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1.
Glob Health Action ; 14(1): 1953243, 2021 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-34338167

RESUMO

BACKGROUND: In South Africa, female sex workers (FSWs) are perceived to play a pivotal role in the country's HIV epidemic. Understanding their health status and risk factors for adverse health outcomes is foundational for developing evidence-based health care for this population. OBJECTIVE: Describe the methodology used to successfully implement a community-led study of social and employment circumstances, HIV and associated factors amongst FSWs in South Africa. METHOD: A community-centric, cross-sectional, survey of 3,005 adult FSWs was conducted (January-July 2019) on 12 Sex Work (SW) programme sites across nine provinces of South Africa. Sites had existing SW networks and support programmes providing peer education and HIV services. FSWs were involved in the study design, questionnaire development, and data collection. Questions included: demographic, sexual behaviour, HIV testing and treatment/PrEP history, and violence exposure. HIV rapid testing, viral load, CD4 count, HIV recency, and HIV drug resistance genotypic testing were undertaken. Partner organisations provided follow-up services. RESULTS: HIV Prevalence was 61.96%, the median length of selling sex was 6 years, and inconsistent condom use was reported by 81.6% of participants, 88.4% reported childhood trauma, 46.2% reported physical or sexual abuse by an intimate partner and 57.4% by a client. More than half of participants had depression and post-traumatic stress disorder (52.7% and 54.1%, respectively). CONCLUSION: This is the first national survey of HIV prevalence amongst FSWs in programmes in South Africa. The data highlight the vulnerability of this population to HIV, violence and mental ill health, suggesting the need for urgent law reform. Based on the unique methodology and the successful implementation alongside study partners, the outcomes will inform tailored interventions. Our rapid rate of enrolment, low rate of screening failure and low proportion of missing data showed the feasibility and importance of community-centric research with marginalised, highly vulnerable populations.


Assuntos
Infecções por HIV , Profissionais do Sexo , Adulto , Estudos Transversais , Emprego , Feminino , Infecções por HIV/epidemiologia , Humanos , África do Sul/epidemiologia
2.
BMJ Open ; 11(7): e049282, 2021 07 26.
Artigo em Inglês | MEDLINE | ID: mdl-34312207

RESUMO

OBJECTIVES: To test associations between men's past year alcohol use and patterns of drinking, and their perpetration of intimate partner violence (IPV) and non-partner sexual violence (NPSV). To test the associations between women's reports of partner alcohol use and their experience of IPV, in three countries in Africa. DESIGN: Pooled analysis of cross-sectional baseline data from men and women participating in four IPV prevention studies across Africa and Asia. SETTING: Data from five data sets generated by four violence against women and girls prevention studies in three countries in sub-Saharan Africa, South Africa, Ghana and Rwanda. PARTICIPANTS: 8104 men 18+ years old and 5613 women 18+ years old from a mix of volunteer and randomly selected samples. MAIN OUTCOME MEASURES: Studies employed comparable measures of past year alcohol use, harmful alcohol use (Alcohol Use Disorder Identification Test scale) and items from modified WHO Women's Health and Domestic Violence to measure physical IPV and NPSV perpetration among men and IPV experience among women. FINDINGS: Overall harmful alcohol use among men was associated with a substantially increased odds of perpetrating physical IPV (adjusted OR (aOR)=3.45 (95% CI 2.56 to 4.64)) and NPSV (aOR=2.64 (95% CI 1.85 to 3.76)) compared with non-drinkers. Women who had seen their partner occasionally drunk (aOR=2.68 (95% CI 2.13 to 3.36)) or frequently drunk (aOR=5.94 (95% CI 4.19 to 8.41)) in the past 12 months had an increased odds of experiencing physical IPV. CONCLUSIONS: Alcohol use is associated with increased IPV and NPSV perpetration for men and (physical) IPV experience for women. Reported frequency of IPV and NPSV increase with increasing levels and frequency of alcohol use. Interventions aimed at reducing alcohol may also lead to reductions in IPV and NPSV perpetration and experience.


Assuntos
Violência por Parceiro Íntimo , Adolescente , Ásia/epidemiologia , Estudos Transversais , Feminino , Gana , Humanos , Violência por Parceiro Íntimo/prevenção & controle , Masculino , Fatores de Risco , Ruanda , Parceiros Sexuais , África do Sul
3.
Artigo em Inglês | MEDLINE | ID: mdl-34170058

