Effectiveness of a culturally appropriate intervention to prevent intimate partner violence and HIV transmission among men, women, and couples in rural Ethiopia: Findings from a cluster-randomized controlled trial
Autoři:
Vandana Sharma aff001; Jessica Leight aff002; Fabio Verani aff003; Samuel Tewolde aff004; Negussie Deyessa aff005
Působiště autorů:
Abdul Latif Jameel Poverty Action Lab, Massachusetts Institute of Technology, Cambridge, Massachusetts, United States of America
aff001; International Food Policy Research Institute, Washington, DC, United States of America
aff002; CARE, New York, United States of America
aff003; EngenderHealth, Addis Ababa, Ethiopia
aff004; Ethiopian Public Health Association, Addis Ababa, Ethiopia
aff005; Addis Ababa University, Department of Preventive Medicine, School of Public Health, Addis Ababa, Ethiopia
aff006
Vyšlo v časopise:
Effectiveness of a culturally appropriate intervention to prevent intimate partner violence and HIV transmission among men, women, and couples in rural Ethiopia: Findings from a cluster-randomized controlled trial. PLoS Med 17(8): e32767. doi:10.1371/journal.pmed.1003274
Kategorie:
Research Article
doi:
https://doi.org/10.1371/journal.pmed.1003274
Souhrn
Background
Intimate partner violence (IPV) is associated with increased HIV risk and other adverse health and psychosocial outcomes. We assessed the impact of Unite for a Better Life (UBL), a gender-transformative, participatory intervention delivered to men, women, and couples in Ethiopia in the context of the coffee ceremony, a traditional community-based discussion forum.
Methods and findings
Villages (n = 64) in 4 Ethiopian districts were randomly allocated to control, men’s UBL, women’s UBL, or couples’ UBL, and approximately 106 households per village were randomly selected for inclusion in the trial. The intervention included 14 sessions delivered twice weekly by trained facilitators; control arm households were offered a short IPV educational session. Primary outcomes were women’s experience of past-year physical or sexual IPV 24 months postintervention. Secondary outcomes included male perpetration of past-year physical or sexual IPV, comprehensive HIV knowledge, and condom use at last intercourse. Additional prespecified outcomes included experience and perpetration of past-year physical and/or sexual IPV and emotional IPV, HIV/AIDs knowledge and behaviors, decision-making, and gender norms. An intention-to-treat (ITT) analysis was conducted, evaluating 6,770 households surveyed at baseline in 2014–2015 (1,680 households, 16 clusters in control; 1,692 households, 16 clusters in couples’ UBL; 1,707 households, 16 clusters in women’s UBL; 1,691 households, 16 clusters in men’s UBL). Follow-up data were available from 88% of baseline respondents and 87% of baseline spouses surveyed in 2017–2018. Results from both unadjusted and adjusted specifications are reported, the latter adjusting for age, education level, marriage length, polygamy, socioeconomic status, and months between intervention and endline. For primary outcomes, there was no effect of any UBL intervention compared to control on women’s past-year experience of physical (couples’ UBL arm adjusted odds ratio [AOR] = 1.00, 95% confidence interval [CI]: 0.77–1.30, p = 0.973; women’s UBL arm AOR = 1.11, 95% CI 0.87–1.42, p = 0.414; men’s UBL arm AOR = 1.02, 95% CI: 0.81–1.28, p = 0.865) or sexual IPV (couples’ UBL arm AOR = 0.86, 95% CI: 0.62–1.20, p = 0.378; women’s UBL arm AOR = 1.15, 95% CI: 0.89–1.50; p = 0.291; men’s UBL arm AOR = 0.80, 95% CI: 0.63–1.01, p = 0.062). For the secondary outcomes, only the men’s UBL intervention significantly reduced male perpetration of past-year sexual IPV (AOR: 0.73; 95% CI: 0.56–0.94, p = 0.014), and no intervention reduced perpetration of past-year physical IPV. Among women, the couples’ UBL intervention significantly improved comprehensive HIV knowledge, and both couples’ and women’s UBL significantly increased reported condom use at last intercourse. Among additional outcomes of interest, the men’s UBL intervention was associated with a significant reduction in women’s experience of past-year physical and/or sexual IPV (AOR = 0.81, 95% CI: 0.66–0.99, p = 0.036) and men’s perpetration of physical and/or sexual IPV (AOR = 0.78; 95% CI: 0.62–0.98, p = 0.037). UBL delivered to men and couples was associated with a significant reduction in HIV risk behaviors and more equitable intrahousehold decision-making and household task-sharing. The primary limitation is reliance on self-reported data.
