Effect Of A Structural Intervention For The Prevention Of Intimate-Partner Violence And HIV In Rural South Africa: A Cluster Randomised Trial
Combining a microfinance program for women with a participatory curriculum to discuss gender roles, relationships, intimate-partner violence, and HIV reduced levels of intimate-partner violence in South Africa.
South Africa is home to one of the most high profile HIV epidemics in the world. In 2012, an estimated 6.1 million people were living with HIV, and 240,000 South Africans died from AIDS-related illnesses. HIV/AIDS and intimate-partner violence remain inextricably linked: one study in South Africa found that young women who experience intimate partner violence are 50% more likely to acquire HIV than women who do not experience violence (UN AIDS, 2013). Underdevelopment, lack of economic opportunities for both men and women, entrenched inequalities in the distribution of power, resources, and responsibilities are contributing social factors that have created a high-risk environment for both HIV infection and intimate-partner violence. These issues can be combatted through interventions such as microfinance, shown to reduce poverty and empower women, and health education programs about sexually transmitted infections and gender violence, which can improve health outcomes. Accordingly, a structural intervention entitled “Intervention with Microfinance for AIDS and Gender Equity” (IMAGE) employed a combination of poverty-focused microfinance initiatives that target the poorest women in communities, along with a participatory curriculum of gender and HIV education. The researchers aim was to determine whether the involvement of women in the program would improve household economic wellbeing, social capital, and empowerment, and thus reduce vulnerability to intimate-partner violence.
Women who received a microfinance loan combined with gender and HIV education experienced less intimate-partner violence and more communication about sex. However, there was no spillover effect as there was no change in unprotected sex with a non-spousal partner amongst co-residents or randomly selected members of the community nor was there a change in HIV incidence in the community.
- Women who received the microfinance loan and training experienced a 55% drop in intimate-partner violence and reported experiencing less controlling behavior by their partners.
- Among women who received the intervention, 90% communicated with their partners about sexual matters in the past 12 months, compared with only 80% of women in the control group.
- Women who received the intervention reported higher levels of participation in social groups and a greater sense of solidarity from their community in a time of crisis.
- The intervention did not affect the rate of unprotected sex with a non-spousal partner among family members in the household.
- Among community members, there was no effect on the rate of unprotected sex with a non-spousal partner or HIV incidence.
A combined microfinance and training intervention can lead to a reduction in levels of intimate-partner violence in South Africa.
Eight villages in the rural Limpopo province of South Africa were randomly assigned to either receive a phased-in intervention at the onset (the intervention group) or three years later (the comparison group). In each intervention village, data was collected on three cohorts of individuals: Cohort 1 was comprised of all 860 women who enrolled in the IMAGE program based on eligibility at baseline. Cohort 2 included 1,835 14-35 year-old co-residents of enrolled women from Cohort 1, and Cohort 3 included 3,881 14-35 year-old individuals randomly selected from households in intervention communities.
The women in Cohort 1 of intervention villages received loans and participated in loan meetings every 2 weeks that integrated training sessions that included topics of gender roles, cultural beliefs, relationships, communication, intimate-partner violence, and HIV. These trainings aimed to strengthen communication skills, critical thinking, and leadership. Key women were then selected for a further week of leadership training to mobilize around priority issues including HIV and intimate-partner violence. Researchers then measured if women in Cohort 1 experienced intimate-partner violence in the past 12 months by a spouse or other sexual intimate. In Cohorts 2 and 3, they measured unprotected sexual intercourse with a non-spousal partner in the past 12 months, and in Cohort 3 they measured HIV incidence.