the host communities, it is essential for the mining sector to be a key health partner in promoting integrated programmes that contribute to achieving the priority objectives and targets aligned with the SDG3 agenda.

The role of gender and romantic jealousy in intimate partner violence against women, a mixed-methods study in Northern Ecuador.

Male romantic jealousy is a commonly cited driver of intimate partner violence against women. An in-depth, contextualised understanding of the pathways and mechanisms from jealousy to intimate partner violence is, however, needed to inform programmes and interventions. We triangulated data from 48 interviews, eight focus groups and 1216 survey findings from low-income married women and men in northern Ecuador. Male jealousy was associated with controlling behaviours (aOR: 14.47, 95% CI: 9.47, 22.12) and sexual intimate partner violence (aOR: 2.4, 95% CI: 1.12, 5.12). Controlling behaviours were associated with physical and sexual intimate partner violence (aOR: 2.16, 95% CI: 1.21, 3.84). Qualitatively we found that most respondents framed jealousy within a discourse of love, and three triggers of male jealousy leading to intimate partner violence were identified: (1) community gossip, which acted as a mechanism of community control over women's movements and sexuality; (2) women joining the labour force, which was quantitatively associated with intimate partner violence and partially mediated by jealousy; and (3) women's refusal to have sex, which could lead husbands to coerce sex through accusations of infidelity. Gender-transformative interventions at the individual, couple and community level providing models of alternative masculinities and femininities may offer promise in reducing intimate partner violence in Ecuador. Importantly, future economic empowerment interventions should address jealousy to mitigate potential intimate partner violence backlash.

Health and wellbeing needs and priorities in mining host communities in South Africa: a mixed-methods approach for identifying key SDG3 targets.

BACKGROUND: The global mining industry has an opportunity to mobilize resources to advance progress against the Sustainable Development Goals (SDGs). In 2018, the Anglo-American Group outlined aspirations for mining host communities to meet the SDG3 health targets. To progress from aspiration to action we designed and implemented a mixed-methods approach to attain a deeper understanding of the health and wellbeing priorities within the local context of host communities of fifteen mines in South Africa. METHODS: To identify local needs and priorities relating to SDG3 targets in host communities, stakeholder workshops and key informant interviews were conducted between June and August 2019. A baseline assessment of health data, related to each of the SDG3 targets and indicators and to each host community location, was also conducted. Findings emerging from the qualitative and quantitative baseline assessments were compared to identify the extent to which health issues aligned and health and wellbeing priority areas for action. RESULTS: A total of 407 people participated in the workshops, and 85 key informants were interviewed. Quantitative data were available at sub-national level for seven of the nine SDG3 targets and eleven of the 21 indicators. Key priority areas for action identified through alignment of the qualitative and quantitative data were maternal mortality (SDG3.1), HIV (SDG3.3.1), tuberculosis (SDG3.3.2), substance abuse (SDG3.5), and road traffic accidents (SDG3.6) We found consistency in the individual, interpersonal, community, societal, and structural factors underlying these priority areas. At a structural level, poor access to quality healthcare was raised at every workshop as a key factor underlying the achievement of all SDG3 targets. Of the five priority areas identified, HIV, TB and substance abuse were found to overlap in the study communities in terms of risk, burden, and underlying factors. CONCLUSIONS: We demonstrate a mixed method approach for identifying local health needs and prioritised SDG3 targets in mining host communities. Consistency in reporting suggests the need for effective, efficient and feasible interventions to address five priority areas. Given the prominent economic role of the mining sector in South Africa, it can play a critical role in implementing programmatic activities that further progress towards achieving the SDG3 targets.

Personal beliefs and social norms regarding the sexual exploitation of girls in age-disparate transactional sexual relationships in Brazil: a mixed-methods study.