Conclusions
A gender-transformative intervention delivered to men was effective in reducing self-reported perpetration of sexual IPV but did not reduce IPV when delivered to couples or women. We found evidence of decreased sexual IPV with men’s UBL across men’s and women’s reports and of increased HIV knowledge and condom use at last intercourse among women. The men’s UBL intervention could help accelerate progress towards gender equality and combating HIV/AIDS.
Trial registration
The trial was prospectively registered at clinicaltrials.gov (NCT02311699) and in the American Economic Association registry (AEARCTR-0000211).
Klíčová slova:
Copulation – Decision making – Emotions – HIV – HIV prevention – Intimate partner violence – Questionnaires – Women's health
Zdroje
1. Devries KM, Mak JY, Garcia-Moreno C, Petzold M, Child JC, Falder G, et al. Global health. The global prevalence of intimate partner violence against women. Science. 2013;340: 1527–8. doi: 10.1126/science.1240937 23788730
2. Campbell JC. Health consequences of intimate partner violence. Lancet. 2002;359: 1331–6. doi: 10.1016/S0140-6736(02)08336-8 11965295
3. Ellsberg M, Jansen HA, Heise L, Watts CH, Garcia-Moreno C. Intimate partner violence and women's physical and mental health in the WHO multi-country study on women's health and domestic violence: an observational study. Lancet. 2008;371: 1165–72. doi: 10.1016/S0140-6736(08)60522-X 18395577
4. Devries KM, Mak JY, Bacchus LJ, Child JC, Falder G, Petzold M, et al. Intimate partner violence and incident depressive symptoms and suicide attempts: a systematic review of longitudinal studies. PLoS Med. 2013;10: e1001439. doi: 10.1371/journal.pmed.1001439 23671407
5. Hill A, Pallitto C, McCleary‐Sills J, Garcia‐Moreno C. A systematic review and meta‐analysis of intimate partner violence during pregnancy and selected birth outcomes. Int J Gynaecol Obstet. 2016;133(3): 269–76. doi: 10.1016/j.ijgo.2015.10.023 27039053
6. Kouyoumdjian FG, Findlay N, Schwandt M, Calzavara LM. A systematic review of the relationships between intimate partner violence and HIV/AIDS. PLoS ONE. 2013;8: e81044. doi: 10.1371/journal.pone.0081044 24282566
7. Jewkes RK, Dunkle K, Nduna M, Shai N. Intimate partner violence, relationship power inequity, and incidence of HIV infection in young women in South Africa: a cohort study. Lancet. 2010;376: 41–8. doi: 10.1016/S0140-6736(10)60548-X 20557928
8. Dunkle KL, Jewkes RK, Nduna M, Levin J, Jama N, Khuzwayo N, et al. Perpetration of partner violence and HIV risk behavior among young men in the rural Eastern Cape, South Africa. AIDS. 2006;20: 2107–14. doi: 10.1097/01.aids.0000247582.00826.52 17053357
9. UNAIDS. Fact Sheet 2018 [Internet]. 2018 [cited 2019 Jun 11]. Available from: http://www.unaids.org/en/resources/fact-sheet.
