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DeHond A, Brady F, Kalokhe AS. Prevention of Perpetration of Intimate Partner Violence by Men and Boys in Low- and Middle-Income Countries: A Scoping Review of Primary Prevention Interventions. TRAUMA, VIOLENCE & ABUSE 2023; 24:2412-2428. [PMID: 35511498 DOI: 10.1177/15248380221097441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Intimate partner violence (IPV) affects the health of women across the globe, with the greatest burden encountered by women in low- and middle-income countries (LMICs). This scoping review aims to summarize and critically examine primary prevention interventions addressing IPV perpetration by men and boys in LMICs and identify gaps in the evidence base. PubMed, EMbase, and PsychINFO were searched for articles published between January 2001 and October 2020 that examined the efficacy of primary prevention interventions to prevent IPV perpetration by men/boys in LMICs and reported on a quantitative outcome examining IPV perpetration. Data on study population, setting and design, intervention components, evaluation methods, and outcomes were extracted, and study quality was assessed using the Effective Public Health Practice Project tool. Of 8,392 articles, 16 intervention studies met inclusion criteria. All 16 were of moderate or weak quality. The majority were conducted in Africa, delivered by peers, theoretically grounded, and included content to challenge IPV acceptance and gender norms. Half demonstrated intervention efficacy in prevention of IPV perpetration; these studies tended to intervene at multiple levels of the Socio-Ecological Model, be delivered over a minimum of eight sessions, and utilize a validated IPV measure to assess intervention impact. In conclusion, the field of IPV perpetration prevention research in LMICs is rapidly evolving, with many interventions demonstrating promise. Future intervention studies should consider expanding to LMICs outside Africa, targeting school-age youth, exploring whether shorter intervention durations are effective, and addressing the methodological shortcomings noted in the quality assessment.
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Affiliation(s)
- Allayna DeHond
- Department of Global Health, Emory Rollins School of Public Health, Atlanta, GA, USA
| | - Forrest Brady
- Department of Global Health, Emory Rollins School of Public Health, Atlanta, GA, USA
| | - Ameeta S Kalokhe
- Department of Global Health, Emory Rollins School of Public Health, Atlanta, GA, USA
- Division of Infectious Diseases, Emory School of Medicine, Atlanta, GA, USA
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Bukuluki P, Kisaakye P, Wandiembe SP, Bulenzi-Gulere G, Mulindwa B, Bazira D, Letiyo E, Namirembe HNL, Schmidt I, Nabukhonzo Kakande P, Nissling S. Access to information on gender-based violence prevention during COVID-19 lockdown in Uganda: a cross-sectional study. EClinicalMedicine 2023; 57:101846. [PMID: 36776505 PMCID: PMC9897736 DOI: 10.1016/j.eclinm.2023.101846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 01/10/2023] [Accepted: 01/11/2023] [Indexed: 02/05/2023] Open
Abstract
Background During the lockdowns to contain the COVID-19 pandemic in Uganda, women and girls, disproportionately, had increased exposure to gender-based violence (GBV). Access to high-quality and empowering information or knowledge to minimise the incidences of GBV for women, girls, men and boys, was, therefore, crucial. The purpose of this study was to understand the characteristics of the individuals who were unable to access such information, and if received information, was associated with more awareness in the populace. Methods The data analysed were from a cross-sectional nationally representative phone survey of individuals aged 18 years and above from all four regions of Uganda. The survey was carried out by Uganda Bureau of Statistics using a purely quantitative approach, and all questions were closed-ended. The sample was stratified by sex, age, and geographical region, and executed in November 2020, six months after COVID-19 lockdown restrictions. Binary logistic regression analysis was used for data analysis in STATA software. Findings Female respondents with tertiary education (OR = 0.47; 95% CI = 0.26, 0.85) and male respondents with tertiary education (OR = 0.70; 95% CI: 0.49, 1.00) were more likely to receive information on GBV prevention. Both female (aOR = 0.68; 95% CI: 0.52, 0.88) and male (aOR = 0.66; 95% CI: 0.50, 0.87) respondents who were working had about a third the odds of being unable to access