RESUMO

Rape stigma, both external and self-stigmatization (self-blame), is associated with adverse health outcomes. Understanding its origins and resilience factors is critical for reducing and preventing it. We describe the prevalence of rape stigma, the characteristics of women experiencing it and the pathways to experiencing greater stigma. The Rape Impact Cohort Evaluation study enrolled 852 women aged 16-40 years who had been raped from post-rape care centres in Durban, South Africa. We present a descriptive analysis of the baseline data, a multinomial logistic regression model of factors associated with different levels of stigma and a structural equation model (SEM). Most women reported stigmatizing thoughts or experiences, with self-stigmatizing thoughts being more prevalent than external stigmatization. The multinomial model showed that experiences of childhood or other trauma, emotional intimate partner violence (IPV), having less gender equitable attitudes and food insecurity were significantly associated with medium or high versus low levels of stigma. Internal and external stigma were significantly associated with each other. Women who had been previously raped reported less stigma. The SEM showed a direct path between food insecurity and rape stigma, with poorer women experiencing more stigma. Indirect paths were mediated by more traditional gender attitudes and childhood trauma experience and other trauma exposure. Our findings confirm the intersectionality of rape stigma, with its structural drivers of food insecurity and gender inequality, as well as its strong association with prior trauma exposure. Rape survivors may benefit from gender-empowering psychological support that addresses blame and shame.

4.
AIDS ; 35(4): 633-642, 2021 03 15.
Artigo em Inglês | MEDLINE | ID: mdl-33264114

RESUMO

OBJECTIVE: To determine the incidence of HIV acquisition in women postrape compared with a cohort of women who had not been raped. DESIGN: A prospective cohort study. METHODS: The Rape Impact Cohort Evaluation study based in Durban, South Africa, enrolled women aged 16-40 years from postrape care services, and a control group of women from Primary Healthcare services. Women who were HIV negative at baseline (441 in the rape-exposed group and 578 in the control group) were followed for 12-36 months with assessments every 3 months in the first year and every 6 months thereafter. Multivariable Cox regression models adjusted for baseline and time varying covariates were used to investigate the effect of rape exposure on HIV incidence over follow-up. RESULTS: Eighty-six women acquired HIV during 1605.5 total person-years of follow-up, with an incident rate of 6.6 per 100 person-years [95% confidence interval (CI): 4.8-9.1] among the rape exposed group and 4.7 per 100 person-years (95% CI: 3.5-6.2) among control group. After controlling for confounders (age, previous trauma, social support, perceived stress, multiple partners and transactional sex with a casual partner), women exposed to rape had a 60% increased risk of acquiring HIV [adjusted hazard ratio: 1.59 (95% CI: 1.01-2.48)] compared with those not exposed. Survival analysis showed difference in HIV incident occurred after month 9. CONCLUSION: Rape is a long-term risk factor for HIV acquisition. Rape survivors need both immediate and long-term HIV prevention and care.


Assuntos
Infecções por HIV , Estupro , Adolescente , Adulto , Feminino , Infecções por HIV/epidemiologia , Humanos , Incidência , Estudos Prospectivos , Fatores de Risco , África do Sul/epidemiologia , Adulto Jovem
5.
BMJ Glob Health ; 5(12)2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33277296

RESUMO

INTRODUCTION: Women with disabilities experience higher rates of intimate partner violence (IPV) than women without disabilities. There remains limited evidence about whether IPV prevention interventions for the general population have benefits for women with disabilities that compare to those for women without disabilities. Using data from IPV prevention randomised controlled trials in diverse locations (Rwanda, South Africa and Afghanistan), we assess whether outcomes differed by disability status. METHODS: We assessed disability at baseline in three IPV prevention trials. We performed post-hoc analysis of intervention impacts at endline (22 or 24 months post-baseline) stratified by disability status at study baseline and tested an interaction term for disability at baseline by intervention arm for three sets of outcomes: (1) past year experiences of physical, sexual and severe IPV; (2) economic and livelihood outcomes; and (3) health, mental health and substance use outcomes. RESULTS: At baseline between 17.7% and 26.2% of women reported being disabled. For IPV prevention, in seven out of eight tests across three studies, women with and without disabilities had similar outcomes. For economic, health and substance use outcomes, there was more variation, with women with disabilities reporting both better and worse outcomes than women without disabilities; however there was no clear pattern in these differential results. CONCLUSION: IPV prevention programmes targeting general populations can prevent IPV among women with disabilities participants with benefits that mirror those for women without disabilities. Benefits for participants with and without disabilities on secondary programme outcomes related to economic empowerment and health may be more varied and should be explicitly monitored.