10. Garcia-Moreno C, Jansen HA, Ellsberg M, Heise L, Watts CH. Prevalence of intimate partner violence: findings from the WHO multi-country study on women's health and domestic violence. Lancet. 2006;368: 1260–9. doi: 10.1016/S0140-6736(06)69523-8 17027732
11. Ellsberg M, Arango DJ, Morton M, Gennari F, Kiplesund S, Contreras M, et al. Prevention of violence against women and girls: what does the evidence say? Lancet. 2015;385: 1555–66. doi: 10.1016/S0140-6736(14)61703-7 25467575
12. Abramsky T, Devries K, Kiss L, Nakuti J, Kyegombe N, Starmann E, et al. Findings from the SASA! Study: a cluster randomized controlled trial to assess the impact of a community mobilization intervention to prevent violence against women and reduce HIV risk in Kampala, Uganda. BMC Med. 2014; 12:122. doi: 10.1186/s12916-014-0122-5 25248996
13. Jewkes R, Nduna M, Levin J, Jama N, Dunkle K, Puren A, et al. Impact of stepping stones on incidence of HIV and HSV-2 and sexual behavior in rural South Africa: cluster randomized controlled trial. BMJ. 2008;337: a506. doi: 10.1136/bmj.a506 18687720
14. Wagman JA, Gray RH, Campbell JC, Thoma M, Ndyanabo A, Ssekasanvu J, et al. Effectiveness of an integrated intimate partner violence and HIV prevention intervention in Rakai, Uganda: analysis of an intervention in an existing cluster randomized cohort. Lancet Glob Health. 2015;3: e23–33. doi: 10.1016/S2214-109X(14)70344-4 25539966
15. Jewkes R, Flood M, Lang J. From work with men and boys to changes of social norms and reduction of inequities in gender relations: a conceptual shift in prevention of violence against women and girls. Lancet. 2015;385: 1580–9. doi: 10.1016/S0140-6736(14)61683-4 25467578
16. Peacock D, Levack A: The Men as Partners Program in South Africa:Reaching Men to End Gender-Based Violence and Promote Sexual and Reproductive Health. Int J Mens Health. 2004;3: 173–188.
17. Casey E, Carlson J, Two Bulls S, Yager A. Gender transformative approaches to engaging men in gender-based violence prevention: A review and conceptual model. Trauma Violence Abuse. 2018;19: 231–46. doi: 10.1177/1524838016650191 27197533
18. Barker G, Ricardo C, Nascimento M, Olukoya A, Santos C. Questioning gender norms with men to improve health outcomes: evidence of impact. Glob Public Health. 2010;5: 539–53. doi: 10.1080/17441690902942464 19513910
19. Doyle K, Levtov RG, Barker G, Bastian GG, Bingenheimer JB, Kazimbaya S, et al. Gender-transformative Bandebereho couples’ intervention to promote male engagement in reproductive and maternal health and violence prevention in Rwanda: Findings from a randomized controlled trial. PLoS ONE. 2018;13: e0192756. doi: 10.1371/journal.pone.0192756 29617375
20. Starmann E, Collumbien M, Kyegombe N, Devries K, Michau L, Musuya T, et al. Exploring couples’ processes of change in the context of SASA!, a violence against women and HIV prevention intervention in Uganda. Prev Sci. 2017; 18:233–44. doi: 10.1007/s11121-016-0716-6 27682273
21. McLean L, Heise LL, Stern EA. Shifting and transforming gender-inequitable beliefs, behaviours and norms in intimate partnerships: the Indashyikirwa couples programme in Rwanda. Cult Health Sex. 2019: 1–8.
22. Central Statistical Agency (CSA) [Ethiopia] and ICF. Ethiopia Demographic and Health Survey 2016 –HIV Prevalence Report. Addis Ababa, Ethiopia, and Rockville, Maryland, USA: CSA and ICF; 2016.
23. World Health Organization: Putting women first: ethical and safety recommendations for research on domestic violence against women. Geneva: WHO; 2001.
24. Conroy AA. Gender, power, and intimate partner violence: a study on couples from rural Malawi. J Interpers Violence. 2014;29: 866–88. doi: 10.1177/0886260513505907 24227592
25. Pronyk PM, Kim JC, Abramsky T, Phetla G, Hargreaves JR, Morison LA, et al. A combined microfinance and training intervention can reduce HIV risk behavior in young female participants. AIDS. 2008;22: 1659–65. doi: 10.1097/QAD.0b013e328307a040 18670227
26. Philpart M, Yemane Berhane MD. Prevalence and risk factors of gender-based violence committed by male college students in Awassa, Ethiopia. Violence Vict. 2009;24: 122. doi: 10.1891/0886-6708.24.1.122 19297890
27. Hayes R, Bennett S. Simple sample size calculation for cluster- randomized trials. Int J Epidemiol. 1999;28: 319–26. doi: 10.1093/ije/28.2.319 10342698
28. Zhang J, Kai FY. What's the relative risk?: A method of correcting the odds ratio in cohort studies of common outcomes. JAMA. 1998;280: 1690–1. doi: 10.1001/jama.280.19.1690 9832001
29. Gupta J, Falb KL, Lehmann H, Kpebo D, Xuan Z, Hossain M, et al. Gender norms and economic empowerment intervention to reduce intimate partner violence against women in rural Côte d’Ivoire: a randomized controlled pilot study. BMC Int Health Hum Rights. 2013; 13:46. doi: 10.1186/1472-698X-13-46 24176132
30. Hossain M, Zimmerman C, Kiss L, Abramsky T, Kone D, Bakayoko-Topolska M, et al. Working with men to prevent intimate partner violence in a conflict-affected setting: a pilot cluster randomized controlled trial in rural Côte d’Ivoire. BMC Pub Health. 2014;14: 339.