information about GBV prevention. Female respondents living in urban areas were associated with less odds of being unable to access the information (aOR = 0.77; 95% CI: 0.59, 1.00), while unmarried male respondents had higher odds of being unable to access the information (aOR = 1.37; 95% CI: 1.00, 1.89). Respondents who reported being vulnerable to GBV were also more likely to know someone who experienced GBV. This was similar for female respondents (PR = 3.00; 95% CI: 2.26, 3.98) and male respondents (PR = 3.01, 95% CI: 2.3, 3.95) (PR = 5.49; 95% CI = 4.12-7.30). Results also indicated that both male (PR = 1.28; 95% CI: 1.14, 1.43) and female respondents (PR = 1.24; 95% CI: 1.11, 1.37) who did not perceive themselves at risk of GBV were less likely to know a GBV survivor. Interpretation The individuals who were unable to access information had characteristics associated with GBV perpetration or victimization. Monitoring the dissemination and quality of information empowers individuals and communities to develop local solutions to GBV prevention and protection. The design of GBV prevention messages and delivery channels needs to take into consideration the risk factors at the different levels of the socio-ecological model (individual, community, institutional, and society). Interventions aimed at increasing access to information on GBV prevention should consider the different socio-demographic as well as context-specific factors. Funding There was no funding source for this study.
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Affiliation(s)
- Paul Bukuluki
- Department of Social Work and Social Administration, School of Social Sciences, Makerere University, Uganda
| | - Peter Kisaakye
- Department of Population Studies, School of Statistics and Planning, Makerere University, Uganda
| | - Symon Peter Wandiembe
- Department of Statistical Method and Actuarial Sciences, School of Statistics and Planning, Makerere University, Uganda
| | | | | | - Dan Bazira
- Gender Statistics, UN Women, Kampala, Uganda
| | - Evelyn Letiyo
- Ending Violence Against Women, UN Women, Kampala, Uganda
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Mannell J, Washington L, Khaula S, Khoza Z, Mkhwanazi S, Burgess RA, Brown LJ, Jewkes R, Shai N, Willan S, Gibbs A. Challenges and opportunities in coproduction: reflections on working with young people to develop an intervention to prevent violence in informal settlements in South Africa. BMJ Glob Health 2023; 8:e011463. [PMID: 36990642 PMCID: PMC10069549 DOI: 10.1136/bmjgh-2022-011463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 03/09/2023] [Indexed: 03/31/2023] Open
Abstract
Coproduction is widely recognised as essential to the development of effective and sustainable complex health interventions. Through involving potential end users in the design of interventions, coproduction provides a means of challenging power relations and ensuring the intervention being implemented accurately reflects lived experiences. Yet, how do we ensure that coproduction delivers on this promise? What methods or techniques can we use to challenge power relations and ensure interventions are both more effective and sustainable in the longer term? To answer these questions, we openly reflect on the coproduction process used as part of Siyaphambili Youth ('Youth Moving Forward'), a 3-year project to create an intervention to address the social contextual factors that create syndemics of health risks for young people living in informal settlements in KwaZulu-Natal province in South Africa. We identify four methods or techniques that may help improve the methodological practice of coproduction: (1) building trust through small group work with similar individuals, opportunities for distance from the research topic and mutual exchanges about lived experiences; (2) strengthening research capacity by involving end users in the interpretation of data and explaining research concepts in a way that is meaningful to them; (3) embracing conflicts that arise between researchers' perspectives and those of people with lived experiences; and (4) challenging research epistemologies through creating spaces for constant reflection by the research team. These methods are not a magic chalice of codeveloping complex health interventions, but rather an invitation for a wider conversation that moves beyond a set of principles to interrogate what works in coproduction practice. In order to move the conversation forward, we suggest that coproduction needs to be seen as its own complex intervention, with research teams as potential beneficiaries.