Assuntos
Pessoas com Deficiência , Violência por Parceiro Íntimo , Afeganistão , Feminino , Humanos , Violência por Parceiro Íntimo/prevenção & controle , Ruanda , África do Sul
6.
BMJ Glob Health ; 5(12)2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33355268

RESUMO

BACKGROUND: Between 2015 and 2018, three civil society organisations in Rwanda implemented Indashyikirwa, a four-part intervention designed to reduce intimate partner violence (IPV) among couples and within communities. We assessed the impact of the programme's gender transformative curriculum for couples. METHODS: Sectors (n=28) were purposively selected based on density of village savings and loan association (VLSA) groups and randomised (with stratification by district) to either the full community-level Indashyikirwa programme (n=14) or VSLA-only control (n=14). Within each sector, 60 couples recruited from VSLAs received either a 21-session curriculum or VSLA as usual. No blinding was attempted. Primary outcomes were perpetration (for men) or experience (for women) of past-year physical/sexual IPV at 24 months post-baseline, hypothesised to be reduced in intervention versus control (ClinicalTrials.gov: NCT03477877). RESULTS: We enrolled 828 women and 821 men in the intervention sectors and 832 women and 830 men in the control sectors; at endline, 815 women (98.4%) and 763 men (92.9%) in the intervention and 802 women (96.4%) and 773 men (93.1%) were available for intention-to-treat analysis. Women in the intervention compared with control were less likely to report physical and/or sexual IPV at 24 months (adjusted relative risk (aRR)=0.44, 95% CI 0.34 to 0.59). Men in the intervention compared with control were also significantly less likely to report perpetration of physical and/or sexual IPV at 24 months (aRR=0.54, 95% CI 0.38 to 0.75). Additional intervention benefits included reductions in acceptability of wife beating, conflict with partner, depression, and corporal punishment against children and improved conflict management, communication, trust, self-efficacy, self-rated health, household earnings, food security and actions to prevent IPV. There were no study-related harms. CONCLUSIONS: The Indashyikirwa couples' training curriculum was highly effective in reducing IPV among male/female couples in rural Rwanda. Scale-up and adaptation to similar settings should be considered.


Assuntos
Violência por Parceiro Íntimo , Parceiros Sexuais , Adulto , Criança , Características da Família , Feminino , Humanos , Violência por Parceiro Íntimo/prevenção & controle , Masculino , População Rural , Ruanda
7.
Glob Health Action ; 13(1): 1834769, 2020 12 31.
Artigo em Inglês | MEDLINE | ID: mdl-33314989

RESUMO

BACKGROUND: Little is known about women who have experienced a recent rape, and how they differ from women without this exposure. Identifying factors linked to rape is important for preventing rape and developing effective responses in countries like South Africa with high levels of sexual violence. OBJECTIVE: To describe the socio-demographic and health profile of women recently exposed to rape and to compare them with a non-rape-exposed group. METHODS: The Rape Impact Cohort Evaluation Study (RICE) enrolled 852 women age 16-40 years exposed to rape from post-rape care centres in Durban (South Africa) and a control group of 853 women of the same age range who have never been exposed to rape recruited from public health services. Descriptive analyses include logistic regression modelling of socio-demographic characteristics associated with recent rape exposure. RESULTS: Women with recent rape reported poorer health and more intimate partner violence than those who were not raped. They had a lower likelihood of having completed school (Odds Ratio [OR] 0.46 95% Confidence Interval (CI): 0.24-0.87) and dependence on a government grant as a main source of income (OR 0.61: 95%CI 0.49-0.77). They were more likely to live in informal housing (OR 1.88 95%CI: 1.43-2.46) or rural areas (OR 2.24: 95%CI 1.61-3.07) than formal housing areas - however they were also more likely to report full-time employment (OR 4.24: 95%CI 2.73-6.57). CONCLUSION: The study shows that structural factors, such as lower levels of education, poverty, and living in areas of poor infrastructure are associated with women's vulnerability to rape. It also shows possible protection from rape afforded by the national financial safety net. It highlights the importance of safe transportation in commuting to work. Preventing rape is critical for enabling women's full social and economic development, and structural interventions are key for reducing women's vulnerability.


Assuntos
Violência por Parceiro Íntimo , Estupro , Adolescente , Adulto , Demografia , Feminino , Humanos , África do Sul , Sobreviventes , Adulto Jovem
8.
Glob Public Health ; : 1-11, 2020 Nov 26.
Artigo em Inglês | MEDLINE | ID: mdl-33242387

RESUMO

Women with agency (i.e. the ability to make choices and act on them) may experience reduced food insecurity (FI) and intimate partner violence (IPV). Reducing FI and IPV among women are global goals; however, research focused on agency among Eswatini women has been overlooked, though they experience high rates of FI and IPV. We analysed cross-sectional data from 406 Swazi women who sought care at one rural and one urban-public antenatal clinic in 2013-2014 to understand how FI and agency, our independent variables, are associated with IPV. We assessed the incidence rate ratio (IRR) of number of violent events (including emotional, physical and sexual IPV) in the previous 12 months using Poisson regressions. We found significant relationships between FI and IPV, where higher levels of FI were associated with IPV risk (weekly: IRR = 2.18, 95% CI = 1.82-2.61; Daily: IRR = 3.53, 95% CI = 2.89-4.32) and constrained agency increased women's risk of IPV (IRR = 1.44; 95% CI = 1.22-1.70). Our findings suggest that FI and agency independently impact women's experience(s) of IPV. Interventions focused on women simultaneously experiencing severe FI and constrained agency may have the highest impact; however, providing focused and moderate FI relief (e.g. reducing FI daily to monthly) could potentially reduce women's risk of experiencing violence.

