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Newmann SJ, Zakaras JM, Dworkin SL, Withers M, Ndunyu L, Gitome S, Gorrindo P, Bukusi EA, Rocca CH. Measuring Men's Gender Norm Beliefs Related to Contraception: Development of the Masculine Norms and Family Planning Acceptance Scale. ARCHIVES OF SEXUAL BEHAVIOR 2021; 50:2691-2702. [PMID: 33821378 PMCID: PMC8416878 DOI: 10.1007/s10508-021-01941-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 01/30/2021] [Accepted: 02/02/2021] [Indexed: 06/12/2023]
Abstract
Male partner resistance is identified as a key factor that influences women's contraceptive use. Examination of the masculine norms that shape men's resistance to contraception-and how to intervene on these norms-is needed. To assess a gender-transformative intervention in Kenya, we developed and evaluated a masculinity-informed instrument to measure men's contraceptive acceptance-the Masculine Norms and Family Planning Acceptance (MNFPA) scale. We developed draft scale items based on qualitative research and administered them to partnered Kenyan men (n = 150). Item response theory-based methods were used to reduce and psychometrically evaluate final scale items. The MNFPA scale had a Cronbach's α of 0.68 and loaded onto a single factor. MNFPA scores were associated with self-efficacy and intention to accept a female partner's use of contraception; scores were not associated with current contraceptive use. The MNFPA scale is the first rigorously developed and psychometrically evaluated tool to assess men's contraceptive acceptance as a function of male gender norms. Future work is needed to test the MNFPA measure in larger samples and across different contexts. The scale can be used to evaluate interventions that seek to shift gender norms to increase men's positive engagement in pregnancy spacing and prevention.
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Affiliation(s)
- Sara J Newmann
- Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, CA, USA.
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Zuckerberg San Francisco General Hospital, 1001 Potrero Avenue, Unit 6D-14, San Francisco, CA, 94110, USA.
| | - Jennifer Monroe Zakaras
- Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, CA, USA
| | - Shari L Dworkin
- School of Nursing and Health Studies, University of Washington Bothell, Bothell, WA, USA
| | - Mellissa Withers
- University of Southern California Institute On Inequalities in Global Health, Los Angeles, CA, USA
| | - Louisa Ndunyu
- Kenya Medical Research Institute, Nairobi, Kenya
- The Department of Public Health, School of Public Health and Community Development, Maseno University, Maseno, Kenya
| | - Serah Gitome
- Kenya Medical Research Institute, Nairobi, Kenya
| | - Phillip Gorrindo
- Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, CA, USA
| | | | - Corinne H Rocca
- Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, CA, USA
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, Oakland, CA, USA
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Dworkin SL, Barker G. Gender-Transformative Approaches to Engaging Men in Reducing Gender-Based Violence: A Response to Brush & Miller's "Trouble in Paradigm". Violence Against Women 2019; 25:1657-1671. [PMID: 31640533 DOI: 10.1177/1077801219872555] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Brush and Miller's paper is critical of gender-transformative interventions and they believe that the paradigm is in trouble. In this response, we examine the body of evidence and the conceptual frames that undergird gender-transformative interventions, along with the emergence of these interventions and their efficacy. We argue here that it is reductionist to state either (a) that gender-transformative programs do not work, or (b) that gender-transformative programs only rely on social norms theory. We reveal how these claims omit important developments emerging from research on homophobia, feminist thought, and intersectionality that have made their way into gender-transformative interventions in several countries. We show that the implementation of gender-transformative interventions is far from uniform and we examine how changing power relations, relationships, communities, and masculinities, as well as other structures and practices that negatively influence health and well-being are integrated into this large body of work. We highlight how gender-transformative interventions show solid promise on balance, as measured in several evaluation studies in several settings, when implemented well and sustained. Overall then, gender-transformative interventions represent a tremendous advance over the previous "risk group-focused," single-topic approaches with men that have been implemented in public and global health interventions.