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Affiliation(s)
| | | | | | | | - Smanga Mkhwanazi
- Gender and Health Research Unit, South African Medical Research Council, Pretoria, South Africa
| | - Rochelle A Burgess
- Institute for Global Health, University College London, London, UK
- Department of Social Work, University of Johannesburg, Auckland Park, South Africa
| | - Laura J Brown
- Institute for Global Health, University College London, London, UK
| | - Rachel Jewkes
- Gender and Health Research Unit, South African Medical Research Council, Pretoria, South Africa
- Office of the Executive Scientist, South African Medical Research Council, Pretoria, South Africa
| | - Nwabisa Shai
- Gender and Health Research Unit, South African Medical Research Council, Pretoria, South Africa
| | - Samantha Willan
- Gender and Health Research Unit, South African Medical Research Council, Pretoria, South Africa
| | - Andrew Gibbs
- Gender and Health Research Unit, South African Medical Research Council, Pretoria, South Africa
- Psychology, University of Exeter, Exeter, UK
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Chingono R, Kasese C, Miles S, Busza J. 'I was in need of somewhere to release my hurt:' Addressing the mental health of vulnerable adolescent mothers in Harare, Zimbabwe, through self-help groups. Glob Health Action 2022; 15:2040151. [PMID: 35322767 PMCID: PMC8956306 DOI: 10.1080/16549716.2022.2040151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background Adolescents experiencing multiple vulnerabilities, including poverty, curtailed education, transactional sex and early childbearing, are at risk of poor mental health. In Zimbabwe, girls who are pregnant or new mothers and involved in selling sex struggle to cope with the combined pressures of parenthood, financial insecurity, and social stigma. A pilot intervention brought such girls together into self-help groups to increase peer support, resources and skills. Objective This study aimed to explore whether and how participation in a self-help group intervention affected vulnerable young mothers’ experiences and perceptions of mental health stressors. Methods Self-help groups received 12 participatory sessions over 6 months. Eighteen semi-structured interviews and three focus group discussions were held with participants and drop-outs. Before and after the intervention, participants completed the locally validated 14-item Shona Symptom Questionnaire tool to indicate the probable prevalence of common mental health disorders. Results Adolescent girls described mutually reinforcing stressors in their lives and reported low self-esteem and anxiety. Key themes emerging from qualitative data centred around girls’ struggles with adverse life events, the burden of new motherhood, social isolation related to sex work and self-help groups as a source of hope. Participants joined groups to obtain support and felt their mental well-being improved due to new social networks, feelings of solidarity with peers, and increased confidence for positive action, that is, seeking health services for themselves and their babies. Prior to enrolment 16% showed signs of possible common mental disorders falling to 2% at follow-up. Conclusions Participants believed involvement in interactive self-help groups improved their mental health by strengthening peer support and engendering hope for the future. Although reduced mental distress cannot be attributed to the programme, the pilot intervention offers a low-cost approach that could be rigorously tested and adapted to a wide range of community settings.
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Affiliation(s)
- Rudo Chingono
- Centre for Sexual Health and HIV/AIDS Research, Harare, Zimbabwe.,Biomedical Research and Training Institute, Harare, Zimbabwe.,Institute of Global Health, University College London, UK
| | - Constance Kasese
- Centre for Sexual Health and HIV/AIDS Research, Harare, Zimbabwe
| | - Sam Miles
- Department of Public Health, Environment & Society, London School of Hygiene and Tropical Medicine, London, UK
| | - Joanna Busza
- Department of Public Health, Environment & Society, London School of Hygiene and Tropical Medicine, London, UK
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Orsini MM, Ewald DR, Strack RW. Development and validation of the 4-Factor Critical Consciousness Scale. SSM Popul Health 2022; 19:101202. [PMID: 36052157 PMCID: PMC9425060 DOI: 10.1016/j.ssmph.2022.101202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 06/26/2022] [Accepted: 08/08/2022] [Indexed: 11/03/2022] Open
Abstract
Assessment of critical consciousness among individuals can provide a proxy measure of the readiness of communities, and individual decision-makers within, for social changes that address root causes of ill health. Critical consciousness, as conceived by Paolo Freire, emerges as a consequence of praxis. This iterative, recursive process of reflection and co-created knowledge enables community members to identify salient issues and the actions they want to take to address those issues. Public health and other social science researchers who engage in social- and population-level intervention work need a validated instrument that measures critical consciousness. Our purpose was to develop an instrument that can measure 4 key constructs of critical consciousness (passive adaptation, emotional engagement, cognitive awakening, and intentions to act) in an individual, relative to any salient community issue. We conducted two studies (Initial: June 2018; Retest: October 2019) to develop and validate this instrument. The same sampling strategy was used for both studies, but each study was conducted with a discrete cohort of participants. We used Amazon's Mechanical Turk to recruit and incentivize study participants. Data from the Initial study were used in an iterative process to evaluate construct validity and test our theoretical assumptions. Exploratory factor analyses were used to determine the best model fit that gave the greatest subscale reliability and validity. In the Retest study, confirmatory factor analysis was conducted and construct validity was verified. Our results indicated adequate construct validity as evidenced by good model fit. Additionally, the good fit of the data to the 4-factor structure confirmed our theoretical understanding of critical consciousness.