9.
BMJ Glob Health ; 5(11)2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-33208311

RESUMO

INTRODUCTION: Intimate partner violence (IPV) is a serious public health and human rights violation which impacts approximately one in three women worldwide. Some existing evidence suggests that women with disabilities are at higher risk of IPV, but is largely limited in geographical scope to the Global North, and comparison across settings has been hampered by inconsistent measurement of both IPV and disability. METHODS: Pooled analysis of baseline data from 8549 adult women participating in seven IPV prevention studies in five countries across Africa and Asia that used collaborative, comparative measurement strategies to assess both disability and IPV. RESULTS: After adjusting for age, women with disabilities were more likely to experience past 12-month physical IPV (adjusted OR (aOR)=1.79; 95% CI 1.49 to 2.17), sexual IPV (aOR=1.98; 95% CI 1.36 to 2.89), emotional IPV (aOR=1.84; 95% CI 1.49 to 2.27) and economic IPV (aOR=1.66; 95% CI 1.45 to 1.89), with an overall association between disability and past 12-month physical/sexual IPV of aOR=1.93 (95% CI 1.52 to 2.46). Compared to women without disability, women with moderate and severe disability showed a trend of increasing risk of IPV in the past 12 months for each of physical, sexual, emotional and economic IPV. Overall, both women with moderate disability (aOR=1.86, 95% CI 1.57 to 2.21) and women with severe disability (aOR=2.63; 95% CI 1.95 to 3.55) were significantly more likely to experience any form of IPV when compared with women without disability. CONCLUSION: Women with disabilities are at increased risk of past-year IPV compared to women without disabilities across a range of settings in the Global South, and the risk of IPV increases with increasing severity of disability. IPV prevention and response efforts in these settings must find ways to include and address the needs of women with disabilities, including increased outreach and improved accessibility of programmes.


Assuntos
Pessoas com Deficiência , Violência por Parceiro Íntimo , Adulto , África , Feminino , Humanos , Violência por Parceiro Íntimo/prevenção & controle
10.
SSM Popul Health ; 11: 100635, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32802931

RESUMO

Currently, most efforts to evaluate programmes designed to reduce intimate partner violence (IPV) assume that they affect all people similarly. Understanding whether interventions are more or less effective for different subgroups of individuals, however, can yield important insights for programming. In this study, we conducted subgroup analyses to assess whether treatment effects vary by baseline reporting of IPV experience among women or perpetration among men. Results indicated that for both men and women, the Indashyikirwa intervention in Rwanda was more successful at reducing or stopping ongoing IPV than it was at preventing its onset. The SS-CF intervention in South Africa, by contrast, was more successful at preventing men from starting to perpetrate IPV than it was in reducing the intensity of men's perpetration or stopping it entirely. These results indicate that the prevention field needs to better understand the extent to which IPV interventions may have differential impacts on primary versus secondary prevention. It also emphasizes the importance of distinguishing between intervention strategies that prevent the onset of IPV versus those that reduce or stop ongoing IPV.

11.
BMJ Glob Health ; 5(5)2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32424011

RESUMO

INTRODUCTION: Emerging evidence suggests working with men to prevent intimate partner violence (IPV) perpetration can be effective. However, it is unknown whether all men benefit equally, or whether different groups of men respond differentially to interventions. METHODS: We conducted trajectory modelling using longitudinal data from men enrolled in intervention arms of three IPV trials in South Africa and Rwanda to identify trajectories of IPV perpetration. We then use multinomial regression to describe baseline characteristics associated with group allocation. RESULTS: In South Africa, the Stepping Stones and Creating Futures (SS-CF) trial had 289 men and the CHANGE trial had 803 men, and in Rwanda, Indashyikirwa had 821 men. We identified three trajectories of IPV perpetration: a low-flat (60%-67% of men), high with large reduction (19%-24%) and high with slight increase (10%-21%). Baseline factors associated men in high-start IPV trajectories, compared with low-flat trajectory, varied by study, but included higher poverty, poorer mental health, greater substance use, younger age and more childhood traumas. Attitudes supportive of IPV were consistently associated with high-start trajectories. In separate models comparing high-reducing to high-increasing trajectories, baseline factors associated with reduced IPV perpetration were depressive symptoms (relative risk ratio, RRR=3.06, p=0.01 SS-CF); living separately from their partner (RRR=2.14, p=0.01 CHANGE); recent employment (RRR=1.85, p=0.04 CHANGE) and lower acceptability of IPV (RRR=0.60, p=0.08 Indashyikirwa). Older aged men had a trend towards reducing IPV perpetration in CHANGE (p=0.06) and younger men in Indashyikirwa (p=0.07). CONCLUSIONS: Three distinct groups of men differed in their response to IPV prevention interventions. Baseline characteristics of past traumas and current poverty, mental health and gender beliefs predicted trajectory group allocation. The analysis may inform targeting of interventions towards those who have propensity to change or guide how contextual factors may alter intervention effects. TRIAL REGISTRATION NUMBERS: NCT03022370; NCT02823288; NCT03477877.


