Andrew Gibbs

A global comprehensive review of economic interventions to prevent intimate partner violence and HIV risk behaviours

ABSTRACT Background: Intimate partner violence (IPV) and HIV are co-occurring global epidemics, with similar root causes of gender and economic inequalities. Economic interventions have become a central approach to preventing IPV and HIV.Objective/Methods: We undertook a comprehensive scoping review of published evaluations of economic interventions that sought to prevent IPV and/or HIV risk behaviours.Results: Forty-five separate analyses of interventions met our criteria. Broadly, unconditional cash transfer interventions showed either flat or positive outcomes; economic strengthening interventions had mixed outcomes, with some negative, flat and positive results reported; interventions combining economic strengthening and gender transformative interventions tended to have positive outcomes.Conclusions: The review highlighted a number of gaps. Specifically, there were limited studies evaluating the impact of economic interventions on female sex workers, young women, and men. In addition, there were missed opportunities, with many evaluations only reporting either IPV- or HIV-related outcomes, rather than both, despite overlaps.

An individually randomized controlled trial to determine the effectiveness of the Women for Women International Programme in reducing intimate partner violence and strengthening livelihoods amongst women in Afghanistan: trial design, methods and baseline findings

BackgroundIntimate Partner Violence (IPV) is the most common form of violence in conflict and post-conflict settings, but there are few evaluations of interventions to prevent IPV in such settings.MethodsThe Women for Women International (WfWI) intervention is a year-long combined economic and social empowerment intervention for marginalized women survivors of conflict. Primarily, it seeks to support women to achieve four key outcomes: women earn and save money; women improve their health and well-being; women influence decisions in their homes and communities; women connect to networks for support. The organization recognizes Violence Against Women and Girls (VAWG) as a significant barrier to women’s empowerment and expects to see reduction in VAWG, and specifically IPV, as part of building women’s social and economic empowerment. This program is being quantitatively evaluated through an individually randomized control trial amongst women in Afghanistan, with a 24-month follow up. A comparison of baseline characteristics of participants is also included as well as a discussion of implementation of the baseline research.DiscussionThere is a high demand amongst Afghan women for such interventions, and this posed challenges in completing the randomization and baseline. In addition, the complex security situation in Afghanistan also posed challenges. However, despite these issues, recruitment was successfully achieved and the arms were balanced on socio-demographic measures. The evaluation will contribute to the limited evidence base on interventions to prevent IPV in conflict-affected settings.Trial registrationNCT03236948. Registered 28 July 2017, retrospectively registered.

Beyond syndromic management: Opportunities for diagnosis-based treatment of sexually transmitted infections in low- and middle-income countries.

Introduction In light of the limited impact the syndromic management approach has had on the global sexually transmitted infection (STI) epidemic, we assessed a care model comprising point-of-care (POC) STI testing, immediate treatment, and expedited partner therapy (EPT) among a cohort of young women at high HIV risk in South Africa. Methods and findings HIV negative women presenting for STI care underwent POC testing for Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG) and Trichomonas vaginalis (TV), and swabs were sent for NG culture and susceptibility testing. Results were available within 2 hours and women with STIs were immediately treated and offered EPT packs, including medication, condoms, and information for sexual partners. An EPT questionnaire was administered after one week, and women retested for STIs after 6 and 12 weeks. 267 women, median age 23 (IQR 21–26), were recruited and 88.4% (236/267) reported genital symptoms. STI prevalence was CT 18.4% (95%CI 13.7–23.0), NG 5.2% (95%CI 2.6–7.9) and TV 3.0% (95%CI 1.0–5.0). After 12 weeks, all but one NG and two CT infections were cleared. No cephalosporin-resistant NG was detected. Of 63/267 women (23.6%) diagnosed with STIs, 98.4% (62/63) were offered and 87.1% (54/62) accepted EPT. At one week 88.9% (48/54) stated that their partner had taken the medication. No allergic reactions or social harms were reported. Of 51 women completing 6-week follow up, detection rates were lower amongst women receiving EPT (2.2%, 1/46) compared to those who did not (40.0%, 2/5), p = 0.023. During focus group discussions women supported the care model, because they received a rapid, specific diagnosis, and could facilitate their partners’ treatment. Conclusions POC STI testing and EPT were acceptable to young South African women and their partners, and could play an important role in reducing STI reinfection rates and HIV risk. Larger studies should evaluate the feasibility and cost-effectiveness of implementing this strategy at population level.