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Affiliation(s)
| | - D. Rose Ewald
- University of North Carolina-Greensboro, PO Box 26170, Greensboro, NC, 27402-6170, USA
| | - Robert W. Strack
- University of North Carolina-Greensboro, PO Box 26170, Greensboro, NC, 27402-6170, USA
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Ahmad S, Islam M, Zada M, Khattak A, Ullah R, Han H, Ariza-Montes A, Araya-Castillo L. The Influence of Decision Making on Social Inclusion of Persons with Disabilities: A Case Study of Khyber Pakhtunkhwa. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19020858. [PMID: 35055681 PMCID: PMC8775423 DOI: 10.3390/ijerph19020858] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 12/29/2021] [Accepted: 01/06/2022] [Indexed: 12/10/2022]
Abstract
Decision making is an essentially social process adopted by individuals or groups to identify and choose the best choice among several alternatives. Decision-making choices are influenced by the preferences, values, and beliefs of the individuals or groups involved in the decision-making process. This study was conducted to analyze the social inclusion of Persons with Disabilities (PWDs) in the context of their participation in decision making. The study area consisted of 8028 PWDs registered with the government of Pakistan, from which a sample of 488 PWDs was selected through a multistage stratified random sampling technique. These PWDs included physically disabled, blind, crippled, and deaf persons; however, the data were collected from those who were able to be interviewed. Chi-square and Kendall’s Tau-b tests were used to determine the strength, level, and direction of association among variables. At the multivariate level, the study found a spurious relation between social inclusion and participation in decision making when controlling for gender, monthly family income, and level of disability of the PWDs. The results highlighted that participation in decision making improved the social inclusion of male and moderately disabled PWDs more positively. However, participation in decision making was a universal feature explaining the social inclusion of PWDs irrespective of their monthly family income. The logistic regression model explained that the social inclusion of PWDs was more likely to occur when PWDs were married, had high monthly family income (PKR 16,500 and above), belonged to a joint family, and actively participated in decision making. The study recommends that ensuring the participation of PWDs in decision making in family, community, school, and other relevant institutions ultimately enhances their social inclusion.
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Affiliation(s)
- Shakeel Ahmad
- Department of Social Work and Sociology, Kohat University of Science and Technology (KUST), Kohat 26000, Pakistan; (S.A.); (M.I.)
| | - Mazhar Islam
- Department of Social Work and Sociology, Kohat University of Science and Technology (KUST), Kohat 26000, Pakistan; (S.A.); (M.I.)
| | - Muhammad Zada
- Business School, Henan University, Kaifeng 475000, China
- Correspondence: (M.Z.); (H.H.)
| | | | - Rezwan Ullah
- School of Management and Economics, Beijing Institute of Technology, Beijing 100081, China;
| | - Heesup Han
- College of Hospitality and Tourism Management, Sejong University, Seoul 05006, Korea
- Correspondence: (M.Z.); (H.H.)