Assuntos
Violência por Parceiro Íntimo , Idoso , Humanos , Violência por Parceiro Íntimo/prevenção & controle , Masculino , Saúde Mental , Pessoa de Meia-Idade , Pobreza , Ruanda/epidemiologia , África do Sul/epidemiologia
12.
J Glob Health ; 10(1): 010415, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32373332

RESUMO

Background: Emotional and economic intimate partner violence (IPV) are common. There remain outstanding questions: 1) whether the patterning of emotional and economic IPV varies across contexts, and whether the current indicators adequately capture this variation; 2) whether simply binary or more complex modelling strategies are appropriate; 3) whether health impacts of emotional and economic IPV are sustained in population-based studies, across multiple settings. Methods: Ever partnered women (18-49 years) in cross-sectional, population-based data from three countries, China, Papua New Guinea (PNG) and Sri Lanka, from the United Nations Multi-country Study on Men and Violence in Asia and the Pacific. We assessed lifetime experience of emotional IPV (5 items) and economic IPV (4 items), item uniqueness (ie, the extent to which a person only reported that item), and descriptive associations and multivariable regression between combinations of emotional and economic IPV and physical and/or sexual IPV, for depressive symptoms and generalized health. Results: In all countries, lifetime emotional and economic IPV were common. By item, only one emotional IPV item (he hurt others of importance) had <3% of women uniquely identified by it. There was no item with low uniqueness for economic IPV. By item, and the entire scale, two or more experiences of emotional IPV, or economic IPV, were consistently associated with worse depression and generalized health. Emotional IPV was independently associated with higher depressive scores, and emotional IPV was independently associated with worse generalised health scores, across multiple models. Women experiencing physical and/or sexual IPV combined with emotional or economic IPV, reported the highest depressive symptoms and worst generalised health scores. Conclusions: Emotional IPV and economic IPV are more, or as, common as physical IPV and sexual IPV in three countries in Asia-Pacific. The current set of emotional and economic items captures a range of unique instances of IPV and that forms of emotional and economic IPV are patterned across different contexts. In addition, the use of a simple binary coding of these scales provides a robust way of providing a measure of health impact. The simplicity of this approach enables replication and standardization of measurement of these key constructs across multiple settings, enabling comparison.


Assuntos
Depressão/epidemiologia , Autoavaliação Diagnóstica , Emoções , Violência por Parceiro Íntimo , Adulto , China/epidemiologia , Estudos Transversais , Feminino , Humanos , Violência por Parceiro Íntimo/economia , Violência por Parceiro Íntimo/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Papua Nova Guiné/epidemiologia , Prevalência , Fatores de Risco , Sri Lanka/epidemiologia , Adulto Jovem
13.
J Glob Health ; 10(1): 010406, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32257154

RESUMO

Background: There is considerable interest in community organising and activism as a strategy to shift patriarchal gender norms, attitudes and beliefs and thus reduce intimate partner violence (IPV). Yet there is limited insight into how activism actually translates into reduced violence, including how aspects of programme implementation or cultural context may affect impact. This study evaluates the community activism/mobilisation portion of Indashyikirwa, a multi-component, IPV prevention programme implemented in rural Rwanda. The activism part of Indashyikirwa was based on SASA!, a promising program model from Uganda with demonstrated effectiveness. Methods: We implemented two separate cross-sectional surveys as part of a larger community randomised controlled trial to assess the impact of the community portion of Indashyikirwa on preventing physical and/or sexual IPV and other secondary outcomes at a community level. The survey consisted of a random household-based sample of 1400 women and 1400 men at both waves. Surveys were conducted before community-level activities commenced and were repeated 24 months later with a new cross-sectional sample. Longitudinal, qualitative data were collected as part of an embedded process evaluation. Results: There was no evidence of an intervention effect at a community level on any of the trial's primary or secondary outcomes, most notably women's experience of physical and/or sexual IPV from a current male partner in the past 12 months (adjusted odds ratio (aOR) = 1.25; 95% confidence interval (CI) = 0.92-1.70, P = 0.16), or men's perpetration of male-to-female physical and/or sexual IPV (aOR = 1.02; 95% CI = 0.72-1.45, P = 0.89). Process evaluation data suggest that delays due to challenges in adapting and implementing SASA!-style activites in rural Rwanda may account for the trial's failure to measure an effect. Additionally, the intervention strategy of informal activism was not well suited to the Rwandan context and required considerable modification. Conclusions: Failure to reduce violence when implementing an adaptation of SASA! in rural Rwanda highlights the importance of allowing sufficient time for adapting evidence-based programming (EBP) to ensure cultural appropriateness and fidelity. This evaluation held little chance of demonstrating impact since the project timeline forced endline evaluation only months after certain elements of the programme became operational. Donors must anticipate longer time horizons (5 to 7 years) when contemplating evaluations of novel or newly-adapted programmess for reducing IPV at a population level. These findings also reinforce the value of including embedded process evaluations when investing in rigorous trials of complex phenomena such as community activism. Trial registration: ClinicalTrials.gov, NCT03477877.