BACKGROUND: In the global debate around transactional sex little attention has concentrated on Brazil, despite ranking fourth globally in absolute number of girls married or co-habiting by the age of 15 years, and evidence showing that these unions often begin as age-disparate transactional sex (ADTS). This article contributes to filling this gap by exploring the personal beliefs and social norms related to ADTS in urban (favela) communities of Rio de Janeiro, Brazil between adult men (> 18 years) and girls and adolescents (G/A) (< 18 years) with a minimum 5-year age disparity. The primary objective of this study was to identify the social norms that promote and prevent ADTS, and the dynamics between individual beliefs and social norms, to provide contextualized recommendations to prevent ADTS in this setting. METHODS: An exploratory, sequential, mixed-methods design was used, starting with a qualitative phase that included semi-structured, in-depth interviews and focus groups, and a subsequent quantitative phase comprising of a community survey. The items for the quantitative questionnaires were developed based on the qualitative results. RESULTS: Mixed methods results indicate that in these communities ADTS is normalised and not considered exploitative. We identified three themes related to the reasons ADTS occurs: girls' responsibility, male desires and benefits of ADTS. Men's role in ADTS was largely minimised because of a general acceptance of a notion of masculinity characterised by hypersexuality and lack of impulse control. Individual beliefs, however, did not tend to align with these social norms. CONCLUSIONS: In this study, personal beliefs and social norms often did not align, suggesting that initiatives working to change personal or attitudes regarding ADTS may not lead to meaningful change in ADTS behaviours, and social norms interventions may be more effective. Our findings reinforce the need to develop programs tailored to local understandings of ADTS, targeting not only girls but also a wide range of actors. Interventions could also consider the structural factors acting in local and global contexts that promote or prevent ADTS.

This article explores the personal beliefs and social norms related to the exchange of sexual favours or relationships for material favours, gifts and/or support in some form, between adult men (> 18 years) and girls and adolescents (< 18 years) with a minimum 5-year age difference. We used interviews, focus groups and questionnaires to understand the factors that promote and prevent these sexual relationships between men and girls. Motivators for these relationships were often related to girls' responsibilities, male desires and the benefits of these relationships. Men's responsibility for their participation in these relationships with girls were often minimised due to a general acceptance of men as overly sexual and lacking impulse control. In this study, personal beliefs and social norms were often not aligned, suggesting that interventions focused on changing personal beliefs or attitudes about these sexual relationships may not be enough to change social norms. The findings highlight the need to develop solutions that consider a wider range of actors, instead of interventions focused only on girls. The study findings also support the need to further investigate how communities and shared expectations can influence sexual relationships in exchange for goods between adult men and girls and adolescents.

Adolescent girls' perceived readiness for sex in Central Uganda - liminal transitions and implications for sexual and reproductive health interventions.

Young women in Uganda are at risk of negative sexual and reproductive health outcomes, in part because of sex with older men. Theoretically grounded in the concept of liminality, this paper examines perceived markers of adolescent girls' suitability for sexual activity. In 2014, we conducted 19 focus group discussions and 44 in-depth interviews in two communities in Uganda. Interviews were conducted using a semi-structured tool, audio-recorded and transcribed verbatim. Interviews examined markers of transition between childhood, adolescence and adulthood and how these were seen as relating to girls' perceived readiness for sex. Analysis was thematic. Pre-liminal status was most often accorded to childhood. Sex with a child was strongly condemned. Physical changes during puberty and children's increasing responsibility, autonomy and awakening sexuality reflected a liminal stage during which girls and young women were not necessarily seen as children and were increasingly described as suitable for sex. Being over 18, leaving home, and occupying 'adult' spaces reflected post-liminal status and perceived appropriateness for sexual activity including for girls under the age of 18. Interventions that seek to prevent early sexual debut and sexual activity with older men have the potential to reduce sexual and reproductive health risks.

'I trap her with a CD, then tomorrow find her with a big old man who bought her a smart phone'. Constructions of masculinities and transactional sex: a qualitative study from North-Western Tanzania.

Men's role in transactional sex is relatively unexplored, limiting initiatives to prevent exploitative transactional sex and its negative health implications for girls and women. We addressed this literature gap by conducting eight focus group discussions and twenty in-depth-interviews with boys and men aged 14 - 49 years in 2015 in Tanzania. We employed a novel combination of theoretical perspectives - gender and masculinities, and social norms - to understand how transactional sex participation contributes to perpetuating gendered hierarchies, and how reference groups influence men's behaviour. Findings signal two gender norms that men display within transactional sex: the expectation of men's provision in sexual relationships, and the expectation that men should exhibit heightened sexuality and sexual prowess. Adherence to these expectations in transactional sex relationships varied between older and younger men and created hierarchies among men and between men and women and girls. We found that approval of transactional sex was contested. Although young men were likely to object to transactional sex, they occupied a structurally weaker position than older men. Findings suggest that interventions should employ gender synchronised and gender transformative approaches and should prioritise the promotion of alternative positive norms over preventing the exchange of gifts or money in relationships.

