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Pichon M, Buller AM, Gimunta V, Rutenge O, Thiaw Y, Sono R, Howard-Merrill L. Qualitative evaluation of an edutainment intervention to prevent age-disparate transactional sex in Tanzania: Changes in educational aspirations and gender equitable attitudes towards work. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002527. [PMID: 38568918 PMCID: PMC10990206 DOI: 10.1371/journal.pgph.0002527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 03/13/2024] [Indexed: 04/05/2024]
Abstract
Age-disparate transactional sex is a major contributor to the disproportionate rates of HIV experienced by adolescent girls in sub-Saharan Africa, and a key driver of unintended adolescent pregnancy. This paper comprises one element of the impact evaluation of the Learning Initiative on Norms, Exploitation and Abuse (LINEA) radio drama intervention to prevent age-disparate transactional sex. It provides new insights into the radio drama's influence on distal drivers of age-disparate transactional sex identified in formative research: girls' own educational aspirations, and gendered attitudes towards work. The intervention, which targeted adolescent girls and their caregivers in the Shinyanga Region of Tanzania, uses an edutainment approach to prevent transactional sex between girls aged 12-16 years and men at least 5-10 years older. We distributed the 39-episode radio drama on USB flash drives to 331 households and conducted longitudinal in-depth interviews with 59 participants. We conducted a thematic analysis of endline (December 2021) transcripts from 23 girls, 18 women caregivers, and 18 men caregivers of girls (n = 59), and midline (November 2021) transcripts from a sub-sample of these participants: 16 girls, 16 women and 13 men (n = 45). Findings suggest the radio drama created an enabling environment for preventing age-disparate transactional sex by increasing girls' motivation to focus on their studies and remain in school. There was also strong evidence of increased gender-equitable attitudes about work among girls and women and men caregivers. These supported women joining the workforce in positions traditionally reserved for men and challenging the male provider role. Our findings suggest that the LINEA radio drama can supplement interventions that address structural drivers of age-disparate transactional sex. The radio drama may also have impacts beyond preventing age-disparate transactional sex, such as reducing girls' HIV morbidity and mortality, and challenging attitudes that promote sexual and gender-based violence to foster more gender-equitable communities across Tanzania.
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Affiliation(s)
- Marjorie Pichon
- Gender Violence & Health Centre, Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Ana Maria Buller
- Gender Violence & Health Centre, Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | | | - Oscar Rutenge
- Tanganyika Christian Refugee Service, Dar es Salaam, United Republic of Tanzania
| | - Yandé Thiaw
- Gender Violence & Health Centre, Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Revocatus Sono
- Amani Girls Organization, Mwanza, United Republic of Tanzania
| | - Lottie Howard-Merrill
- Department of Education, Practice and Society, Institute of Education, University College London, London, United Kingdom
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Johnson SL, Rasmussen JM, Mansoor M, Ibrahim H, Rono W, Goel P, Vissoci JRN, Von Isenburg M, Puffer ES. Correlates of Intimate Partner Violence Victimization and Perpetration in Adolescents and Young Adults in Sub-Saharan Africa: A Systematic Review. TRAUMA, VIOLENCE & ABUSE 2024; 25:1168-1183. [PMID: 37226506 DOI: 10.1177/15248380231173428] [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: 05/26/2023]
Abstract
Intimate partner violence (IPV) is a global public health crisis with long-term adverse consequences for both victims and perpetrators. Patterns of violence often begin during adolescence, yet most interventions target adult relationships. A systematic review was conducted to identify correlates of IPV victimization and perpetration among adolescents and young adults in sub-Saharan Africa (SSA). Eligible studies included participants 10 to 24 years old, took place in SSA, and tested a statistical association between a correlate and an IPV outcome. Correlates were defined as any condition or characteristic associated with statistically significant increased or decreased risk of IPV victimization or perpetration. PsycInfo, PubMed, Embase, and African Index Medicus were searched and included studies published between January 1, 2000 and February 4, 2022. The search resulted in 3,384 original studies, of which 55 met inclusion criteria and were analyzed. Correlates were first qualitatively synthesized by developmental period (e.g., early adolescence, older adolescence, and young adulthood) and then organized in a conceptual framework by correlate type (e.g., socio-demographic; health, behavior, and attitudes; relational; or contextual). Over two decades of literature reveals variability in evidence by developmental period but also substantial overlap in the correlates of victimization and perpetration. This review identifies multiple points for intervention and results suggest the urgent need for earlier, developmentally appropriate prevention efforts among younger adolescents as well as combined approaches that target both victimization and perpetration of IPV.