Assuntos
Participação da Comunidade , Violência por Parceiro Íntimo/prevenção & controle , População Rural , Parceiros Sexuais , Adolescente , Adulto , Serviços de Saúde Comunitária , Estudos Transversais , Características da Família , Feminino , Humanos , Violência por Parceiro Íntimo/etnologia , Violência por Parceiro Íntimo/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Ruanda , Maus-Tratos Conjugais/etnologia , Maus-Tratos Conjugais/prevenção & controle , Maus-Tratos Conjugais/estatística & dados numéricos
14.
Glob Health Action ; 13(1): 1748401, 2020 12 31.
Artigo em Inglês | MEDLINE | ID: mdl-32338589

RESUMO

Background: Randomised controlled trials (RCTs) are a gold standard for evaluations in public health, economics and social sciences, including prevention of violence against women (VAW). They substantially reduce bias, but do not eliminate measurement error. Control arms often show change, but this is rarely systematically examined.Objective: We present a secondary analysis of data from the control arms of evaluations of VAW prevention programming to understand measurement variance over time, factors that may systematically impact this and make recommendations for stronger trial design and interpretation.Methods: We examine data from six RCTs and one quasi-experimental study, all of which used comparable measures. We look at change over time among control participants in prevalence of physical intimate partner violence (IPV), sexual IPV, and severe physical/sexual IPV, by participants' gender and study design (cohort vs. repeat cross-sectional).Results: On average, repeated assessments of past year IPV varied by 3.21 (95%Cis 1.59,4.83) percentage points for the studies with no active control arms. The prevalence at endline, as a proportion of that at baseline, on average differed by 17.7%. In 10/35 assessments from 4/7 studies, the difference was more than 30%. We did not find evidence of the Hawthorne effect or repeat interview bias as explanations. Our findings largely supported non-differential misclassification (measurement error) as the most likely error and it was a greater problem for men.Conclusions: Control arms are very valuable, but in VAW research their measures fluctuate. This must be considered in sample size calculations. We need more rigorous criteria for determining trial effect. Our findings suggest this may be an absolute change in prevalence of 7% and proportionate change of 0.4 or more (especially for studies in populations with lower IPV prevalence (<20%)). More elaborate pre-defined outcomes are necessary for determining impact (or possible harms) of VAW prevention interventions.


Assuntos
Mulheres Maltratadas/psicologia , Mulheres Maltratadas/estatística & dados numéricos , Guias como Assunto , Violência por Parceiro Íntimo/prevenção & controle , Violência por Parceiro Íntimo/estatística & dados numéricos , Ensaios Clínicos Controlados Aleatórios como Assunto/normas , Parceiros Sexuais/psicologia , Adolescente , Adulto , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
15.
Glob Health Action ; 13(1): 1739845, 2020 12 31.
Artigo em Inglês | MEDLINE | ID: mdl-32202227

RESUMO

Background: Understanding the drivers of intimate partner violence (IPV), perpetrated by men and experienced by women, is a critical task for developing effective prevention programmes.Objectives: To provide a comprehensive assessment of the drivers of IPV.Methods: A comprehensive review of the drivers of IPV, at the end of a six-year programme of research through the What Works to Prevent Violence Against Women and Girls Global Programme with reference to other important research in the field.Results: Broadly, we argue that IPV is driven by poverty, patriarchal privilege, and the normative use of violence in interpersonal relationships. These factors also increase childhood trauma, poor mental health and substance misuse, and poor communication and conflict in relationships, which in turn impact on IPV. Disability status, and contexts of armed conflict, or post-conflict, further reinforce and exacerbate these risks. We move beyond describing associations towards describing the causal pathways through which these factors operate to increase IPV.Conclusions: Specific recommendations about the future of further research on drivers of IPV include a greater focus on understanding the causal pathways from drivers to IPV and clearly delineating association from causality in studies, particularly for women and girls with disabilities, in armed conflicts, and adolescent girls and young women. To achieve this, we recommend extensive in-depth qualitative research, and complex quantitative modeling studies. Understanding drivers and causal pathways better will enable the identification of points of entry for the development of more effective IPV prevention interventions.


