Process elements contributing to community mobilization for HIV risk reduction and gender equality in rural South Africa

Understanding mechanisms of impact from community-led delivery of HIV self-testing: Mediation analysis of a cluster-randomised trial in Malawi

Community HIV strategies are important for early diagnosis and treatment, with new self-care technologies expanding the types of services that can be led by communities. We evaluated mechanisms underlying the impact of community-led delivery of HIV self-testing (HIVST) using mediation analysis. We conducted a cluster-randomised trial allocating 30 group village heads and their catchment areas to the community-led HIVST intervention in addition to the standard of care (SOC) or the SOC alone. The intervention used participatory approaches to engage established community health groups to lead the design and implementation of HIVST campaigns. Potential mediators (individual perceptions of social cohesion, shared HIV concern, critical consciousness, community HIV stigma) and the outcome (HIV testing in the last 3 months) were measured through a post-intervention survey. Analysis used regression-based models to test (i) intervention-mediator effects, (ii) mediator-outcome effects, and (iii) direct and indirect effects. The survey included 972 and 924 participants in the community-led HIVST and SOC clusters, respectively. The community-led HIVST intervention increased uptake of recent HIV testing, with no evidence of indirect effects from changes in hypothesised mediators. However, standardised scores for community cohesion (adjusted mean difference [MD] 0.15, 95% CI -0.03 to 0.32, p = 0.10) and shared concern for HIV (adjusted MD 0.13, 95% CI -0.02 to 0.29, p = 0.09) were slightly higher in the community-led HIVST arm than the SOC arm. Social cohesion, community concern, and critical consciousness also apparently had a quadratic association with recent testing in the community-led HIVST arm, with a positive relationship indicated at lower ranges of each score. We found no evidence of intervention effects on community HIV stigma and its association with recent testing. We conclude that the intervention effect mostly operated directly through community-driven service delivery of a novel HIV technology rather than through intermediate effects on perceived community mobilisation and HIV stigma.

Examining Masculinities to Inform Gender-Transformative Violence Prevention Programs: Qualitative Findings From Rakai, Uganda

While the majority of men in rural Uganda upheld 2 conflicting masculine norms that are conceptualized as reputation (“cool man”) and respectability (“responsible man”), men in younger age groups who participated in a gender-transformative program expressed gender-equitable beliefs and attitudes.

Introduction:

Evidence-based programs are needed to engage men and boys that encourage the transformation of concepts of masculinity that uphold patterns of intimate partner violence (IPV). This study explores the constructs of masculinity and male gender norms surrounding sexual attitudes and IPV among men and boys living in Rakai, Uganda.

Methods:

Between April and August 2017, we conducted 38 interviews and 5 focus group discussions with men and boys aged 15 to 49 years and 4 focus groups with key stakeholders to understand how male use of violence is influenced by personal, community, and society-level concepts of masculinity. We adapted 2 constructs of masculinities, reputation and respectability, in the analysis to examine masculinities in relation to IPV in the rural Ugandan setting.

Results:

Findings suggest men and boys upheld 2 types of masculinities: respectability versus reputation. Masculine attributes related to respectability (referred to as “responsible men”) included having a job, house, wife, and many children and taking care of family. Masculine attributes related to reputation (referred to as “cool men”) included having sexual prowess, multiple sexual partners, and the resources to buy nice things. Both masculine norms were used to justify dominance over women and IPV. The divergence of masculinity was observed among youth and young adults who participated in a gender-transformative program, suggesting the effectiveness of the program.

Discussion:

The gender-transformative approach should provide men and boys a chance to reflect on dynamic, often conflicting, images of a man and should empower individuals to renegotiate and reconceptualize masculine norms. This critical reflection on masculinity, which resonates with men and boys, needs to be included when engaging men within HIV and IPV prevention programs.

A Mixed-Methods Systematic Review: Infidelity, Romantic Jealousy and Intimate Partner Violence against Women

Infidelity and romantic jealousy (RJ) are commonly cited relational level drivers of intimate partner violence (IPV) but remain undertheorized and underutilized in IPV research and prevention. This global systematic review aims to characterize the existing research on real or suspected infidelity and RJ in relation to IPV and inform future research and programming. We systematically searched 11 databases for peer-reviewed research, published between April 2009 and 2019, that provided data on the prevalence or a measure of association (quantitative), or pathway (qualitative), between real or suspected infidelity or RJ, and IPV. Fifty-one papers from 28 countries were included and the evidence showed a consistent association between real or suspected infidelity, RJ and IPV. Our findings identify three overarching mechanisms and six pathways between infidelity, RJ and IPV. These provide support for prominent theories in the field related to patriarchal culture, threatened masculinities and femininities and a lack of emotional regulation and conflict resolution skills, but not evolutionary theories. Our findings suggest that researchers should use standardized measurement tools that make the distinction between RJ and suspected, confirmed and accusations of infidelity. Policy and programming should aim to transform traditional gender roles, accounting for infidelity and RJ and improving couple’s communication and trust.