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Affiliation(s)
- Savannah L Johnson
- Department of Psychology and Neuroscience, Duke University, Durham, NC, USA
- Duke Global Health Institute, Durham, NC, USA
| | - Justin M Rasmussen
- Department of Psychology and Neuroscience, Duke University, Durham, NC, USA
- Duke Global Health Institute, Durham, NC, USA
| | | | - Hawo Ibrahim
- Department of Psychology and Neuroscience, Duke University, Durham, NC, USA
| | - Wilter Rono
- Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Pari Goel
- Department of Psychology and Neuroscience, Duke University, Durham, NC, USA
| | - João R N Vissoci
- Duke Global Health Institute, Durham, NC, USA
- Department of Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Megan Von Isenburg
- Duke University Medical Center Library, Duke University Medical Center Archives, Durham, NC, USA
| | - Eve S Puffer
- Department of Psychology and Neuroscience, Duke University, Durham, NC, USA
- Duke Global Health Institute, Durham, NC, USA
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Mathur S, Mahapatra B, Mishra R, Heck CJ, Mbizvo M. Which Intervention Synergies Maximize AGYW's HIV Outcomes? A Classification and Regression Tree Analysis of Layered HIV Prevention Programming. J Acquir Immune Defic Syndr 2023; 94:317-324. [PMID: 37884052 PMCID: PMC10617659 DOI: 10.1097/qai.0000000000003289] [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: 02/13/2023] [Accepted: 08/04/2023] [Indexed: 10/28/2023]
Abstract
INTRODUCTION Intersecting behavioral, social, and structural factors increase adolescent girls' (AG) and young women's (YW) HIV vulnerability. Yet, understanding of optimal intervention synergies remains limited. We identified intervention combinations that statistically maximized reductions in AGYW's HIV-related risk. METHODS Using data collected in 2018 with Zambian AG (n = 487, aged 15-19 years) and YW (n = 505, aged 20-25 years) after 12-14 months exposure to Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe (multisectoral HIV program), we used classification and regression trees to explore relationships between interventions (safe space/social asset building [SAB] and provision of/linkage to youth-friendly health services [YFHS], education social protection [Educ], economic social protection [Econ]) and HIV-related outcomes (HIV testing, consistent condom use, transactional sex, and sexual violence experience from partners and nonpartners). RESULTS Overall, 59.9% completed SAB and 81.5%, 35.4%, and 29.6% received YHFS, Educ, and Econ, respectively. For AG, HIV testing improved (from 73% to 83%) with exposure to all interventions, condom use improved with Econ (from 33% to 46%), transactional sex reduced with SAB + Educ, and sexual violence from partners and nonpartners reduced with Educ and SAB, respectively. For YW, HIV testing increased with Educ (from 77% to 91%), condom use increased with SAB + YFHS (from 36% to 52%), transactional sex reduced with combinations of all interventions, and sexual violence from partners reduced with YFHS and from nonpartners with SAB + Econ. CONCLUSIONS Tailored interventions might be more effective than uniform combination intervention packages in reducing AGYW's HIV risk. AG benefitted most from SAB and/or Educ while YFHS, Educ, and/or SAB reduced YW's HIV-related risk. Educational and asset-building interventions could have the greatest impact on AGYW's HIV risk.
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Affiliation(s)
| | | | - Raman Mishra
- College of Health Science, Korea University, Seoul, South Korea
| | - Craig J. Heck
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
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Pichon M, Carter DJ, Howard-Merrill L, Sono R, Gimunta V, Rutenge O, Thiaw Y, Stoebenau K, Perrin N, Buller AM. A mixed-methods, exploratory, quasi-experimental evaluation of a radio drama intervention to prevent age-disparate transactional sex in Tanzania. FRONTIERS IN REPRODUCTIVE HEALTH 2022; 4:1000853. [PMID: 36531443 PMCID: PMC9755860 DOI: 10.3389/frph.2022.1000853] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 11/04/2022] [Indexed: 09/27/2023] Open
Abstract
INTRODUCTION Age-disparate transactional sex (ADTS) is associated with HIV, unintended pregnancy, school dropout and violence, yet few interventions have successfully prevented it, and none have set ADTS prevention as their primary outcome. This exploratory evaluation aimed to assess indications of change after exposure to the Learning Initiative on Norms, Exploitation and Abuse (LINEA) intervention, a mass-media, gender-transformative social norms intervention aimed at preventing ADTS in Tanzania. METHODS In a condensed implementation 331 participants were instructed to listen to the LINEA radio drama over seven weeks, and 60 were randomly allocated to household discussion sessions about content. In-depth interviews (n = 81) from girls aged 12-16 years, and women and men caregivers were collected at baseline (September 2021), midline (November) and endline (December 2021). Surveys were conducted (n = 120) at baseline and endline using the Norms and Attitudes on ADTS Scale (NAATSS) and the Gender Roles and Male Provision Expectations (GRMPE) scale. Interviews were thematically analyzed using a framework approach. Age-stratified linear regression models adjusted for baseline scores were used to measure association between the intervention and endline scale scores. RESULTS Longitudinal data were available from 59 qualitative (73%) and 95 quantitative participants (79%). Qualitative evidence revealed the drama facilitated family conversations about adolescent challenges, allowing caregivers to advise daughters. Some girls gained confidence to refuse men's gifts, learning that accepting them could necessitate sexual reciprocation. Some caregivers felt increased responsibility for supporting girls in the community to avoid ADTS. Blame for ADTS shifted for some from girls to men, suggesting increased understanding of inequitable power dynamics and reductions in victim blaming. Marginal quantitative evidence revealed that highly exposed girls had improved gender equitable beliefs on the GRMPE (β = -6.26; 95% CI: -12.94, 0.42). Moderately exposed men had increased gender inequitable norms on the NAATSS subscale (β = 0.42 95% CI: 0.05, 0.79), but there was no effect in highly exposed men. CONCLUSIONS Given the small sample results should be interpreted cautiously. Our initial findings indicate high engagement with the LINEA intervention shows promise in shifting knowledge, behaviors, and attitudes, beliefs and social norms driving ADTS in Shinyanga, Tanzania, supporting a robust impact evaluation.