A qualitative study exploring parent-daughter approaches for communicating about sex and transactional sex in Central Uganda: Implications for comprehensive sexuality education interventions.

INTRODUCTION: Ugandan adolescent girls and young women are disproportionately impacted by human immunodeficiency virus, and this is largely driven by their engagement in transactional sex. Globally, parent-daughter communication about sex is associated with increased contraceptive use and delayed/decreased sexual activity, but research on parent-daughter communication about transactional sex is lacking. This paper elucidates local perspectives on, and experiences of parent-daughter communication about sex and transactional sex, to inform family-level comprehensive sexuality education interventions. METHODS: We conducted a secondary, thematic analysis of 13 focus group discussions (n = 119) and 30 in-depth interviews collected between 2014 and 2015 with adolescent girls and young women aged 14+, and men and women in Kampala and Masaka. RESULTS: We found that parents used three approaches to discuss sex and transactional sex with their daughters: (1) frightening their daughters into avoiding sex; (2) being "strict"; and (3) relying on mothers rather than fathers to "counsel" daughters. Mother-daughter communication about transactional sex was common, but frequently unidirectional. Adolescent girls and young women bringing home gifts sparked conversations about the risks of transactional sex, although less in poorer households. Mothers felt they lacked control over their daughters' sexual behaviors and thus restricted their movements and friendships to try to prevent them from having sex. In contrast to previous research, we found some evidence of mothers encouraging condom use and father-daughter communication about sex. CONCLUSIONS: Family-level comprehensive sexuality education interventions targeting parent-daughter communication about sex could further highlight the role that fathers might play, and emphasize communication about the inequitable power dynamics in transactional sex and condom negotiation skills, while reducing fear surrounding parent-daughter communication.

"Eat and you will be eaten": a qualitative study exploring costs and benefits of age-disparate sexual relationships in Tanzania and Uganda: implications for girls' sexual and reproductive health interventions.

BACKGROUND: Age-disparate sex is associated with increased HIV risk among adolescent girls and young women (AGYW) in sub-Saharan Africa. However, little has been done to understand the dynamics of such relationships from the perspectives of either AGYW or older men, and the communities in which these relationships are embedded. This article explores the motivations and perceived benefits of such relationships for AGYW and older men, plus the social and sexual and reproductive health (SRH) consequences. METHODS: This study held 37 participatory focus group discussions and 87 in-depth interviews with young people aged 14-24 and adult community members aged 25-49 in rural and urban Tanzania and Uganda. Participants were sampled using purposive and snowball techniques. Thematic analysis was conducted with the aid of NVIVO 10 software. RESULTS: Motivations, perceived benefits and costs for AGYW centred around four main themes: financial motivations, emotional support, meeting social expectations and reflections on sexual health. Specifically, AGYW noted that older partners gave gifts/money of higher value compared with younger men. Men's perceived benefits and costs revolved around the need to satisfy their sexual desire, the perception that AGYW were capable of engaging in new and creative sexual styles and their desire for prestige among male peers. Both AGYW and men recognised the social and SRH consequences as: risk of violence, social stigma, risk of unplanned pregnancy and risk of sexually transmitted infections including HIV. CONCLUSION: Interventions need to acknowledge the perceived benefits of age-disparate sexual relationships for AGYW and older men and engage them in critical reflection on the medium- to longer-term consequences versus the shorter-term satisfaction of needs, desires and aspirations, as a way to navigate the constrained opportunities they face given existing structural limitations. Interventions should also tackle the structural constraints AGYW face by helping them access resources, become empowered and challenge the expectation of having to depend financially on men. Interventions with men should unpack the assumption that men are naturally hypersexual. The role of peers for both girls and men should be acknowledged, and a shift from individual targeted interventions to changing norms at the community level should be considered.

