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Effect Of A Structural Intervention For The Prevention Of Intimate-partner Violence And HIV In Rural South Africa: A Cluster Randomised Trial

P. Pronyk, J. Hargreaves, J. Kim, Linda Morison, J. D. Porter
Published 2006 · Medicine

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BACKGROUND HIV infection and intimate-partner violence share a common risk environment in much of southern Africa. The aim of the Intervention with Microfinance for AIDS and Gender Equity (IMAGE) study was to assess a structural intervention that combined a microfinance programme with a gender and HIV training curriculum. METHODS Villages in the rural Limpopo province of South Africa were pair-matched and randomly allocated to receive the intervention at study onset (intervention group, n=4) or 3 years later (comparison group, n=4). Loans were provided to poor women who enrolled in the intervention group. A participatory learning and action curriculum was integrated into loan meetings, which took place every 2 weeks. Both arms of the trial were divided into three groups: direct programme participants or matched controls (cohort one), randomly selected 14-35-year-old household co-residents (cohort two), and randomly selected community members (cohort three). Primary outcomes were experience of intimate-partner violence--either physical or sexual--in the past 12 months by a spouse or other sexual intimate (cohort one), unprotected sexual intercourse at last occurrence with a non-spousal partner in the past 12 months (cohorts two and three), and HIV incidence (cohort three). Analyses were done on a per-protocol basis. This trial is registered with ClinicalTrials.gov, number NCT00242957. FINDINGS In cohort one, experience of intimate-partner violence was reduced by 55% (adjusted risk ratio [aRR] 0.45, 95% CI 0.23-0.91; adjusted risk difference -7.3%, -16.2 to 1.5). The intervention did not affect the rate of unprotected sexual intercourse with a non-spousal partner in cohort two (aRR 1.02, 0.85-1.23), and there was no effect on the rate of unprotected sexual intercourse at last occurrence with a non-spousal partner (0.89, 0.66-1.19) or HIV incidence (1.06, 0.66-1.69) in cohort three. INTERPRETATION A combined microfinance and training intervention can lead to reductions in levels of intimate-partner violence in programme participants. Social and economic development interventions have the potential to alter risk environments for HIV and intimate-partner violence in southern Africa.
This paper references
10.1007/s11524-005-9007-4
Structural Interventions: Concepts, Challenges and Opportunities for Research
K. Blankenship (2005)
10.1016/S0277-9536(01)00294-5
Risk factors for domestic violence: findings from a South African cross-sectional study.
R. Jewkes (2002)
10.1038/SCIENTIFICAMERICAN1199-114
The Grameen Bank.
M. Yunus (1999)
10.1146/ANNUREV.PUBLHEALTH.19.1.379
Implications of the results of community intervention trials.
G. Sorensen (1998)
Pathways out of poverty : innovations in microfinance for the poorest families
S. Daley-Harris (2002)
10.1016/J.SOCSCIMED.2006.03.026
Should structural interventions be evaluated using RCTs? The case of HIV prevention.
C. Bonell (2006)
10.5860/choice.38-4585
Microfinance Systems: Designing Quality Financial Services for the Poor
G. Wright (2000)
Highly prevalent circular migration: Households, mobility and economic status in rural South Africa
M. Collinson (2003)
Guidelines for microfinance impact assessments
C Barnes (1999)
10.1016/S0190-9622(96)90335-7
Impact of improved treatment of sexually transmitted diseases on HIV infection in rural Tanzania: randomised controlled trial: Grosskurth J, Mosha F, Todd J, et al. Lancet 1995;346:530–536
K. Tomecki (1996)
10.1016/S0140-6736(04)17109-2
Preventing HIV/AIDS through poverty reduction: the only sustainable solution?
Lynda Fenton (2004)
10.1136/bmj.324.7331.183
How men's power over women fuels the HIV epidemic
G. R. Gupta (2002)
10.1016/S0140-6736(95)91380-7
Impact of improved treatment of sexually transmitted diseases on HIV infection in rural Tanzania: randomised controlled trial
H. Grosskurth (1995)
Department of Tropical Hygiene and Public Health, Im Neuenheimer Feld 324, 69120 Heidelberg
10.1136/bmj.326.7403.1384
Back to basics in HIV prevention: focus on exposure
E. Pisani (2003)
Social capital assessment
A Krishna (1999)
10.2307/20111887
The Economics of Microfinance
B. Armendáriz (2005)
10.1016/S0140-6736(04)16098-4
Gender-based violence, relationship power, and risk of HIV infection in women attending antenatal clinics in South Africa
K. Dunkle (2004)
10.1097/00002030-200006001-00001
Enriching the mix: incorporating structural factors into HIV prevention.