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Affiliation(s)
- Marjorie Pichon
- Gender Violence & Health Centre, Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Daniel J Carter
- Gender Violence & Health Centre, Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Lottie Howard-Merrill
- Department of Education, Practice and Society, Institute of Education, University College London, London, United Kingdom
| | - Revocatus Sono
- Adolescent Girls and Young Women Department, Amani Girls Home, Mwanza, United Republic of Tanzania
| | - Veronicah Gimunta
- Adolescent Girls and Young Women Department, Amani Girls Home, Mwanza, United Republic of Tanzania
| | - Oscar Rutenge
- Tanganyika Christian Refugee Service, Shinyanga Unit, United Republic of Tanzania
| | - Yandé Thiaw
- Gender Violence & Health Centre, Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Kirsten Stoebenau
- Department of Behavioral and Community Health, School of Public Health, University of Maryland, College Park, MD, United States
| | - Nancy Perrin
- Department of Behavioral and Community Health, Johns Hopkins School of Nursing, Baltimore, MD, United States
| | - Ana Maria Buller
- Gender Violence & Health Centre, Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, United Kingdom
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Mutumba M, Bhattacharya S, Ssewamala FM. Assessing the social patterning and magnitude of inequalities in sexual violence among young women in Uganda: Findings from 2016 demographic and health survey. Glob Public Health 2022; 17:2826-2840. [PMID: 35167776 DOI: 10.1080/17441692.2022.2037149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Sexual violence (SV) is a significant global public health problem. To develop effectively targeted interventions to prevent SV and allocate resources equitably requires identifying the most vulnerable groups and the magnitude of these social inequities. However, these data are currently lacking. Using the Uganda Demographic and Health Survey, we examined SV among all young women and ever-married young women. We conducted univariate and bivariate analyses to characterise the prevalence and social patterning of SV, and then utilised the World Health Organization Health Equity Assessment Toolkit (HEAT) to assess the magnitude of social inequities in SV. At the national level, 5.5% among all young women and 20.5% of ever-married young women had experienced SV. For all young women, the largest inequities in SV were based on sub-national region of residence. Among the ever-married young women, we found profound education, wealth and place-based inequities in SV, which favoured young women with higher education, in wealthier households, and within central regions of Uganda. Our findings suggest a need for regionally targeted multi-sectoral interventions that take into consideration that multiple intersecting social dimensions such as education, poverty and the safe built environment, to address young women's risk for SV.
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Affiliation(s)
- Massy Mutumba
- Department of Health Behavior & Biological Sciences, University of Michigan School of Nursing, Ann Arbor, MI, USA
| | | | - Fred M Ssewamala
- Brown School of Social Work, University of Washington at St. Louis, St. Louis, MO, USA
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Waidler J, Gilbert U, Mulokozi A, Palermo T. A "Plus" Model for Safe Transitions to Adulthood: Impacts of an Integrated Intervention Layered onto A National Social Protection Program on Sexual Behavior and Health Seeking among Tanzania's Youth. Stud Fam Plann 2022; 53:233-258. [PMID: 35315072 DOI: 10.1111/sifp.12190] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Poverty is a structural driver of risky sexual behaviors. While cash transfers can mitigate some of this risk, complementary interventions have been posited as a way to further reduce multidimensional vulnerability. We examine the impacts of a multicomponent intervention targeted to Tanzanian adolescents on their sexual behaviors and reproductive health. The intervention comprised livelihood and life skills training, mentoring, and health facilities' strengthening. Data come from a cluster randomized controlled trial, where one study arm received the intervention and the other was randomized to control, but both arms participated in a government cash transfer program. Among 1,933 adolescents interviewed over three rounds, we found increases in contraceptive and HIV knowledge. The program also increased health seeking and HIV testing among boys, but slightly reduced age at sexual debut among girls. There were no impacts on contraceptive use, number of sexual partners, or pregnancy. Findings support the value of an adolescent intervention, and the fact that it was delivered within a social protection platform suggests a potential for scalability. Additional efforts are required to delay sexual debut and reduce the number of sexual partners and pregnancy, possibly through addressing supply-side barriers and social norms, or through additional linkages to economic opportunities.