The way to a man's heart is through his stomach?: a mixed methods study on causal mechanisms through which cash and in-kind food transfers decreased intimate partner violence.

BACKGROUND: Intimate partner violence (IPV) is highly prevalent and has detrimental effects on the physical and mental health of women across the world. Despite emerging evidence on the impacts of cash transfers on intimate partner violence, the pathways through which reductions in violence occur remain under-explored. A randomised controlled trial of a cash and in-kind food transfer programme on the northern border of Ecuador showed that transfers reduced physical or sexual violence by 30 %. This mixed methods study aimed to understand the pathways that led to this reduction. METHODS: We conducted a mixed methods study that combined secondary analysis from a randomised controlled trial relating to the impact of a transfer programme on IPV with in-depth interviews and focus group discussions with male and female beneficiaries. A sequential analysis strategy was followed, whereby qualitative results guided the choice of variables for the quantitative analysis and qualitative insights were used to help interpret the quantitative findings. RESULTS: We found qualitative and quantitative evidence that the intervention led to reductions in IPV through three pathways operating at the couple, household and individual level: i) reduced day-to-day conflict and stress in the couple; ii) improved household well-being and happiness; and iii) increased women's decision making, self-confidence and freedom of movement. We found little evidence that any type of IPV increased as a result of the transfers. DISCUSSION: While cash and in-kind transfers can be important programmatic tools for decreasing IPV, the positive effects observed in this study seem to depend on circumstances that may not exist in all settings or programmes, such as the inclusion of a training component. Moreover, the programme built upon rather than challenged traditional gender roles by targeting women as transfer beneficiaries and framing the intervention under the umbrella of food security and nutrition - domains traditionally ascribed to women. CONCLUSIONS: Transfers destined for food consumption combined with nutrition training reduced IPV among marginalised households in northern Ecuador. Evidence suggests that these reductions were realised by decreasing stress and conflict, improving household well-being, and enhancing women's decision making, self-confidence and freedom of movement. TRIAL REGISTRATION: ClinicalTrials.gov NCT02526147 . Registered 24 August 2015.

Infusing Technology Into Perinatal Home Visitation in the United States for Women Experiencing Intimate Partner Violence: Exploring the Interpretive Flexibility of an mHealth Intervention.

BACKGROUND: Intimate partner violence (IPV) is common during pregnancy and the postpartum. Perinatal home visitation provides favorable conditions in which to identify and support women affected by IPV. However, the use of mHealth for delivering IPV interventions in perinatal home visiting has not been explored. OBJECTIVE: Our objective was to conduct a nested qualitative interpretive study to explore perinatal home visitors' and women's perceptions and experiences of the Domestic Violence Enhanced Home Visitation Program (DOVE) using mHealth technology (ie, a computer tablet) or a home visitor-administered, paper-based method. METHODS: We used purposive sampling, using maximum variation, to select women enrolled in a US-based randomized controlled trial of the DOVE intervention for semistructured interviews. Selection criteria were discussed with the trial research team and 32 women were invited to participate. We invited 45 home visitors at the 8 study sites to participate in an interview, along with the 2 DOVE program designers. Nonparticipant observations of home visits with trial participants who chose not to participate in semistructured interviews were undertaken. RESULTS: We conducted 51 interviews with 26 women, 23 home visiting staff at rural and urban sites, and the 2 DOVE program designers. We conducted 4 nonparticipant observations. Among 18 IPV-positive women, 7 used the computer tablet and 11 used the home visitor method. Among 8 IPV-negative women, 7 used the home visitor method. The computer tablet was viewed as a safe and confidential way for abused women to disclose their experiences without fear of being judged. The meanings that the DOVE technology held for home visitors and women led to its construction as either an impersonal artifact that was an impediment to discussion of IPV or a conduit through which interpersonal connection could be deepened, thereby facilitating discussion about IPV. Women's and home visitors' comfort with either method of screening was positively influenced by factors such as having established trust and rapport, as well as good interpersonal communication. The technology helped reduce the anticipated stigma associated with disclosing abuse. The didactic intervention video was a limiting feature, as the content could not be tailored to accommodate the fluidity of women's circumstances. CONCLUSIONS: Users and developers of technology-based IPV interventions need to consider the context in which they are being embedded and the importance of the patient-provider relationship in promoting behavior change in order to realize the full benefits. An mHealth approach can and should be used as a tool for initiating discussion about IPV, assisting women in enhancing their safety and exploring help-seeking options. However, training for home visitors is required to ensure that a computer tablet is used to complement and enhance the therapeutic relationship. CLINICALTRIAL: Clinicaltrials.gov NCT01688427; https://clinicaltrials.gov/ct2/show/NCT01688427 (Archived by WebCite at http://www.webcitation.org/6limSWdZP).

