Nata Duvvury

Impact of Stepping Stones on incidence of HIV and HSV-2 and sexual behaviour in rural South Africa: cluster randomised controlled trial

Objective To assess the impact of Stepping Stones, a HIV prevention programme, on incidence of HIV and herpes simplex type 2 (HSV-2) and sexual behaviour. Design Cluster randomised controlled trial. Setting 70 villages (clusters) in the Eastern Cape province of South Africa. Participants 1360 men and 1416 women aged 15-26 years, who were mostly attending schools. Intervention Stepping Stones, a 50 hour programme, aims to improve sexual health by using participatory learning approaches to build knowledge, risk awareness, and communication skills and to stimulate critical reflection. Villages were randomised to receive either this or a three hour intervention on HIV and safer sex. Interviewers administered questionnaires at baseline and 12 and 24 months and blood was tested for HIV and HSV-2. Main outcome measures Primary outcome measure: incidence of HIV. Other outcomes: incidence of HSV-2, unwanted pregnancy, reported sexual practices, depression, and substance misuse. Results There was no evidence that Stepping Stones lowered the incidence of HIV (adjusted incidence rate ratio 0.95, 95% confidence interval 0.67 to 1.35). The programme was associated with a reduction of about 33% in the incidence of HSV-2 (0.67, 0.46 to 0.97; P=0.036)—that is, Stepping Stones reduced the number of new HSV-2 infections over a two year period by 34.9 (1.6 to 68.2) per 1000 people exposed. Stepping Stones significantly improved a number of reported risk behaviours in men, with a lower proportion of men reporting perpetration of intimate partner violence across two years of follow-up and less transactional sex and problem drinking at 12 months. In women desired behaviour changes were not reported and those in the Stepping Stones programme reported more transactional sex at 12 months. Conclusion Stepping Stones did not reduce incidence of HIV but had an impact on several risk factors for HIV—notably, HSV-2 and perpetration of intimate partner violence. Trial Registration Clinical Trials NCT00332878.

Perpetration of partner violence and HIV risk behaviour among young men in the rural Eastern Cape, South Africa

Objectives:To examine associations between the perpetration of intimate partner violence and HIV risk behaviour among young men in rural South Africa. Design:An analysis of baseline data from men enrolling in a randomized controlled trial of the behavioural intervention, Stepping Stones. Methods:Structured interviews with 1275 sexually experienced men aged 15–26 years from 70 villages in the rural Eastern Cape. Participants were asked about the type, frequency, and timing of violence against female partners, as well as a range of questions about HIV risk behaviours. Results:A total of 31.8% of men reported the perpetration of physical or sexual violence against female main partners. Perpetration was correlated with higher numbers of past year and lifetime sexual partners, more recent intercourse, and a greater likelihood of reporting casual sex partners, problematic substance use, sexual assault of non-partners, and transactional sex. Men who reported both physical and sexual violence against a partner, perpetration both before and within the past 12 months, or more than one episode of perpetration reported significantly higher levels of HIV risk behaviour than men who reported less severe or less frequent perpetration of violence. Conclusion:Young men who perpetrate partner violence engage in significantly higher levels of HIV risk behaviour than non-perpetrators, and more severe violence is associated with higher levels of risky behaviour. HIV prevention interventions must explicitly address the links between the perpetration of intimate partner violence and HIV risk behaviour among men, as well as the underlying gender and power dynamics that contribute to both.

A cluster randomized-controlled trial to determine the effectiveness of Stepping Stones in preventing HIV infections and promoting safer sexual behaviour amongst youth in the rural Eastern Cape, South Africa: trial design, methods and baseline findings

Objective  To describe the study design, methods and baseline findings of a behavioural intervention trial aimed at reducing HIV incidence.

Physical spousal violence against women in India: Some risk factors.