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Affiliation(s)
- Jennifer Waidler
- UNICEF Office of Research-Innocenti, Via degli Alfani 58 50121, Florence, Italy
| | - Ulrike Gilbert
- UNICEF Tanzania, Karume Road, Dar es Salaam, United Republic of Tanzania
| | - Aroldia Mulokozi
- Tanzania Commission for AIDS (TACAIDS), Dar es Salaam, United Republic of Tanzania
| | - Tia Palermo
- Department of Epidemiology at Environmental Health, University of New York at Buffalo, Buffalo, NY, 14214-8001, USA
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Mannell J, Lowe H, Brown L, Mukerji R, Devakumar D, Gram L, Jansen HAFM, Minckas N, Osrin D, Prost A, Shannon G, Vyas S. Risk factors for violence against women in high-prevalence settings: a mixed-methods systematic review and meta-synthesis. BMJ Glob Health 2022; 7:bmjgh-2021-007704. [PMID: 35296455 PMCID: PMC8928330 DOI: 10.1136/bmjgh-2021-007704] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 02/08/2022] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION Violence against women (VAW) affects one in three women globally. In some countries, women are at much higher risk. We examined risk factors for VAW in countries with the highest 12-month prevalence estimates of intimate partner violence (IPV) to develop understanding of this increased risk. METHODS For this systematic review, we searched PUBMED, CINAHL, PROQUEST (Middle East and North Africa; Latin America and Iberia; East and South Asia), Web of Science, EMBASE and PsycINFO (Ovid) for records published between 1 January 2000 and 1 January 2021 in English, French and Spanish. Included records used quantitative, qualitative, or mixed-methods, reported original data, had VAW as the main outcome, and focused on at least one of 23 countries in the highest quintile of prevalence figures for women's self-reported experiences of physical and/or sexual violence in the past 12 months. We used critical interpretive synthesis to develop a conceptual model for associations between identified risk factors and VAW. RESULTS Our search identified 12 044 records, of which 241 were included for analysis (2 80 360 women, 40 276 men, 274 key informants). Most studies were from Bangladesh (74), Uganda (72) and Tanzania (43). Several quantitative studies explored community-level/region-level socioeconomic status and education as risk factors, but associations with VAW were mixed. Although fewer in number and representing just one country, studies reported more consistent effects for community-level childhood exposure to violence and urban residence. Theoretical explanations for a country's high prevalence point to the importance of exposure to other forms of violence (armed conflict, witnessing parental violence, child abuse) and patriarchal social norms. CONCLUSION Available evidence suggests that heightened prevalence of VAW is not attributable to a single risk factor. Multilayered and area-level risk analyses are needed to ensure funding is appropriately targeted for countries where VAW is most pervasive. PROSPERO REGISTRATION NUMBER The review is registered with PROSPERO (CRD42020190147).
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Affiliation(s)
| | - Hattie Lowe
- Institute for Global Health, UCL, London, UK
| | - Laura Brown
- Institute for Global Health, UCL, London, UK
| | | | | | - Lu Gram
- Institute for Global Health, UCL, London, UK
| | | | | | - David Osrin
- Institute for Global Health, UCL, London, UK
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Mathur S, Heck CJ, Kishor Patel S, Okal J, Chipeta E, Mwapasa V, Chimwaza W, Musheke M, Mahapatra B, Pulerwitz J, Pilgrim N. Temporal shifts in HIV-related risk factors among cohorts of adolescent girls and young women enrolled in DREAMS programming: evidence from Kenya, Malawi and Zambia. BMJ Open 2022; 12:e047843. [PMID: 35105561 PMCID: PMC8808410 DOI: 10.1136/bmjopen-2020-047843] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
OBJECTIVES To assess temporal shifts in HIV risk factors among adolescent girls (AG, aged 15-19 years) and young women (YW, aged 20-24 years) in Kenya, Malawi and Zambia. DESIGN Prospective cohorts with two time points (Kenya: 2016/2017, 2018; Malawi: 2017, 2018; Zambia: 2016/2017, 2018) SETTING: Community-based programming. PARTICIPANTS 1247 AG (Kenya: 389, Malawi: 371, Zambia: 487) and 1628 YW (Kenya: 347, Malawi: 883, Zambia: 398) INTERVENTION: Determined, Resilient, Empowered, AIDS-free, Mentored and Safe (DREAMS), a multisectoral approach to reduce AGYW's HIV vulnerability by delivering a package of tailored, multilayered activities and services.Primary and secondary outcome measures: HIV testing, sexually transmitted infection (STI) symptom experience, number of sexual partners, condom use (consistently, at last sex), transactional sex, experience of physical violence (from intimate partners) and sexual violence (from intimate partners and strangers/non-partners). RESULTS Changes in HIV-related risk behaviours among DREAMS participants varied by age group and country. Among AG, HIV testing increased (Kenya and Zambia) and sexual violence from partners (in Kenya and Malawi) and non-partners (in Malawi) decreased. Among YW, HIV testing increased and STI experience decreased in Malawi; consistent condom use decreased in Kenya; transactional sex increased in Kenya and Zambia; and physical violence (in Malawi) and sexual violence from partners (in Kenya and Malawi) and non-partners (all three countries) decreased over time. CONCLUSIONS Improvements in HIV testing and reductions in experiences of sexual violence were coupled with variable shifts in HIV-related risk behaviours among DREAMS participants in Kenya, Malawi and Zambia. Additional consideration of AGYW's risk circumstances during key life transitions may be needed to address the risk heterogeneity among AG and YW across different contexts.