Associations between intimate partner violence and health among men who have sex with men: a systematic review and meta-analysis.

BACKGROUND: Intimate partner violence (IPV) among men who have sex with men (MSM) is a significant problem. Little is known about the association between IPV and health for MSM. We aimed to estimate the association between experience and perpetration of IPV, and various health conditions and sexual risk behaviours among MSM. METHODS AND FINDINGS: We searched 13 electronic databases up to 23 October 2013 to identify research studies reporting the odds of health conditions or sexual risk behaviours for MSM experiencing or perpetrating IPV. Nineteen studies with 13,797 participants were included in the review. Random effects meta-analyses were performed to estimate pooled odds ratios (ORs). Exposure to IPV as a victim was associated with increased odds of substance use (OR = 1.88, 95% CI(OR) 1.59-2.22, I²â€Š= 46.9%, 95% CI(I)² 0%-78%), being HIV positive (OR = 1.46, 95% CI(OR) 1.26-1.69, I²â€Š= 0.0%, 95% CI(I)² 0%-62%), reporting depressive symptoms (OR = 1.52, 95% CI(OR) 1.24-1.86, I²â€Š= 9.9%, 95% CI(I)² 0%-91%), and engagement in unprotected anal sex (OR = 1.72, 95% CI(OR) 1.44-2.05, I²â€Š= 0.0%, 95% CI(I)² 0%-68%). Perpetration of IPV was associated with increased odds of substance use (OR = 1.99, 95% CI(OR) 1.33-2.99, I²â€Š= 73.1%). These results should be interpreted with caution because of methodological weaknesses such as the lack of validated tools to measure IPV in this population and the diversity of recall periods and key outcomes in the identified studies. CONCLUSIONS: MSM who are victims of IPV are more likely to engage in substance use, suffer from depressive symptoms, be HIV positive, and engage in unprotected anal sex. MSM who perpetrate IPV are more likely to engage in substance use. Our results highlight the need for research into effective interventions to prevent IPV in MSM, as well as the importance of providing health care professionals with training in how to address issues of IPV among MSM and the need to raise awareness of local and national support services.

Qualitative evaluation of an edutainment intervention to prevent age-disparate transactional sex in Tanzania: Changes in educational aspirations and gender equitable attitudes towards work.

Age-disparate transactional sex is a major contributor to the disproportionate rates of HIV experienced by adolescent girls in sub-Saharan Africa, and a key driver of unintended adolescent pregnancy. This paper comprises one element of the impact evaluation of the Learning Initiative on Norms, Exploitation and Abuse (LINEA) radio drama intervention to prevent age-disparate transactional sex. It provides new insights into the radio drama's influence on distal drivers of age-disparate transactional sex identified in formative research: girls' own educational aspirations, and gendered attitudes towards work. The intervention, which targeted adolescent girls and their caregivers in the Shinyanga Region of Tanzania, uses an edutainment approach to prevent transactional sex between girls aged 12-16 years and men at least 5-10 years older. We distributed the 39-episode radio drama on USB flash drives to 331 households and conducted longitudinal in-depth interviews with 59 participants. We conducted a thematic analysis of endline (December 2021) transcripts from 23 girls, 18 women caregivers, and 18 men caregivers of girls (n = 59), and midline (November 2021) transcripts from a sub-sample of these participants: 16 girls, 16 women and 13 men (n = 45). Findings suggest the radio drama created an enabling environment for preventing age-disparate transactional sex by increasing girls' motivation to focus on their studies and remain in school. There was also strong evidence of increased gender-equitable attitudes about work among girls and women and men caregivers. These supported women joining the workforce in positions traditionally reserved for men and challenging the male provider role. Our findings suggest that the LINEA radio drama can supplement interventions that address structural drivers of age-disparate transactional sex. The radio drama may also have impacts beyond preventing age-disparate transactional sex, such as reducing girls' HIV morbidity and mortality, and challenging attitudes that promote sexual and gender-based violence to foster more gender-equitable communities across Tanzania.