Domestic spousal violence against women in developing countries like India, is now beginning to be recognized as a widespread health problem impeding development. This study aimed to explore the risk and protective factors for lifetime spousal physical violence. A cross-sectional household survey was carried out in rural, urban and urban-slum areas across seven sites in India, among women aged 15-49 years, living with a child less than 18 years of age. The sample was selected using the probability proportionate to size method. Trained field workers administered a structured questionnaire to elicit information on spousal physical violence. The main hypothesized variables were social support, witnessed father beating mother and experience of harsh physical violence during childhood, alcohol abuse by spouse and socioeconomic variables. The outcome variables included three physical violence behaviours of hit, kick and beat. Odds ratios were calculated for risk and protective factors of violence using logistic regression. Of 9938 women surveyed, 26% reported experiencing spousal physical violence during the lifetime of their marriage. Adjusted odds ratios calculated using multiple logistic regression analysis suggest that women whose husbands regularly consumed alcohol (OR 5.6; 95% CI 4.7-6.6); who experienced dowry harassment (OR 3.2; 95% CI 2.7-3.8); had reported experiencing harsh physical punishment during childhood (OR 1.6; 95% CI 1.4-1.8) and had witnessed their fathers beat their mothers (OR 1.9; 95% CI 1.6-2.1), were at increased risk of spousal physical violence (beat, hit and kick). Higher socioeconomic status and good social support acted as protective buffers against spousal physical violence. The findings provide compelling evidence of the potential risk factors for spousal physical violence, which in turn could help in planning interventions.

The health-related impacts and costs of violence against women and girls on survivors, households and communities in Ghana

Past research on violence in Ghana primarily discusses domestic violence and some types of sexual violence, but lacks a comprehensive analysis of violence against women and girls (VAWG) and its wider costs and impacts. Our study on the social costs of VAWG is a unique contribution, which aims to fill that gap. Through indepth interviews (IDIs) and focus group discussions (FGDs) with adult women and men, we explored the health impact of VAWG and the resulting social and economic consequences on survivors, their families and their communities. The research, which took place in the Eastern, Central, and Greater Accra regions of Ghana, points to several physical and mental health outcomes among survivors including physical injuries and disability, as well as impacts on mental health such as anxiety and suicidal ideation. Many VAWG survivors also experience stigma and social isolation. Our findings also reveal that survivors’ families can bear various social and economic costs. Lack of public and private service provision and shelters for survivors heighten these impacts. Without institutional support for survivors, families and communities absorb these costs of VAWG.

Erosion of pension rights: Experiences of older women in Ireland

The recent economic crisis of 2008 and the fragility of government revenues sharply illuminated the contested nature of pension rights in Europe. The crisis intensified calls for an overhaul of pen...

Sexual violence, masculinity, and the journey of recovery.

Sexual violence has been recognized as one of the most frequent forms of lived trauma worldwide (World Health Organization, 2013). Given their predominance as survivors, women have been the almost exclusive focus of research and support in this area to date. However, the growing number of studies exploring the sexual abuse, sexual assault and rape of boys and men has broadened the discourse around sexual violence and gender identity. Although the profound consequences are common to survivors regardless of gender, it is evident that particular aspects are connected to the manner in which the trauma is processed and expressed. There is a dearth of evidence on the experiences of men who seek professional help, such as counseling, nonetheless. Given the increasing number of male survivors accessing Irish Rape Crisis Centres (RCCs; Rape Crisis Network Ireland, 2015), the need for counselors to have knowledge of gender relevant interventions is of vital importance. In this article, we explore how norms of masculinity influence the recovery process in the context of RCC counseling in the Republic of Ireland. The findings enhance our understanding of the gendered nature of healing and have important implications for practice.

The Macroeconomic Loss due to Violence Against Women: The Case of Vietnam

ABSTRACT Violence against women (VAW) is now acknowledged as a global problem with substantial economic costs. However, the current estimates of costs in the literature provide the aggregate loss of income, but not the macroeconomic loss in terms of output and demand insofar as they fail to consider the structural interlinkages of the economy. Focusing on Vietnam, this study proposes an approach based on the social accounting matrix (SAM) to estimate the macroeconomic loss due to violence. Using Vietnam’s 2011 SAM, the study estimates the income and multiplier loss due to VAW. From a policy point of view, the study argues that the macroeconomic loss due to VAW renders a permanent invisible leakage to the circular flow that can potentially destabilize, weaken, or neutralize the positive gains from government expenditure on welfare programs.