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Affiliation(s)
| | | | | | - Jerry Okal
- Population Council Kenya, Nairobi, Kenya
| | - Effie Chipeta
- Centre for Reproductive Health, University of Malawi College of Medicine, Blantyre, Southern Region, Malawi
| | - Victor Mwapasa
- Centre for Reproductive Health, University of Malawi College of Medicine, Blantyre, Southern Region, Malawi
| | - Wanangwa Chimwaza
- Centre for Reproductive Health, University of Malawi College of Medicine, Blantyre, Southern Region, Malawi
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Montiel Ishino FA, Rowan C, Ambikile JS, Conserve DF, Lopez D, Sabado-Liwag M, Williams F. Intimate partner violence and HIV testing during antenatal care: A latent class analysis to identify risk factors for HIV infection in mothers and their children in the United Republic of Tanzania. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000831. [PMID: 36962397 PMCID: PMC10021740 DOI: 10.1371/journal.pgph.0000831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 07/18/2022] [Indexed: 11/18/2022]
Abstract
Intimate partner violence has adverse effects on mother's overall health and prevention of mother to child HIV transmission. To identify and examine subgroups of mothers experiencing intimate partner violence and the likelihood of HIV testing during antenatal care, we conducted a latent class analysis using data from the Tanzania Demographic and Health Survey 2010 (N = 2,809). Intimate partner violence included mother's experiences with partners' controlling behaviors, as well as emotional, physical, and sexual violence. The outcome was mother's accepting HIV testing offered during their antenatal care visit. Covariates included mother's level of education, rural/urban residence, and prevention of mother to child HIV transmission talk during antenatal care visit. The latent class analysis indicated a three-class solution was the best model and identified the following profiles: mothers with no experience of intimate partner violence (61% of sample) with a 90.5% likelihood of HIV testing; mothers with moderate levels of intimate partner violence (26%) with an 84.7% likelihood of testing; and mothers with extreme levels of intimate partner violence (13%) with an 82% likelihood of testing. An auxiliary multinomial logistic regression with selected covariates was conducted to further differentiate IPV profiles, where mothers with extreme levels of intimate partner violence had 57% increased odds [95%CI:1.06-2.33, p = .023] of living in rural areas compared to mothers with no experience of intimate partner violence. Our person-centered methodological approach provided a novel model to understand the impact of multiple intimate partner violence risk factors on antenatal care HIV testing to identify mothers in need of interventions and their children at highest for parent to child HIV transmission. Our model allows person-centered interventional designs tailored for the most at-risk subgroups within a population.
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Affiliation(s)
- Francisco A Montiel Ishino
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, Maryland, United States of America
- Transdisciplinary Center for Health Equity Research, College of Education and Human Development, Texas A&M University, College Station, Texas, United States of America
| | - Claire Rowan
- Transdisciplinary Center for Health Equity Research, College of Education and Human Development, Texas A&M University, College Station, Texas, United States of America
| | - Joel Seme Ambikile
- School of Nursing, Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania
| | - Donaldson F Conserve
- Prevention and Community Health, Milken Institute School of Public Health, The George Washington University, Washington, District of Columbia, United States of America
| | - Diana Lopez
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Melanie Sabado-Liwag
- Department of Public Health, California State University, Los Angeles, Los Angeles, California, United States of America
| | - Faustine Williams
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, Maryland, United States of America
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Mtaita C, Likindikoki S, McGowan M, Mpembeni R, Safary E, Jahn A. Knowledge, Experience and Perception of Gender-Based Violence Health Services: A Mixed Methods Study on Adolescent Girls and Young Women in Tanzania. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:8575. [PMID: 34444324 PMCID: PMC8392576 DOI: 10.3390/ijerph18168575] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 08/11/2021] [Accepted: 08/11/2021] [Indexed: 12/03/2022]
Abstract
Many adolescent girls and young women (AGYW) experience gender-based violence (GBV) in Tanzania and only few seek GBV health services following violence. The objectives of our study are (1) to evaluate knowledge of gender-based violence among AGYW, (2) to explore their perceptions of and experiences with GBV health service quality and (3) to evaluate access to comprehensive GBV services. This study employed an explanatory, sequential mixed methods design in two districts of Dar es Salaam, Tanzania (Kinondoni and Temeke). A quantitative cross-sectional survey among AGYW (n = 403) between 15-24 years old was performed to assess their knowledge of GBV as well as perceptions of and experiences with GBV health services. The quantitative data was complemented by 20 semi-structured in-depth interviews with participants. Out of 403 study participants, more than three quarters (77.9%) had moderate to good knowledge of how GBV is defined and what constitutes gender-based violence. However, few participants (30.7%, n = 124) demonstrated knowledge of GBV health services offered at local health facilities. For example, only 10.7% (n = 43) of participants reported knowledge of forensic evidence collection. Additionally, of 374 participants (93% of total participants) who reported to have received GBV education sessions, only 66% accessed GBV health services (n = 247) and about half of these (52.7%, n = 130) were satisfied with these services. The study indicated that-despite good knowledge about what constituted GBV-knowledge about the roles and availability of GBV health services was limited and utilization of GBV health services remained low. Coordinated actions need to be strengthened to reach AGYW who remain unaware of GBV health services offered at health facilities by improving GBV service quality, bettering interventions aimed at reducing GBV among AGYW in Tanzania, and scaling-up integrated service models, such as GBV one-stop centers.