Assuntos
Mulheres Maltratadas/psicologia , Vítimas de Crime/psicologia , Relações Interpessoais , Violência por Parceiro Íntimo/prevenção & controle , Violência por Parceiro Íntimo/psicologia , Masculinidade , Delitos Sexuais/prevenção & controle , Delitos Sexuais/psicologia , Parceiros Sexuais/psicologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Violência por Parceiro Íntimo/estatística & dados numéricos , Masculino , Homens , Pessoa de Meia-Idade , Delitos Sexuais/estatística & dados numéricos , Fatores Socioeconômicos
16.
PLoS One ; 15(3): e0230105, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32182255

RESUMO

To assess i) whether there is an independent association between HIV-prevalence and settlement types (urban formal, urban informal, rural formal, rural informal), and, ii) whether this changes over time, in South Africa. We draw on four (2002; 2005; 2008; 2012) cross-sectional South African household surveys. Data is analysed by sex (male/female), and for women by age categories (15-49; and 15-24; 25-49) at all-time points, for men in 2012 data is analysed by age categories (15-24; 25-49). By settlement type and sex/age combinations, we descriptively assess the association between socio-demographic and HIV-risk factors; HIV-prevalence; and trends in HIV-prevalence by time. Relative risk ratios assess unadjusted and adjusted risk for HIV-prevalence by settlement type. All estimates are weighted, and account for survey design. In all survey years, and combinations of sex/age categorisations, HIV-prevalence is highest in urban informal settlements. For men (15-49) an increasing HIV-prevalence over time in rural informal settlements was seen (p = 0.001). For women (15-49) HIV-prevalence increases over time for urban informal, rural informal, rural formal, and women (15-24) decreases in urban formal and urban informal, and women (25-49) increases urban informal and rural informal settlements. In analyses adjusting for potential socio-demographic and risk factors, compared to urban formal settlements, urban informal settlements had consistently higher relative risk of HIV for women, in all age categorisations, for instance in 2012 this was RR1.89 (1.50, 2.40) for all women (15-49), for 15-24 (RR1.79, 1.17-2.73), and women 25-49 (RR1.91, 1.47-2.48). For men, in the overall age categorization, urban informal settlements had a higher relative risk for HIV in all years. In 2012, when this was disaggregated by age, for men 15-24 rural informal (IRR2.69, 1.28-5.67), and rural formal (RR3.59, 1.49-8.64), and for men 25-49 it was urban informal settlements with the highest (RR1.68, 1.11-2.54). In 2012, rural informal settlements also had higher adjusted relative risk for HIV-prevalence for men (15-49) and women (15-49; 15-24; 25-49). In South Africa, HIV-prevalence is patterned geographically, with urban informal settlements having a particularly high burden. Geographical targeting of responses is critical for the HIV-response.


Assuntos
Infecções por HIV/epidemiologia , HIV/isolamento & purificação , População Rural/estatística & dados numéricos , População Urbana/estatística & dados numéricos , Adolescente , Adulto , Estudos Transversais , Feminino , Infecções por HIV/diagnóstico , Infecções por HIV/virologia , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores Socioeconômicos , África do Sul/epidemiologia , Adulto Jovem
17.
J Adolesc Health ; 67(1): 69-75, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32061464

RESUMO

PURPOSE: Little is known about temporal patterns of physical intimate partner violence (PIPV) among South African adolescent girls. We sought to identify and describe PIPV risk trajectories and related correlates in this population. METHODS: Our analytical cohort came from the HPTN 068 Cash Transfer Trial in Mpumalanga Province, South Africa. Cohort members were eighth and ninth graders (median age 14 years) who enrolled in 2011 and had three to four annual, self-reported PIPV measurements. We used group-based trajectory models to identify groups of girls with similar longitudinal patterns of PIPV risk over 4 years and potential correlates of group membership. RESULTS: We identified two trajectory groups (n = 907): a higher-risk group (~52.8% of the cohort) with predicted PIPV probabilities of 13.5%-41.1% over time and a lower-risk group (~47.2% of the cohort) with predicted probabilities of 2.3%-10.3%. Baseline correlates of higher-risk group membership were ever having had sex (adjusted odds ratio [aOR]: 4.42, 95% confidence interval [CI]: 1.56-12.57), borrowing money (aOR: 1.95, 95% CI: 1.01-3.79), and older age (aOR per 1-year increase: 1.39, 95% CI: 1.11-1.73), while being in the 068 intervention arm (aOR: .29, 95% CI: .17-.51) and supporting more gender-equitable norms (aOR per 1-unit score increase: .89, 95% CI: .81-.97) were inversely associated. CONCLUSIONS: A high proportion of adolescent girls experience sustained PIPV risk in rural South Africa, suggesting a need for interventions in late primary school that encourage gender-equitable norms, healthy relationships, and safe ways to earn income during adolescence.