Decolonising the field of violence against women and girls: A scoping review and recommendations for research and programming.

In response to continuing legacies of colonialism, there is increasing recognition of the need to decolonise various fields of research and practice, including within work on violence against women and girls (VAWG). An emerging body of literature critiques how VAWG is framed, how prevention and response interventions may be imposed on communities as part of White Saviourism, and the existence of hierarchical approaches to data collection, analysis and interpretation. This scoping review is the first known attempt to describe global published and grey literature on colonialism and decolonisation within VAWG research and programming. We conducted an extensive search across databases and search engines including research studies, reports, commentaries and blogs, and identified 55 sources that focused on VAWG and related to the legacy of colonialism and/or decolonial approaches within the field. Included literature discussed the role of colonialism in shaping VAWG, referenced decolonial approaches to respond to VAWG and identified five key recommendations for VAWG research and practice: 1. Consider the context and power hierarchies within which VAWG occurs; 2. Incorporate community resources and perspectives into efforts to end VAWG; 3. Use methods and approaches to researching VAWG that centre perspectives and lived experience of communities; 4. Shift VAWG funding to local actors and ensure VAWG funding streams are more responsive to local needs and realities; and 5. Ensure local, contextually-relevant framings of feminisms inform decolonising of VAWG. We conclude that shifting towards a bottom-up approach to decolonising VAWG research and programming is essential to prevent decolonisation from being reduced to a buzzword. While literature explored the use of specific methods to decolonise research on VAWG, researchers need broader strategies to embed a decolonial perspective throughout the research process, transcending mere methodological adaptations. There is a need for VAWG research and programming to scrutinise structural inequities, particularly acknowledging how colonial practices entrenched within wider societal power structures impact the field of VAWG.

Men's Reflections on Romantic Jealousy and Intimate Partner Violence in Mwanza, Tanzania.

Romantic jealousy is a prominent trigger for intimate partner violence. Yet, there are few studies on this relationship in sub-Saharan Africa and none captures men's perspectives. To expand the existing knowledge on romantic jealousy and its relation to intimate partner violence, our study analyzed 30 in-depth interviews with male participants. Triggers of romantic jealousy included suspicion or confirmed infidelity, reduced attention from their partners, and challenges to male supremacy. Men reported that intimate partner violence was a frequently used response to triggers of romantic jealousy. Social norms and inequitable gender norms were key underlying factors to all those triggers.

Cash plus programming and intimate partner violence: a qualitative evaluation of the benefits of group-based platforms for delivering activities in support of the Ethiopian government's Productive Safety Net Programme (PSNP).

OBJECTIVES: Intimate partner violence (IPV) is a public health challenge but there is evidence that cash and cash 'plus' interventions reduce IPV. An increasingly popular design feature of these kind of interventions is the group-based modality for delivering plus activities, however, evidence of the mechanisms through which this modality of delivery impacts IPV is limited. We explore how the group-based modality of delivering plus activities that complemented the Government of Ethiopia's Productive Safety Net Programme contributed to modifying intermediate outcomes on the pathway to IPV. DESIGN: Qualitative study using in-depth interviews and focus group discussions between February and March 2020. Data were analysed using a thematic content and gender lens approach. Findings were interpreted, refined and drafted in collaboration with our local research partners. SETTING: Amhara and Oromia regions in Ethiopia. PARTICIPANTS: In total 115 men and women beneficiaries from the Strengthen PSNP4 Institutions and Resilience (SPIR) programme took part in the study. Fifty-eight were interviewed and 57 took part in 7 focus group discussions. RESULTS: We found that Village Economic and Social Associations-through which SPIR activities were delivered-improved financial security and increased economic resilience against income shocks. The group-based delivery of plus activities to couples appeared to enhance individual agency, collective power and social networks, which in turn strengthened social support, gender relations and joint decision-making. Critical reflective dialogues provided a reference group to support the shift away from social norms that condone IPV. Finally, there appeared to be gender differences, with men highlighting the financial benefits and enhanced social status afforded by the groups, whereas women's accounts focused primarily on strengthened social networks and social capital. CONCLUSION: Our study offers important insights into the mechanisms by which the group-based delivery of plus activities affects intermediate outcomes on the pathway to IPV. It underscores the importance of the modality of delivery in such programmes, and suggests that policy-makers should consider gender-specific needs as men and women might differentially benefit from interventions that enhance social capital to generate gender transformative impacts.