Understanding how Afghan women utilise a gender transformative and economic empowerment intervention: A qualitative study

ABSTRACT The processes through which womens economic empowerment interventions are envisaged to improve womens health are strongly embedded in notions of building womens agency and autonomy. Yet despite the ubiquity of such interventions, there remains incredibly little qualitative work exploring how women actually utilise interventions to reshape their lives and wellbeing. Drawing on 9 focus groups discussions among 52 women who participated in the Women for Women International intervention in Afghanistan, an economic strengthening and social empowerment intervention, we explore processes of change. Data showed women learnt new skills around numeracy and animal husbandry; they perceived themselves to have become more respected within the household setting; they invested cash they received for intervention attendance in businesses, primarily their husbands or familys, and saved cash. Women did not, however, report their relationships to have been radically restructured. Rather women described incremental changes in their relationships within their household and used what they gained from the intervention to secure and sustain this. This conceptualisation of agency and empowerment reflects approaches to understanding agency, which move away from ‘action-oriented’ understandings, to ones that recognise ‘distributed agency’ as pathways to change through interventions.

‘I play with the baby so that people can see that I'm a man’: Young fathers' involvement in the first 1 000 days of a child's life in South Africa

ABSTRACT There is a growing focus on mens involvement in the first 1 000 days of a childs life (i.e. conception through to two years of age). Mens involvement is understood to improve child health and as a pathway to gender equality. We sought to understand the forms of care and support men provided during the first 1 000 days of a childs life in an urban informal settlement in Durban, South Africa. We conducted in-depth interviews with 20 men and 15 women and three focus groups with men to understand mens involvement. Men and women described multiple ways in which men were involved in care and support during the first 1 000 days and reasons supporting and hindering this. In contrast to much literature that situates mens involvement in care as intrinsically gender equitable, we argue that while men do become involved in care and support, it is not linked to a wider commitment to gender equity. Rather it bolsters a relatively conservative understanding of masculinity, linked to the establishment of a household. Where men do not become involved in care, this is linked to men seeking to retain a more youthful masculinity. We suggest interventions working with men to increase caregiving need to engage around transforming gender norms.

Sticks and Stones Will Break My Bones but Words Will Always Hurt Me

Abstract Emotional abuse is a highly neglected part of dating violence. It is commonly measured in scales, along with forms of controlling behavior, but there has been comparatively little theoretical work underpinning the development of measures, which makes it difficult to compare studies and settings about the prevalence of emotional dating violence. There is currently no widely accepted gold-standard measure. Data analysis strategies commonly do not consider the unique health impact of emotional dating violence, taking into account the substantial overlap with physical and sexual dating abuse. Where research has been done to separate these out, there findings point towards emotional violence being highly impactful on mental and physical health. This chapter illustrates this with analyses from South Africa. Adolescent dating violence is recognized to be strongly related to peer violence and thus expected to be associated with factors such as exposure to childhood trauma, coming from disrupted families, engaging in peer violence and, for men, upholding ideals of masculinity that are predicted on gender inequality and control and dominance over women. Moreover, most prevention interventions have not examined impact on emotional violence, nor considered if this might be differently impacted by an intervention from physical and sexual violence. Additional research is warranted.

PA 19-2-0610 Does employment in the formal sector protect women from intimate partner violence in the context of patriarchy? the case of garment workers in bangladesh

This paper assessed the magnitude of different types of intimate partner violence (IPV) and identified the correlates of IPV using cross-sectional survey data collected during September-December, 2016 from 800 female garment workers randomly selected from lists provided by eight garment factories in Dhaka, Bangladesh. The results reveal high levels of IPV experienced by the workers (physical=34%; sexual=43%; economic=35%, last 12 months). Logistic regression analyses show while 6 years or higher education reduced the likelihood of IPV, young age, having two or more children and education equal to or more than husband increased its likelihood. Financial factors such as ownership of savings and jewellery/household assets increased IPV likelihood, while ability of the worker to mobile resources in crisis reduced it. Middle income group also protected against economic IPV, while household food insecurity increased IPV likelihood. High acceptance of IPV and experience of non-partner sexual violence of the worker increased likelihood of IPV. Having a highly or moderately highly controlling husband predicted different types of IPV. Husband’s substance abuse and extramarital sex also predicted IPV. Work at a factory in the Export Processing Zone protected against IPV. The findings indicate that financial empowerment alone is not sufficient to protect workers from IPV. They support interventions that combine gender empowerment training for workers in the context of better factory working conditions. They also suggest that interventions would be more effective if working with men is included as a programme component.