| | - Antonio Ariza-Montes
- Social Matters Research Group, Universidad Loyola Andalucía, C/Escritor Castilla Aguayo, 4, 14004 Córdoba, Spain;
| | - Luis Araya-Castillo
- Facultad de Economía y Negocios, Universidad Andrés Bello, Santiago de Chile 7591538, Chile;
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Stern E, Batista M, Shannon G, Heise L, Mannell J. A case study comparison of engaging community activists to prevent gender-based violence in Peru and Rwanda. Glob Public Health 2021; 17:2300-2315. [PMID: 34932917 DOI: 10.1080/17441692.2021.2018010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Community mobilisation is recognised as an important strategy to shift inequitable gender norms and ensure an enabling environment to prevent gender-based violence (GBV). Yet there is a need to better understand the factors that facilitate effective community activism in particular contexts. Although fundamental to the success of mobilisation programmes, there is also limited appreciation of the experiences and agency of engaged community activists. This paper draws on qualitative evaluations from two community mobilisation GBV prevention programmes: the Gender Violence in the Amazon of Peru (GAP) Project and the Indashyikirwa programme in Rwanda. In Peru, participatory data was collected, in addition to baseline and endline interviews with 8 activists. In Rwanda, baseline and endline interviews and observations were conducted with 12 activists, and interviews were conducted with 8 staff members. The data was thematically analysed, and a comparative case study approach was applied to both data sets. The comparative study identified similar programmatic aspects that could hinder or enable activist's engagement and development, and how these are embedded within contextual social and structural factors. We discuss these insights in reference to the current emphasis in public health on individualistic programming, with insufficient attention to how wider environments influence violence prevention programming.
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Affiliation(s)
- Erin Stern
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Johns Hopkins School of Nursing, Baltimore, MD, USA.,London School of Hygiene and Tropical Medicine, London, UK
| | - Murylo Batista
- London School of Hygiene and Tropical Medicine, London, UK
| | - Geordan Shannon
- Institute for Global Health, University of College London, London, UK
| | - Lori Heise
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Johns Hopkins School of Nursing, Baltimore, MD, USA
| | - Jenevieve Mannell
- Institute for Global Health, University of College London, London, UK
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Caperon L, Arakelyan S, Innocenti C, Ager A. Identifying opportunities to engage communities with social mobilisation activities to tackle NCDs in El Salvador in the context of the global COVID-19 pandemic. Int J Equity Health 2021; 20:222. [PMID: 34627271 PMCID: PMC8501926 DOI: 10.1186/s12939-021-01559-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 09/16/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Social mobilisation is potentially a key tool in the prevention of non-communicable diseases (NCDs) in fragile settings. This formative study addressed existing and potential social mobilisation mechanisms seeking behaviour to tackle NCDs in El Salvador, with an emphasis on the implications in the context of the current COVID-19 pandemic. METHODS We conducted 19 semi-structured interviews with health workers, government officials, NGO leaders, and community members. Interviews addressed mechanisms for social mobilisation which existed prior to COVID-19, the ways in which these mechanisms tackled NCDs, the impact of COVID-19 on social mobilisation activities and new, emerging mechanisms for social mobilisation in the wake of the COVID-19 pandemic. RESULTS Findings indicate a growing awareness of NCDs within communities, with social mobilisation activities seen as valuable in tackling NCDs. However, major barriers to NCD prevention and treatment provision remain, with COVID-19 constraining many possible social mobilisation activities, leaving NCD patients with less support. Factors linked with effective social mobilisation of communities for NCD prevention included strong engagement of community health teams within community structures and the delivery of NCD prevention and management messages through community meetings with trusted health professionals or community members. There are gender differences in the experience of NCDs and women were generally more engaged with social mobilisation activities than men. In the context of COVID-19, traditional forms of social mobilisation were challenged, and new, virtual forms emerged. However, these new forms of engagement did not benefit all, especially those in hard-to-reach rural areas. In these contexts, specific traditional forms of mobilisation such as through radio (where possible) and trusted community leaders - became increasingly important. CONCLUSIONS New mechanisms of fostering social mobilisation include virtual connectors such as mobile phones, which enable mobilisation through platforms such as WhatsApp, Facebook and Twitter. However, traditional forms of social mobilisation hold value for those without access to such technology. Therefore, a combination of new and traditional mechanisms for social mobilisation hold potential for the future development of social mobilisation strategies in El Salvador and, as appropriate, in other fragile health contexts.