Shifting social norms to prevent age-disparate transactional sex in Tanzania: what we can learn from intervention development research.

This paper reflects on the development process (2015-2020) of the Learning Initiative for Norms, Exploitation, and Abuse (LINEA) Intervention. The LINEA Intervention is a multi-component social norms intervention to prevent age-disparate transactional sex in Tanzania. This paper aims to: (1) critically reflect on the LINEA Intervention development process by retrospectively comparing it with a pragmatic, phased framework for intervention development in public health, the Six Essential Steps for Quality Intervention Development (6SQuID); and (2) discuss the usefulness and applicability of this framework to guide intervention development for gender-based violence prevention. This paper contributes to a growing field of intervention development research to improve the designs of interventions to prevent gender-based violence. Findings showed that the LINEA Intervention development approach mostly aligned with the steps in 6SQuID framework. However, the LINEA Intervention development process placed particular emphasis on two phases of the 6SQuID framework. First, the LINEA Intervention development process included significant investment in formative research, feasibility testing, and refinement; and second, the LINEA Intervention was informed by a clearly articulated behavior change theory-social norms theory. Beyond the 6SQuID framework the LINEA Intervention development process: (i) followed a non-linear, iterative process; (ii) applied ongoing feasibility testing to refine the intervention, and (iii) relied on co-development with local implementers and participants. This paper suggests future components for a robust intervention development process, highlighting beneficial additions to the 6SQuID approach, a well-recognized intervention development sequence. Particularly useful additions include incorporating sufficient time, flexibility, and resources to foster meaningful collaborations and iteration on the intervention design.

"We saw that jealousy can also bring violence": A qualitative exploration of the intersections between jealousy, infidelity and intimate partner violence in Rwanda and Uganda.

Efforts to prevent intimate partner violence (IPV) have been informed by emerging research on common triggers of IPV and the importance of engaging with couple dynamics. This paper reports on secondary data analysis from the qualitative evaluations of the SASA! intervention in Uganda, (conducted in 2012 involving 40 community members) and the Indashyikirwa intervention in Rwanda, (conducted between 2014 and 2018 involving 14 couples and 36 other stakeholders). It explores the under-researched linkages between romantic jealousy and IPV, and describes how these interventions mitigated it. A qualitative approach using interviews and focus groups with women and men was used. Overall, jealousy was common in both settings, and led to relationship challenges including breakdown of trust; quarrels about resources; conflict, controlling behaviours, and ultimately, physical and emotional IPV. Jealousy was seen to operate through different gendered pathways. Participants described women to question men about their whereabouts and intentions because of jealousy or the suspicion of infidelity, whereas participants described men to be jealous or suspicious of women socialising with, or attracting the attention of, other men and using violence in response. Through gender transformative strategies, SASA! and Indashyikirwa were described by participants to reduce the contribution of romantic jealousy to conflict and violence by encouraging improved relationship faithfulness and honesty; supporting reduced suspicion through improved relationship trust and communication; and identifying jealousy and suspicion of, or real infidelity, as direct triggers of IPV. While these programmes show promising results, gaps remain including a lack of standardised measures of the multidimensional concept of romantic jealousy. Recognition that programmes should be evaluated for their ability to reduce romantic jealousy when identified as a trigger for IPV in a specific context should also be emphasised. More research is also needed on the forms, gendered pathways, and consequences of romantic jealousy to inform context-specific programming.

Displacement, Polygyny, Romantic Jealousy, and Intimate Partner Violence: A Qualitative Study among Somali Refugees in Ethiopia.