PA 19-1-0606 Effect of intimate partner violence and workplace violence on depression of female garment workers in bangladesh

Rate of Intimate Partner Violence (IPV) is high (54%) in Bangladesh. Moreover, female garments workers reports higher rate of IPV and are vulnerable to different forms workplace violence (WPV). Experience of violence put women at increased risk of developing depressive symptoms which is related with low self-esteem, lower life satisfaction and lower productivity. However, effect of IPV and WPV on female garment workers mental health has not been studied yet in Bangladesh and the pathways through which these experience lead to development of depressive symptomatology remain unknown. This paper aims to address this gap using data from a cross sectional survey of female garment workers (n=800) conducted as baseline survey of HERrespect trial. We conducted descriptive analyses and structural equation modelling to explore the pathways. The findings shows rate of any IPV (69%) and WPV (73%) experienced or witnessed is high. Around 40% of the female workers reported depressive symptomatology. The pathways analysis shows that IPV contributed to depression through increased WPV, and work related stress; reduced life satisfaction, self-esteem, and general health. WPV was directly associated with higher depression. It also contributed to depression through work related stress, life satisfaction and general health. It also reveals that a worker’s ability to mobilize resources in crisis situation, however, increased self-esteem and life satisfaction; and reduced work related stress. The rate of IPV, WPV and depressive symptomatology is high among female garment workers; these experiences of violence adversely impact their mental health through various paths. Experience of violence increased work related stress and ultimately led to development of depression, which may reduce productivity. Thus, violence incurs cost at individual, family and the garment sector levels. The findings suggest that programmes to reduce IPV and WPV and promote women’s empowerment would improve women’s mental health through enhanced self-esteem, life satisfaction and productivity.

Conceptualisations of fatherhood and socio-contextual dynamics influencing father involvement in informal settlements in Durban, South Africa

Abstract Many men living in informal settlements are unemployed and many do not live with their children. Nevertheless, these men can play a critical role in their children’s lives. In this paper, we explore the extent to which fathers in informal settlements manage or aspire to do this. We explore how they appreciate the social and familial role of “the father” and how they seek to translate these ideas into actions. Findings are based on three FGDs and 19 IDIs with young men in two informal settlements in South Africa. In this setting, father involvement is predicated on financial provision, yet lack of economic opportunities for men condemns them to the undesirable status of “failed fathers.” Men’s involvement in childcare is contested with some men supporting father involvement that goes beyond financial provision. Notions of traditional masculinity, praise and recognition by community, and the view that looking after your own child is tantamount to looking after your own future, are factors that enhance father involvement. Unemployment or precarious work, alcohol abuse, gender ideologies, and maternal and cultural gatekeeping are socio-contextual dynamics that undermine father involvement. For interventions to be effective in promoting father involvement, they should address critical context-specific issues.

P4.115 High uptake of effective expedited partner therapy among young women with sti and their partners in south africa

Introduction Expedited Partner Therapy (EPT) for STIs delivered by the index case or through pharmacies has been implemented in some settings in the US. In South Africa, partner notification through the provision of a contact card to the patient reminding the partner to seek treatment has been unsuccessful (partner treatment rates of 17%). Here, we explored the feasibility and acceptability of index case delivered EPT among young women in a high HIV incidence setting. Methods HIV negative women, aged 18–40 years were screened for chlamydia, gonorrhoea (Xpert CT/NG) and trichomonas (OSOM) at an urban primary health care clinic. Women with STIs were treated with stat doses of antibiotics and were offered EPT packs, which included medication, condoms and an information leaflet for the current partner(s). An EPT questionnaire was administered telephonically one week later, and women were reviewed in clinic after 6 and 12 weeks. Results: A total of 267 women, median age 23 (IQR 21–27), were screened and 63 (23.6%) were diagnosed with a STI. Of these, 62/63 (98.4%) were offered and 54/62 (87.1%) accepted EPT for their regular partner. Two women chose EPT for one additional casual partner. At telephonic follow-up 47/54 (87.0%) stated that they had successfully delivered EPT, i.e. the partner ingested the medication either observed 41/54 (75.9%) or unobserved 6/54 (11.1%). Only five women (9.2%) still had to deliver EPT and one partner refused. Some women reported that they (17.5%) or their partners (4.8%) experienced minor drug side effects consistent with antibiotic profiles, but no allergic reactions or social harms were reported. Of the first 53 women completing follow up reinfection rates were lower amongst women receiving EPT (1/47, 2.1%) compared to those not receiving EPT (2/6, 33.3%), p=0.031. Conclusion EPT uptake among young South African women and their partners was high and could play an important role in reducing reinfection rates and HIV risk. Larger studies should evaluate the feasibility of implementing this strategy at population level. Support: This work was co-funded by the South African Medical Research Council and the NIH (AI116759)