E. Sumartojo (2000)
Multiple levels of analysis and intervention in HIV prevention science: exemplars and directions for new research.
C. R. Waldo (2000)
Microfinance and HIV prevention—perspectives and emerging lessons from a community randomized trial in rural South Africa
PM Pronyk (2005)
Effective communication between partners: AIDS and risk reduction for women
P Mane (1994)
Who takes credit? Power and control over loan use in rural credit programmes in Bangladesh
AM Goetz (1996)
Nelson Mandela / HSRC study of HIV/AIDS. South African national HIV prevalence behavioural risks and mass media. Household survey 2002.
O. Shisana (2002)
Questionário Integrado para Medir Capital Social (QI-MCS) (Integrated Questionnaire for the Measurement of Social Capital) (SC-IQ)
Banco Mundial (2003)
10.1007/0-306-47518-9_2
Structural barriers and facilitators in HIV prevention: a review of international research
R. Parker (2000)
10.1093/ije/28.2.319
Simple sample size calculation for cluster-randomized trials.
R. Hayes (1999)
Putting women first : ethical and safety recommendations for research on domestic violence against women
C. García-Moreno (2001)
10.3362/0957-1329.2005.030
Microfinance and HIV prevention - Emerging lessons from rural South Africa
Pronyk (2005)
10.1016/J.JINTECO.2006.02.001
The economics of microfinance
María Soledad Martínez Pería (2006)
10.1016/J.SOCSCIMED.2004.12.024
The social structural production of HIV risk among injecting drug users.
T. Rhodes (2005)
10.1079/PHN2001320
Prevalence of household food poverty in South Africa: results from a large, nationally representative survey.
K. Charlton (2002)
Measuring the Impact of Microfi nance: Taking Stock of What We Know
Nathanael Goldberg (2005)
10.1093/IJE/DYI150
Season of death and birth predict patterns of mortality in Burkina Faso.
G. Kynast-Wolf (2006)
may not be properly assessed with the conventional bulk soil analysis. Publication Types: Research Support, Non-U.S. Gov't PMID: 16236406 [PubMed -indexed for MEDLINE
(2005)
Assessing the Relative Poverty of Microfinance Clients
C. Henry (2000)
Sociocultural interventions at the community level.
S. Friedman (1997)
Violence against women: its importance for HIV/AIDS.
C. García-Moreno (2000)
Effectiveness of HIV prevention interventions in developing countries.
M. Merson (2000)
10.1093/IJE/28.1.10
Evaluation designs for adequacy, plausibility and probability of public health programme performance and impact.
J. P. Habicht (1999)
10.1093/HEAPOL/17.1.106
Measuring social capital within health surveys: key issues.
T. Harpham (2002)
Income and assets as impact indicators
PD Little (1997)
Housing, and household access to services and facilities
J. Lestrade-Jefferis (2000)
10.1163/2210-7975_hrd-9824-0090
Ending violence against women.
An oxfam Guide (1999)
WHO Multi-country Study on Women's Health and Domestic Violence against Women: Initial Results on Prevalence, Health Outcomes and Women's Responses
C. García-Moreno (2008)
Empowering Women Through Microfinance
Susy Cheston (2001)
10.1016/0305-750X(95)00124-U
Who takes the credit? Gender, power, and control over loan use in rural credit programs in Bangladesh
A. Goetz (1996)
10.2307/2138085
Credit programs, women's empowerment, and contraceptive use in rural Bangladesh.
S. Schuler (1994)



This paper is referenced by
Community-based approaches to intimate partner violence : a review of evidence and essential steps to adaptation
Manuel Contreras-Urbina (2016)
10.1186/1471-2458-11-755
An integrated structural intervention to reduce vulnerability to HIV and sexually transmitted infections among female sex workers in Karnataka state, south India
Vandana Gurnani (2011)
10.2989/16085906.2011.637725
HIV prevention in the world of work in sub-Saharan Africa: research and practice
G. George (2011)
10.2147/SAR.S45961
The relevance of social contexts and social action in reducing substance use and victimization among women participating in an HIV prevention intervention in Cape Town, South Africa
E. Reed (2013)
10.1007/s10995-016-1921-4
Access to Money and Relation to Women’s Use of Family Planning Methods Among Young Married Women in Rural India
E. Reed (2016)
10.1186/1752-1505-7-13
Development of a screening tool to identify female survivors of gender-based violence in a humanitarian setting: qualitative evidence from research among refugees in Ethiopia
A. Wirtz (2013)
10.1186/1471-2458-13-288
Poor mental health in Ghana: who is at risk?