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Affiliation(s)
- Lizzie Caperon
- Research Unit on Health in Situations of Fragility, Institute for Global Health & Development, Queen Margaret University, Edinburgh, UK.
| | - Stella Arakelyan
- Research Unit on Health in Situations of Fragility, Institute for Global Health & Development, Queen Margaret University, Edinburgh, UK
| | | | - Alastair Ager
- Research Unit on Health in Situations of Fragility, Institute for Global Health & Development, Queen Margaret University, Edinburgh, UK
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What's in a Name? A Mixed Method Study on How Young Women Who Sell Sex Characterize Male Partners and Their Use of Condoms. J Acquir Immune Defic Syndr 2021; 87:652-662. [PMID: 33507013 DOI: 10.1097/qai.0000000000002623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 12/01/2020] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Young women who sell sex (YWSS) are at disproportionate risk of HIV. Reducing YWSS' vulnerability requires engaging their male sexual partners. To achieve this, we need to understand the characteristics and dynamics of their sexual partnerships to inform effective interventions. METHODS We conducted a mixed-methods study to compare YWSS' qualitative descriptions of male partners with categories reported in a behavioral survey. Data were drawn from enrollment into an evaluation of the DREAMS initiative in Zimbabwe in 2017. As part of a respondent-driven sampling survey, we recruited 40 seed participants from 2 intervention and 4 comparison sites. We conducted semistructured interviews with 19 "seeds," followed by a behavioral survey with 2387 YWSS. We interpreted quantitative and qualitative data together to understand how YWSS perceived male sexual partners, assess how well survey variables related to narrative descriptions, and describe patterns of risk behavior within partnerships. RESULTS Qualitative data suggest survey categories "husband" and "client" reflect YWSS' perceptions but "regular partner/boyfriend" and "casual partner" do not. In interviews, use of the term "boyfriend" was common, describing diverse relationships with mixed emotional and financial benefits. More than 85% of male partners provided money to YWSS, but women were less likely to report condomless sex with clients than regular partners (11% vs 37%) and more likely to report condomless sex with partners who ever forced them to have sex (37% vs 21%). CONCLUSIONS Reducing HIV risk among YWSS requires prevention messages and tools that recognize diverse and changing vulnerability within and between sexual relationships with different male partners.
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Atujuna M, Simpson N, Ngobeni M, Monese T, Giovenco D, Pike C, Figerova Z, Visser M, Biriotti M, Kydd A, Bekker LG. Khuluma: Using Participatory, Peer-Led and Digital Methods to Deliver Psychosocial Support to Young People Living With HIV in South Africa. FRONTIERS IN REPRODUCTIVE HEALTH 2021; 3:687677. [PMID: 36304024 PMCID: PMC9580650 DOI: 10.3389/frph.2021.687677] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 06/11/2021] [Indexed: 11/13/2022] Open
Abstract
Khuluma is a psychosocial and peer-to-peer mHealth intervention that uses text messaging to facilitate support groups for adolescents living with HIV (ALWH) with the aim of contributing toward positive health outcomes. Although use of mobile technology in the form of mHealth interventions has proliferated recently in the field of health, published literature describing methods and processes of its application are limited. We present a set of methods and processes utilised to develop and pilot the Khuluma mHealth intervention amongst young people (15–20 years) in South Africa. We recruited and enrolled 52 adolescents (15–20-year olds) from four clinics in Pretoria and Cape Town to participate in a 6-month pilot of Khuluma. Participants were ALWH, aware of their status, on antiretroviral therapy for more than 12 months, and not suffering from severe depression. We conducted four pre and post intervention focus group discussions (FGDs) with a proportion of ALWH (n = 36) enrolled in the pilot study using participatory methods. Several processes were utilised to then implement this pilot study. These included engaging ALWH for minor study implementation modifications; forming virtual groups; activating the mHealth platform; facilitating and delivering the Khuluma intervention. The acceptability of the intervention was informed by follow-up focus group discussions and text message data. The initial participatory processes helped to tailor the intervention design to participants' needs. The peer-led facilitation of the groups allowed for the provision of sensitive psychosocial support that allowed young people to express themselves freely, develop a sense of self-worth, and interact more. The nature of the mobile technology also allowed participants to build friendships beyond their geographic area and interact with their peers in real time. Within the evolving context of COVID-19, establishing evidence-based processes and methods for intervention design and curation in virtual spaces is critical.