Romantic jealousy is a well-known relational driver of intimate partner violence (IPV), but is under-studied among displaced and polygynous populations. This study aimed to explore factors that elicit jealousy among Somali refugees in the Bokolmayo Refugee camp in Ethiopia, and the pathways leading from jealousy to IPV against women and men, to inform interventions. We conducted an exploratory, thematic analysis of 30 in-depth interviews with both women and men who were Somali refugees, as well as elders and religious leaders, organizational and service providers, policy makers, and host community members. We found that jealousy experienced by women was elicited by an unequal distribution of money and affection between co-wives, which was exacerbated by displacement-related economic hardship, and women in monogamous partnerships suspecting their husband of having other relationships. The jealousy experienced by men was elicited by their wives' increased financial independence and interactions with other men when working outside of the home, which became more common because of displacement-related economic hardship and relaxed patriarchal gender norms. IPV interventions should address jealousy and controlling behaviors in all relationship types. Addressing conflict and relationship dynamics in polygynous households and in humanitarian settings may require specialized content, acknowledging the complex interactions and resource allocation between co-wives. Gender-transformative interventions that move away from masculinities that are built on the provider role and the introduction of alternative masculinities could also be effective in reducing IPV in this and other similar contexts.

Government of Ethiopia's public works and complementary programmes: A mixed-methods study on pathways to reduce intimate partner violence.

There is evidence that cash transfers reduce intimate partner violence (IPV), but less is known about the impacts of public works and complementary programmes on IPV. Using mixed-methods we examined whether and how the Ethiopian government's public works programme (that includes food or cash transfers for seasonal labour) alongside complementary activities that engage women and men affected IPV. We analysed midline data collected in July-October 2019 from a randomised controlled trial (RCT) designed to measure the added impacts of the complementary programming in the Amhara and Oromia regions. Eligible households for this analysis had at least one child aged 0-35 months and a primary female caregiver who was married, and under 50 years-old (n = 2604). A nested qualitative study was conducted with a sub-sample of RCT participants from February-March 2020; data included seven focus group discussions and 58 in-depth interviews. Male partners of women who reported experiencing IPV were purposively sampled. Ordinary Least Squares regression analyses were used to estimate the average treatment effect of the complementary programming, and sub-analyses were conducted on the poorest ten households from each village who received additional livelihood transfers. Qualitative data were analysed using thematic content analysis. We found no impacts of the complementary programming on IPV in the full sample, but some impacts among the poorest sample. Evidence on pathways found that both the public works and complementary programming decreased poverty-related stress and arguments within relationships and increased emotional wellbeing. There were some impacts on women's empowerment from the complementary programming. However, men's reactions to women's empowerment were mixed. There was strong evidence that engaging men in nutrition behaviour change communication contributed to improving gender relations. Our findings indicate that social protection and complementary programmes have the potential to be gender transformative and prevent the drivers of IPV.

Capitalising on aspirations of adolescent girls and young women to reduce their sexual health risks: Implications for HIV prevention.

This paper explores adolescent girls' and young women's (AGYW) aspirations, factors that influence aspirations, and how their aspirations inform their sexual decision-making and behaviour. This study employed a qualitative design involving six participatory focus group discussions and 17 in-depth interviews with AGYW in - and out-of-school. Fieldwork was undertaken in rural and urban Tanzania. Thematic analysis was conducted using NVIVO software. Aspirations of AGYW's were categorised as short and long-term. Short-term aspirations were associated with the social status derived from obtaining trendy items such as nice clothing, or smart phones. Long-term aspirations included completing secondary education, having a professional job, being respected, getting married and having children. Aspirations were influenced by aspects of the social context, such as peers and structural factors that dictated what was acceptable for respectable AGYW. AGYW lacked the independent capabilities to meet long-term aspirations such as completing education. In pursuit of their short - and long-term aspirations, AGYW engaged in higher risk sexual behaviours such as transactional sex, age-disparate sex and condomless sex. AGYW's aspirations were important in determining their sexual decision making. Interventions should capitalise on AGYW's aspirations when addressing their SRH risks by finding innovative ways of engaging them based on their circumstances and aspirations.