Assuntos
Infecções por HIV , Violência por Parceiro Íntimo , Adolescente , Idoso , Feminino , Humanos , Fatores de Risco , População Rural , África do Sul/epidemiologia
18.
Glob Public Health ; 15(2): 161-172, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31510867

RESUMO

Understanding factors shaping attendance at behavioural interventions is critical for programmatic planning. Through the Stepping Stones and Creating Futures intervention trial amongst young (18-30) women and men to reduce intimate partner violence and strengthen livelihoods, we prospectively assessed factors associated with intervention attendance. Baseline data were collected between September 2015 and September 2016 among 677 women and 675 men. For women, in multinomial models, compared to high attenders, medium (ß = -0.04, p = 0.001) and low (ß = -0.05, p = 0.003) attenders had lived less time in the community, medium attenders were more likely to have children (ß = 0.97, p = 0.001), and low attenders had less gender-equitable attitudes (ß = -0.57, p = 0.035). For men, in multinomial models, compared to high attenders, medium attenders were more likely to have completed secondary school (ß = 1.48, p = 0.011) and to have worked in the past three months (ß = 0.64, p = 0.021). Low attenders had lived for a shorter period in the community (ß = -0.06, p = 0.005), and were more likely to have worked in the past three months (ß = 0.66, p = 0.041) compared to high attenders. Attendance was shaped by structural factors, and gender-specific factors, and these need to be incorporated into future interventions.


Assuntos
Violência por Parceiro Íntimo/prevenção & controle , Participação dos Interessados , Adolescente , Adulto , Feminino , Humanos , Masculino , Estudos Prospectivos , África do Sul , Adulto Jovem
19.
Cult Health Sex ; 22(1): 31-47, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-30762491

RESUMO

Qualitative research suggests that men's inability to achieve dominant forms of masculinity may be related to HIV-risk behaviours and intimate partner violence (IPV) perpetration. Using clustered cross-sectional data, we assessed how young men's gender role conflict was associated with HIV-risk behaviours in urban informal settlements in KwaZulu-Natal, South Africa. Gender Role Conflict and Stress (GRC/S) was measured using a South African adaptation of the GRC/S scale comprising three sub-scales: subordination to women; restrictive emotionality; and success, power and competition. In random-effect models adjusting for socio-demographics, we tested the relationship with GRC/S sub-scales and sexual health behaviours (transactional sex, use of sex workers, ≥2 main partners and ≥2 casual/once off partners), and relationship practices (relationship satisfaction, relationship control, partnership type and perpetration of IPV). Overall, 449 young men (median age = 25, Q1, Q3 = 23-28) were included in the analysis. Higher GRC/S scores, denoting more GRC/S, were associated with increased relationship control and increased odds of having ≥2 casual or one-off partners and engaging in transactional sex. We found differences in associations between each sub-scale and sexual health and relationship practices, highlighting important implications for informing both theoretical understandings of masculinity and gender transformative efforts.


Assuntos
Papel de Gênero , Relações Interpessoais , Masculinidade , Assunção de Riscos , Saúde Sexual , População Urbana , Adulto , Estudos Transversais , Humanos , Violência por Parceiro Íntimo , Masculino , Ensaios Clínicos Controlados Aleatórios como Assunto , África do Sul , Inquéritos e Questionários
20.
Eval Program Plann ; 79: 101770, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-31865010

RESUMO

Women with disabilities are more vulnerable to violence, including intimate partner violence (IPV), yet the majority of emerging IPV prevention programs fail to explicitly consider the needs of participants with disabilities. Women and men living with disabilities engaged with IPV prevention programs in four countries were interviewed to explore how disability shaped their experiences of gender, violence, IPV, and whether the programs met their disability related needs. In-depth interviews were conducted with 16 women and 15 men living with disabilities in Ghana, Rwanda, Tajikistan and South Africa. The data were analysed thematically and compared across the settings. Participants described experiencing disability-related stigma, discrimination, exclusion, and for women, increased vulnerability to IPV. Barriers to full participation in programs included limited accessibility, and lack of disability-specific materials, recruitment or outreach. Enablers of inclusion included recruitment and monitoring strategies aimed at people with disabilities, partnering with a local disabled people's organization, training staff in disability inclusion, and raising awareness of disability rights. The data encouragingly suggests that inclusion of women and men with disabilities in IPV prevention programs designed for the general population has beneficial outcomes. Inclusion can prevent violence, promote their wellbeing, support economic empowerment, and challenge disability-related stigma and discrimination.

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