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Strategies for engaging men in HIV services. Lancet HIV 2019; 6:e191-e200. [PMID: 30777726 DOI: 10.1016/s2352-3018(19)30032-3] [Citation(s) in RCA: 74] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2018] [Revised: 12/20/2018] [Accepted: 12/20/2018] [Indexed: 12/14/2022]
Abstract
The importance of men in the global HIV response is increasingly recognised. In most settings, men are less engaged in HIV services and have worse health outcomes than women. The multiple gender, social, economic, political, and institutional factors behind these patterns are well documented. More recently, researchers have been reporting evidence on strategies aimed at improving the engagement of men in HIV services. Several promising approaches exist, including community-based outreach programmes, gender-transformative interventions to shift gender norms and practices, and the development of more responsive, male-friendly health services. Challenges remain, however, in terms of cost and sustainability, intersecting inequalities like race and class, and the difficulty of changing community-level gender norms. Future research should focus on developing theory-informed interventions and evaluations, on improving the understanding of specific subpopulations of men, and on broadening the evidence base beyond the few countries that produce most research in this field.
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Gottert A, Barrington C, McNaughton-Reyes HL, Maman S, MacPhail C, Lippman SA, Kahn K, Twine R, Pettifor A. Gender Norms, Gender Role Conflict/Stress and HIV Risk Behaviors Among Men in Mpumalanga, South Africa. AIDS Behav 2018; 22:1858-1869. [PMID: 28161801 PMCID: PMC6440537 DOI: 10.1007/s10461-017-1706-9] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Men's gender role conflict and stress (GRC/S), the psychological strain they experience around fulfilling expectations of themselves as men, has been largely unexplored in HIV prevention research. We examined associations between both men's gender norms and GRC/S and three HIV risk behaviors using data from a population-based survey of 579 18-35 year-old men in rural northeast South Africa. Prevalence of sexual partner concurrency and intimate partner violence (IPV) perpetration in the last 12 months were 38.0 and 13.4%, respectively; 19.9% abused alcohol. More inequitable gender norms and higher GRC/S were each significantly associated with an increased odds of concurrency (p = 0.01; p < 0.01, respectively), IPV perpetration (p = 0.03; p < 0.01), and alcohol abuse (p = 0.02; p < 0.001), controlling for demographic characteristics. Ancillary analyses demonstrated significant positive associations between: concurrency and the GRC/S sub-dimension subordination to women; IPV perpetration and restrictive emotionality; and alcohol abuse and success, power, competition. Programs to transform gender norms should be coupled with effective strategies to prevent and reduce men's GRC/S.
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Affiliation(s)
- Ann Gottert
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
- Population Council, HIV and AIDS Program, 4301 Connecticut Avenue, NW, #280, Washington, DC, 20008, USA.
| | - Clare Barrington
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Heath Luz McNaughton-Reyes
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Suzanne Maman
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Catherine MacPhail
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- School of Health, University of New England, Armidale, NSW, Australia
| | - Sheri A Lippman
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Center for AIDS Prevention Studies, Department of Medicine, University of California at San Francisco, San Francisco, CA, USA
| | - Kathleen Kahn
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Wits Reproductive Health and HIV Institute (WRHI), University of the Witwatersrand, Johannesburg, South Africa
- Umeå Centre for Global Health Research, Division of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Rhian Twine
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Wits Reproductive Health and HIV Institute (WRHI), University of the Witwatersrand, Johannesburg, South Africa
| | - Audrey Pettifor
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Khoza N, Stadler J, MacPhail C, Chikandiwa A, Brahmbhatt H, Delany-Moretlwe S. Cash transfer interventions for sexual health: meanings and experiences of adolescent males and females in inner-city Johannesburg. BMC Public Health 2018; 18:120. [PMID: 29316885 PMCID: PMC5761158 DOI: 10.1186/s12889-018-5027-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 01/03/2018] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND In sub-Saharan Africa, there is growing interest in the use of cash transfer (CT) programs for HIV treatment and prevention. However, there is limited evidence of the consequences related to CT provision to adolescents in low-resourced urban settings. We explored the experiences of adolescents receiving CTs to assess the acceptability and unintended consequences of CT strategies in urban Johannesburg, South Africa. METHODS We collected qualitative data during a pilot randomized controlled trial of three CT strategies (monthly payments unconditional vs. conditional on school attendance vs. a once-off payment conditional on a clinic visit) involving 120 adolescents aged 16-18 years old in the inner city of Johannesburg. Interviews were conducted in isiZulu, Sesotho or English with a sub-sample of 49 participants who adhered to study conditions, 6 months after receiving CT (280 ZAR/ 20 USD) and up to 12 months after the program had ended. Interviews were transcribed and translated by three fieldworkers. Codes were generated using an inductive approach; transcripts were initially coded based on emerging issues and subsequently coded deductively using Atlas.ti 7.4. RESULTS CTs promoted a sense of independence and an adult social identity amongst recipients. CTs were used to purchase personal and household items; however, there were gender differences in spending and saving behaviours. Male participants' spending reflected their preoccupation with maintaining a public social status through which they asserted an image of the responsible adult. In contrast, female participants' expenditure reflected assumption of domestic responsibilities and independence from older men, with the latter highlighting CTs' potential to reduce transactional sexual partnerships. Cash benefits were short-lived, as adolescents reverted to previous behavior after the program's cessation. CONCLUSION CT programs offer adolescent males and females in low-income urban settings a sense of agency, which is vital for their transition to adulthood. However, gender differences in the expenditure of CTs and the effects of ending CT programs must be noted, as these may present potential unintended risks.