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Affiliation(s)
- Caroline Mtaita
- Heidelberg Institute of Global Health, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany; (M.M.); (E.S.); (A.J.)
| | - Samuel Likindikoki
- Department of Psychiatry and Mental Health, School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam 65001, Tanzania;
| | - Maureen McGowan
- Heidelberg Institute of Global Health, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany; (M.M.); (E.S.); (A.J.)
| | - Rose Mpembeni
- Department of Epidemiology, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam 65015, Tanzania;
| | - Elvis Safary
- Heidelberg Institute of Global Health, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany; (M.M.); (E.S.); (A.J.)
| | - Albrecht Jahn
- Heidelberg Institute of Global Health, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany; (M.M.); (E.S.); (A.J.)
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Vyas S. Exploring the Roles of Familial and Dating Relationship Violence and Sexual Assault on Adolescent Girls and Young Women's Risk of Partner Violence in Tanzania. Violence Against Women 2021; 28:1124-1138. [PMID: 34074176 DOI: 10.1177/10778012211014555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study explored the role of non-partner violence on adolescent girls and young women's (AGYW) risk of partner violence in Tanzania. Among currently partnered AGYW, 36.7% reported lifetime physical and/or sexual partner violence. Prevalence of parental punishment, dating relationship violence, and sexual assault measured 3.0%, 2.5%, and 2.9%, respectively. There is evidence that exposure to all forms of non-partner abuse is associated with partner violence. Population attributable fractions suggest that 20% of partner violence incidence was because of non-partner violence. Adolescence and young adulthood is a critical intervention age group to prevent multiple forms of violence including in intimate relationships.
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Affiliation(s)
- Seema Vyas
- London School of Hygiene & Tropical Medicine, UK
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12
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Filiatreau LM, Giovenco D, Twine R, Gómez-Olivé FX, Kahn K, Haberland N, Pettifor A. Examining the relationship between physical and sexual violence and psychosocial health in young people living with HIV in rural South Africa. J Int AIDS Soc 2021; 23:e25654. [PMID: 33340267 PMCID: PMC7749553 DOI: 10.1002/jia2.25654] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 10/16/2020] [Accepted: 11/19/2020] [Indexed: 12/12/2022] Open
Abstract
Introduction Experiences of violence during youth contravene young people’s rights and increase the risk of depression and poor human immunodeficiency virus (HIV) care outcomes among youth living with HIV (YLWH). Intervention targets for mitigating the negative psychosocial effects of violence are needed, particularly in areas like rural South Africa where violence remains pervasive and mental healthcare is limited. This study aims to quantify the associations between physical and sexual violence and depressive symptoms in YLWH in rural South Africa and explore the modification of these associations by key measures of psychosocial well‐being. Methods We conducted a cross‐sectional survey among 362 YLWH ages 12 to 24 in rural South Africa to ascertain participants’ history of physical and sexual violence, current depressive symptoms (Center for Epidemiological Studies‐Depression Scale) and levels of social support (Medical Outcomes Social Support Scale), resilience (Conner‐Davidson Resilience Scale) and self‐esteem (Rosenberg Self‐Esteem Scale). Log‐binomial regression was used to estimate the association between history of physical or sexual violence and clinically meaningful depressive symptoms (scores ≥16). Effect measure modification by high versus low resilience, social support and self‐esteem was assessed using likelihood ratio tests (α = 0.20). Results A total of 334 individuals with a median age of 21 (interquartile range: 16 to 23) were included in this analysis. Most participants were female (71.3%), single (81.4%) and attending school (53.0%). Ninety‐four participants (28.1%) reported a history of physical or sexual violence and 92 individuals (27.5%) had clinically meaningful depressive symptoms. Meaningful depressive symptoms were significantly higher among participants with a history of physical or sexual violence as compared to those with no history of violence (adjusted prevalence ratio: 2.01; 95% CI: 1.43, 2.83). However, this association was significantly modified by social support (p = 0.04) and self‐esteem (p = 0.02). Conclusions In this setting, the prevalence of meaningful depressive symptoms was significantly higher among YLWH with a history of physical or sexual violence as compared to those without a history of violence. However, higher levels of self‐esteem or social support appeared to mitigate this association. Programmes to improve self‐esteem and social support for youth have the potential to minimize depressive symptoms in YLWH who have experienced physical or sexual violence.