31. Jones DL, Peltzer K, Villar-Loubet O, Shikwane E, Cook R, Vamos S, et al. Reducing the risk of HIV infection during pregnancy among South African women: a randomized controlled trial. AIDS Care. 2013;25: 702–9. doi: 10.1080/09540121.2013.772280 23438041
32. Kapiga S, Harvey S, Mshana G, Hansen CH, Mtolela GJ, Madaha F, et al. A social empowerment intervention to prevent intimate partner violence against women in a microfinance scheme in Tanzania: findings from the MAISHA cluster randomised controlled trial. Lancet Global Health. 2019;7: e1423–34. doi: 10.1016/S2214-109X(19)30316-X 31537372
33. Kyegombe N, Starmann E, Devries KM, Michau L, Nakuti J, Musuya T, et al. ‘SASA! is the medicine that treats violence’. Qualitative findings on how a community mobilisation intervention to prevent violence against women created change in Kampala, Uganda. Global health action. 2014;7: 25082. doi: 10.3402/gha.v7.25082 25226421
34. Abramsky T, Devries KM, Michau L, Nakuti J, Musuya T, Kyegombe N, Watts C. The impact of SASA!, a community mobilisation intervention, on women's experiences of intimate partner violence: secondary findings from a cluster randomised trial in Kampala, Uganda. J Epidemiol Community Health. 2016;70: 818–25. doi: 10.1136/jech-2015-206665 26873948
35. Gibbs A, Dunkle K, Jewkes R. Emotional and economic intimate partner violence as key drivers of depression and suicidal ideation: A cross-sectional study among young women in informal settlements in South Africa. PLoS ONE. 2018 Apr 16;13(4):e0194885. doi: 10.1371/journal.pone.0194885 29659595
36. Jewkes R. Emotional abuse: a neglected dimension of partner violence. Lancet. 2010;376: 851–52. doi: 10.1016/S0140-6736(10)61079-3 20822808
37. Raj A, Ghule M, Ritter J, Battala M, Gajanan V, Nair S, et al. Cluster randomized controlled trial evaluation of a gender equity and family planning intervention for married men and couples in rural India. PLoS ONE. 2016;11: e0153190. doi: 10.1371/journal.pone.0153190 27167981
38. Saggurti N, Nair S, Silverman JG, Naik DD, Battala M, Dasgupta A, et al. Impact of the RHANI Wives intervention on marital conflict and sexual coercion. Int J Gynaecol Obstet. 2014;126: 18–22. doi: 10.1016/j.ijgo.2014.01.015 24795094
39. Kim J, Ferrari G, Abramsky T, Watts C, Hargreaves J, Morison L, et al. Assessing the incremental effects of combining economic and health interventions: the IMAGE study in South Africa. Bull World Health Organ. 2009;87: 824–32. doi: 10.2471/blt.08.056580 20072767
40. Singh K, Bloom S, Brodish P. Gender equality as a means to improve maternal and child health in Africa. Health Care Women Int. 2015;36: 57–69. doi: 10.1080/07399332.2013.824971 24028632
41. Moher D, Hopewell S, Schulz KF, Montori V, Gøtzsche PC, Devereaux PJ, et al. CONSORT 2010 explanation and elaboration: updated guidelines for reporting parallel group randomized trials. BMJ 2010; 340: c869 doi: 10.1136/bmj.c869 20332511
42. Rothman KJ. No adjustments are needed for multiple comparisons. Epidemiology. 1990;1: 43–46. 2081237
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