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Affiliation(s)
- Nomhle Khoza
- Wits Reproductive Health and HIV Institute (Wits RHI), Faculty of Health Sciences, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Jonathan Stadler
- Wits Reproductive Health and HIV Institute (Wits RHI), Faculty of Health Sciences, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Catherine MacPhail
- Wits Reproductive Health and HIV Institute (Wits RHI), Faculty of Health Sciences, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
- School of Health and Society, University of Wollongong, Wollongong, NSW Australia
| | - Admire Chikandiwa
- Wits Reproductive Health and HIV Institute (Wits RHI), Faculty of Health Sciences, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Heena Brahmbhatt
- Wits Reproductive Health and HIV Institute (Wits RHI), Faculty of Health Sciences, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
- Department of Population Reproductive and Family Health, John Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Sinead Delany-Moretlwe
- Wits Reproductive Health and HIV Institute (Wits RHI), Faculty of Health Sciences, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
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Zakaras JM, Weiser SD, Hatcher AM, Weke E, Burger RL, Cohen CR, Bukusi EA, Dworkin SL. A Qualitative Investigation of the Impact of a Livelihood Intervention on Gendered Power and Sexual Risk Behaviors Among HIV-Positive Adults in Rural Kenya. ARCHIVES OF SEXUAL BEHAVIOR 2017; 46:1121-1133. [PMID: 27507020 PMCID: PMC5299074 DOI: 10.1007/s10508-016-0828-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Revised: 04/01/2016] [Accepted: 07/28/2016] [Indexed: 06/02/2023]
Abstract
Despite the recognized links between food insecurity, poverty, and the risk of HIV/AIDS, few randomized trials have evaluated the impact of livelihood interventions on HIV risk behaviors. The current study draws upon data collected from a qualitative process evaluation that was embedded into a pilot randomized controlled trial that tested whether a multisectoral agricultural intervention (Shamba Maisha) affected the HIV-related health of HIV-positive adults in rural Kenya. In the current study, we drew upon longitudinal, in-depth interviews with 45 intervention participants and nine control participants (N = 54) in order to examine the impacts of the intervention on gendered power and sexual risk reduction among both women and men. Female and male participants in the intervention described positive changes in sexual practices and gendered power dynamics as a result of intervention participation. Changes included reduced sexual risk behaviors, improved gender-related power dynamics, and enhanced quality of intimate relationships. These findings illuminate how a multisectoral agricultural intervention may affect inequitable gender relations and secondary transmission risk. Further research is needed to explore how to best leverage agricultural interventions to address the important intersections between poverty and inequitable gender relations that shape HIV risks.
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Affiliation(s)
- Jennifer M Zakaras
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, CA, USA
| | - Sheri D Weiser
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
- Center of Expertise in Women's Health and Empowerment, University of California Global Health Institute, San Francisco, CA, USA
| | - Abigail M Hatcher
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, CA, USA
- Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg, South Africa
| | - Elly Weke
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Rachel L Burger
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, CA, USA
| | - Craig R Cohen
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, CA, USA
- Center of Expertise in Women's Health and Empowerment, University of California Global Health Institute, San Francisco, CA, USA
| | - Elizabeth A Bukusi
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Shari L Dworkin
- Center of Expertise in Women's Health and Empowerment, University of California Global Health Institute, San Francisco, CA, USA.