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Affiliation(s)
- Millicent Atujuna
- Desmond Tutu HIV Centre, Cape Town, South Africa
- *Correspondence: Millicent Atujuna
| | - Nikita Simpson
- SHM Foundation, London, United Kingdom
- Department of Anthropology, London School of Economics and Political Science, London, United Kingdom
| | | | | | - Danielle Giovenco
- Desmond Tutu HIV Centre, Cape Town, South Africa
- Department of Epidemiology, The University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Carey Pike
- Desmond Tutu HIV Centre, Cape Town, South Africa
| | | | - Maretha Visser
- Department of Psychology, University of Pretoria, Pretoria, South Africa
| | | | - Anna Kydd
- SHM Foundation, London, United Kingdom
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Mannell J, Amaama SA, Boodoosingh R, Brown L, Calderon M, Cowley-Malcolm E, Lowe H, Motta A, Shannon G, Tanielu H, Vergara CC. Decolonising violence against women research: a study design for co-developing violence prevention interventions with communities in low and middle income countries (LMICs). BMC Public Health 2021; 21:1147. [PMID: 34130681 PMCID: PMC8205204 DOI: 10.1186/s12889-021-11172-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 05/31/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There has been substantial progress in research on preventing violence against women and girls (VAWG) in the last 20 years. While the evidence suggests the potential of well-designed curriculum-based interventions that target known risk factors of violence at the community level, this has certain limitations for working in partnership with communities in low- and middle-income (LMIC) countries, particularly when it comes to addressing the power dynamics embedded within north-south research relationships. METHODS As an alternative approach, we outline the study design for the EVE Project: a formative research project implemented in partnership with community-based researchers in Samoa and Amantaní (Peru) using a participatory co-design approach to VAWG prevention research. We detail the methods we will use to overcome the power dynamics that have been historically embedded in Western research practices, including: collaboratively defining and agreeing research guidelines before the start of the project, co-creating theories of change with community stakeholders, identifying local understandings of violence to inform the selection and measurement of potential outcomes, and co-designing VAWG prevention interventions with communities. DISCUSSION Indigenous knowledge and ways of thinking have often been undermined historically by Western research practices, contributing to repeated calls for better recognition of Southern epistemologies. The EVE Project design outlines our collective thinking on how to address this gap and to further VAWG prevention through the meaningful participation of communities affected by violence in the research and design of their own interventions. We also discuss the significant impact of the COVID-19 pandemic on the project in ways that have both disrupted and expanded the potential for a better transfer of power to the communities involved. This article offers specific strategies for integrating Southern epistemologies into VAWG research practices in four domains: ethics, theories of change, measurement, and intervention design. Our aim is to create new spaces for engagement between indigenous ways of thinking and the evidence that has been established from the past two decades of VAWG prevention research and practice.
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Affiliation(s)
| | | | | | - Laura Brown
- Institute for Global Health, University College London, London, UK
| | | | | | - Hattie Lowe
- Institute for Global Health, University College London, London, UK
| | - Angélica Motta
- Department of Anthropology, San Marcos University, San Marcos, Peru
| | - Geordan Shannon
- Institute for Global Health, University College London, London, UK
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