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Affiliation(s)
- Lindsey M Filiatreau
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Danielle Giovenco
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Rhian Twine
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Science, University of the Witwatersrand, Johannesburg, South Africa
| | - F Xavier Gómez-Olivé
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Science, University of the Witwatersrand, Johannesburg, South Africa
| | - Kathleen Kahn
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Science, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Audrey Pettifor
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Science, University of the Witwatersrand, Johannesburg, South Africa
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13
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Corley A, Glass N, Remy MM, Perrin N. A Latent Class Analysis of Gender Attitudes and Their Associations with Intimate Partner Violence and Mental Health in the Democratic Republic of Congo. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18084063. [PMID: 33921491 PMCID: PMC8068999 DOI: 10.3390/ijerph18084063] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 04/05/2021] [Accepted: 04/08/2021] [Indexed: 11/23/2022]
Abstract
Gender role attitudes, views held by individuals regarding the roles men and women should play in society, are a powerful social determinant of health. However, work remains in elucidating the associations between gender attitudes and intimate partner violence (IPV) perpetration or victimization and mental health problems. We used latent class analysis to classify patterns of responses on survey items on gender attitudes by male and female adults in households that participated in an economic empowerment intervention and evaluation in rural villages in the Democratic Republic of Congo. Attitudes about IPV and gender equality were two subdomains to emerge from analysis and a 3-class model solution was found to best fit response patterns. Results indicated that, as compared to the least gender equitable class, individuals in the moderately gender equitable and fully gender equitable classes had lower odds of having experienced or perpetrated psychological abuse. Individuals within the moderately gender equitable class were at lower odds of having experienced or perpetrated physical or sexual violence. Further, individuals in the moderately gender equitable and fully gender equitable classes had significantly lower mean scores on symptoms associated with PTSD than individuals in the least gender equitable class. Future research should explore the relationships between gender attitudes, partner violence and mental health to build resilient families.
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Affiliation(s)
- Andrew Corley
- School of Nursing, Johns Hopkins University, 525 North Wolfe Street, Baltimore, MD 21205, USA; (N.G.); (N.P.)
- Correspondence:
| | - Nancy Glass
- School of Nursing, Johns Hopkins University, 525 North Wolfe Street, Baltimore, MD 21205, USA; (N.G.); (N.P.)
| | - Mitima Mpanano Remy
- Programme d’Appui aux Initiatives de Développement Economique au Kivu (PAIDEK), Bukavu, Democratic Republic of Congo;
| | - Nancy Perrin
- School of Nursing, Johns Hopkins University, 525 North Wolfe Street, Baltimore, MD 21205, USA; (N.G.); (N.P.)
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14
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Mchome Z, Mshana G, Aloyce D, Peter E, Malibwa D, Dwarumpudi A, Kapiga S, Stöckl H. " Don't You Think It Is Violence Forcing Me to Have Sex While Not Happy?" Women's Conceptualization of Enjoyable Sex and Sexual Intimate Partner Violence in Mwanza, Tanzania. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17217937. [PMID: 33138073 PMCID: PMC7662311 DOI: 10.3390/ijerph17217937] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 10/22/2020] [Accepted: 10/24/2020] [Indexed: 12/03/2022]
Abstract
Intimate partner violence is a recognized public health and development issue that is consistently and comparatively measured through women's experience of physical and/or sexual acts by their partner. While physical intimate partner violence is covered by a wide range of behaviors, sexual intimate partner violence (SIPV) is often only measured through attempted or completed forced sex, ignoring less obvious forms of sexual intimate partner violence. We explored women's conceptualizations of SIPV by conducting in-depth interviews with 18 Tanzanian women. Using a thematic approach, we identified key features of women's sexual intimate relationships and their perceptions of them. The women clearly defined acts of positive sexual relationships that occurred with mutual consent and seduction and SIPV that included acts of forced sex and sex under the threat of violence. They also identified several acts that were crossing the line, whereby a discrepancy of views existed whether they constituted SIPV, such as having sex when out of the mood, sex being the duty of the wife, sex during the menses, requests for anal sex, having sex to not lose the husband, husband refusing sex and husband having other partners. Women in this study felt violated by a far wider range of sexual acts in their relationships. Future studies need to improve the measurement of sexual intimate partner violence to allow the collection of encompassing, yet comparable, data on this harmful phenomenon.