H. Sipsma (2013)
Man tasol I ken senisim man: Only men can change men to address gender based violence in Bougainville
N. P. Patel (2020)
Gender and AI DS: time to act
Alan Greiga (2008)
10.2139/ssrn.3235642
The Impact of an Intervention to Prevent Intimate Partner Violence Against Women in Tanzania: Findings from the Maisha Cluster Randomised Controlled Trial
S. Kapiga (2018)
10.1177/0886260518800318
Violence and Economic Empowerment of Women in Pakistan: An Empirical Investigation.
Javeria Khalid (2018)
10.2139/ssrn.2504579
Do Improved Property Rights Decrease Violence Against Women in India?
S. Amaral (2014)
10.1186/s12889-016-2888-1
The Adolescent Girls Initiative-Kenya (AGI-K): study protocol
K. Austrian (2016)
10.1093/WBRO/LKS010
The Role of Men in the Economic and Social Development of Women: Implications for Gender Equality
L. Farré (2012)
10.1136/bmjgh-2019-001972
Promoting women’s and children’s health through community groups in low-income and middle-income countries: a mixed-methods systematic review of mechanisms, enablers and barriers
L. Gram (2019)
The effect of HIV prevention products on incentives to supply unprotected commercial sex in South Africa
M. Quaife (2017)
10.1097/QAI.0000000000001207
Community Mobilization for HIV Testing Uptake: Results From a Community Randomized Trial of a Theory-Based Intervention in Rural South Africa
S. Lippman (2017)
10.1016/J.IDC.2007.03.005
The future of HIV prevention: control of sexually transmitted infections and circumcision interventions.
V. Sahasrabuddhe (2007)
Changing discriminatory norms affecting adolescent girls through communications activities: Insights for policy and practice from an evidence review
R. Marcus (2014)
10.1080/10852351003640849
Findings from SHAZ!: A Feasibility Study of a Microcredit and Life-Skills HIV Prevention Intervention to Reduce Risk Among Adolescent Female Orphans in Zimbabwe
Megan S. Dunbar (2010)
10.1161/CIRCULATIONAHA.108.768895
Quality Improvement: Science and Action
H. Ting (2009)
10.1002/14651858.CD008330.PUB2
Economic interventions for prevention of HIV risk and HIV infection
Ifeanyi R Ezedunukwe (2016)
10.1371/journal.pone.0153907
Community Dialogue to Shift Social Norms and Enable Family Planning: An Evaluation of the Family Planning Results Initiative in Kenya
Christina Wegs (2016)
10.2105/AJPH.2016.303107
Social Support, Sexual Violence, and Transactional Sex Among Female Transnational Migrants to South Africa.
Margaret Giorgio (2016)
10.1186/1745-6215-14-274
HIV prevention in favour of the choice-disabled in southern Africa: study protocol for a randomised controlled trial
N. Andersson (2013)
10.1136/bmjgh-2018-001109
Changing the norms that drive intimate partner violence: findings from a cluster randomised trial on what predisposes bystanders to take action in Kampala, Uganda
T. Abramsky (2018)
10.1007/s10461-010-9860-3
The Role of a Microfinance Program on HIV Risk Behavior Among Haitian Women
M. Rosenberg (2010)
10.1080/17441692.2013.768686
Community understandings of and responses to gender equality and empowerment in Rakai, Uganda
Margo Mullinax (2013)
10.1177/1077801218802640
“If He’s Abusing You . . . the Baby Is Going to Be Affected”: HIV-Positive Pregnant Women’s Experiences of Intimate Partner Violence
A. Marais (2019)
Hoping or discounting the future : a new perspective on the transmission of HIV/AIDS
T. Barnett (2008)
Can micro-credit empower HIV+ women? An exploratory case study in Northern Vietnam
P. Oosterhoff (2008)
trial in Kampala , Uganda
T. Abramsky (2019)
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