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Affiliation(s)
- Zaina Mchome
- Mwanza Intervention Trials Unit, P.O. Box 11936 Mwanza, Tanzania; (Z.M.); (G.M.); (D.A.); (E.P.); (D.M.); (S.K.)
- National Institute for Medical Research, Mwanza Centre, P.O. Box 1462 Mwanza, Tanzania
| | - Gerry Mshana
- Mwanza Intervention Trials Unit, P.O. Box 11936 Mwanza, Tanzania; (Z.M.); (G.M.); (D.A.); (E.P.); (D.M.); (S.K.)
- National Institute for Medical Research, Mwanza Centre, P.O. Box 1462 Mwanza, Tanzania
| | - Diana Aloyce
- Mwanza Intervention Trials Unit, P.O. Box 11936 Mwanza, Tanzania; (Z.M.); (G.M.); (D.A.); (E.P.); (D.M.); (S.K.)
| | - Esther Peter
- Mwanza Intervention Trials Unit, P.O. Box 11936 Mwanza, Tanzania; (Z.M.); (G.M.); (D.A.); (E.P.); (D.M.); (S.K.)
| | - Donati Malibwa
- Mwanza Intervention Trials Unit, P.O. Box 11936 Mwanza, Tanzania; (Z.M.); (G.M.); (D.A.); (E.P.); (D.M.); (S.K.)
| | - Annapoorna Dwarumpudi
- Gender Violence and Health Centre, Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London WC1H 9SH, UK;
| | - Saidi Kapiga
- Mwanza Intervention Trials Unit, P.O. Box 11936 Mwanza, Tanzania; (Z.M.); (G.M.); (D.A.); (E.P.); (D.M.); (S.K.)
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Heidi Stöckl
- Gender Violence and Health Centre, Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London WC1H 9SH, UK;
- Correspondence: ; Tel.: +44-2079272506
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15
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Ohnishi M, Leshabari S, Tanaka J, Nishihara M. Factors associated with the awareness of contraceptive methods, understanding the prevention of HIV/AIDS and the perception of HIV/AIDS risk among secondary school students in Dar es Salaam, Tanzania. J Rural Med 2020; 15:155-163. [PMID: 33033535 PMCID: PMC7530594 DOI: 10.2185/jrm.2020-001] [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] [Received: 02/04/2020] [Accepted: 04/30/2020] [Indexed: 11/27/2022] Open
Abstract
Objective: To assess the awareness of contraceptive methods, understanding
of HIV/AIDS prevention and the perception of HIV/AIDS risks among secondary school
students in Tanzania. Methods: An anonymous self-administered questionnaire survey was conducted
among secondary school students in Tanzania. The questionnaire included sociodemographic
characteristics, awareness of contraceptive methods, an understanding of HIV/AIDS
prevention, and the perception of HIV/AIDS risks. Three secondary schools were selected by
considering the gender balance and location, which included the urban and surrounding
areas. The research objectives, methods, and ethical considerations were explained, and
the students voluntarily completed the questionnaire. Results: A total of 233 responses were collected, and 204 responses were
considered valid for the analysis. The mean and standard deviation of age were 18.5 ± 1.0.
Regardless of the gender, age, religion, and major course of study, the maternal
educational status (adjusted odds ratio [AOR]: 3.129; 95% confidence interval [CI]: 1.324,
7.398; P=0.009) and the number of information sources (AOR: 7.023, 95%
CI: 3.166, 15.579, P<0.001) demonstrated associations with the
awareness of contraceptive methods. Respondents who lived outside a dormitory (AOR: 3.782;
95% CI: 1.650, 8.671; P=0.002) and who currently had a partner (AOR:
3.616; 95% CI: 1.486, 8.800; P=0.005) were associated with a high level
of understanding of HIV/AIDS prevention regardless of gender, age, religion, and major
course of study. Respondents with few information sources were associated with a high
level of perception of HIV/AIDS risks (AOR: 0.293; 95% CI: 0.115, 0.747;
P=0.010), regardless of gender, age, religion, and major course of
study. Conclusion: Factors associated with the awareness of contraceptive methods,
the understanding of HIV/AIDS prevention, and perception of HIV/AIDS risks were not
consistent. To ensure the improvement of these factors among secondary school students,
sexual health education should be integrated into educational programs and provided
holistically.
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Affiliation(s)
- Mayumi Ohnishi
- Nagasaki University Graduate School of Biomedical Sciences, Japan
| | - Sebalda Leshabari
- School of Nursing, Muhimbili University of Health and Allied Sciences, Tanzania
| | - Junichi Tanaka
- Nagasaki University Graduate School of Biomedical Sciences, Japan
| | - Mika Nishihara
- Nagasaki University Graduate School of Biomedical Sciences, Japan
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