- Department of Social and Behavioral Sciences, School of Nursing, University of California, San Francisco, CA, USA.
- UCSF School of Nursing, 3333 California Street, LHTS #455, San Francisco, CA, 94118, USA.
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Rolston IA. (Re)politicising and (re)positioning prevention: community mobilisations and AIDS prevention in the new AIDS era. AJAR-AFRICAN JOURNAL OF AIDS RESEARCH 2017; 15:173-84. [PMID: 27399047 DOI: 10.2989/16085906.2016.1204332] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
An increasing focus on the relationship between AIDS prevalence and socio-economic inequality signals the need for a revaluation of the role of "politics" and "power" in AIDS prevention. This revaluation bears great significance when considering the future trajectories of the AIDS prevention efforts that target highly marginalised populations with high prevalence rates. An emphasis on intersecting forms of inequality has direct implications for the future of AIDS prevention practice. This study explores the experiences of participants, facilitators and local stakeholders applying the United Nations Development Programme (UNDP) Community Capacity Enhancement-Community Conversations (CCE-CC) approach to AIDS prevention in the Eastern Cape province of South Africa. It uses the political narrative analysis of life histories and semi-structured interviews as a means to interrogate the lived experiences of local actors participating in or influenced by this popularised form of community mobilisation used throughout sub-Saharan Africa. Findings suggest the need for a more explicit and intentional valuation for the intersection between the social and political determinants of health in programmes that use community mobilisation as prevention. They also signal a need to critically re-evaluate "community mobilisation" as an AIDS prevention tradition. Intersecting social and political power dynamics play a significant role in both opening up and constraining community mobilisation efforts. This paper proposes the need for a pedagogical turn to "deep organising" and "participatory forms of democracy", as a necessary frontier for programmes working with highly marginalised populations with high prevalence rates. Programmes need to more explicitly support, protect, and advocate for the ability of affected communities to engage in political processes, discourse and long-term organising.
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Affiliation(s)
- Imara Ajani Rolston
- a Department of Social Psychology & Centre for the Study of Human Rights , London School of Economics and Political Science , London , United Kingdom
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8
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Hilliard S, Bukusi E, Grabe S, Lu T, Hatcher AM, Kwena Z, Mwaura-Muiru E, Dworkin SL. Perceived Impact of a Land and Property Rights Program on Violence Against Women in Rural Kenya: A Qualitative Investigation. Violence Against Women 2016; 22:1682-1703. [PMID: 26951306 DOI: 10.1177/1077801216632613] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The current study focuses on a community-led land and property rights program in two rural provinces in western Kenya. The program was designed to respond to women's property rights violations to reduce violence against women and HIV risks at the community level. Through in-depth interviews with 30 women, we examine the perceived impact that this community-level property rights program had on violence against women at the individual and community level. We also examine perceptions as to how reductions in violence were achieved. Finally, we consider how our findings may aid researchers in the design of structural violence-prevention strategies.
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Affiliation(s)
- Starr Hilliard
- 1 School of Nursing, University of California, San Francisco, CA, USA
| | | | | | - Tiffany Lu
- 4 Massachusetts General Hospital, Boston, MA, USA
| | - Abigail M Hatcher
- 1 School of Nursing, University of California, San Francisco, CA, USA.,5 University of the Witwatersrand, Johannesburg, South Africa
| | | | | | - Shari L Dworkin
- 1 School of Nursing, University of California, San Francisco, CA, USA
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9
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Leventhal KS, DeMaria LM, Gillham JE, Andrew G, Peabody J, Leventhal SM. A psychosocial resilience curriculum provides the "missing piece" to boost adolescent physical health: A randomized controlled trial of Girls First in India. Soc Sci Med 2016; 161:37-46. [PMID: 27239706 DOI: 10.1016/j.socscimed.2016.05.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Revised: 04/14/2016] [Accepted: 05/02/2016] [Indexed: 10/21/2022]
Abstract
RATIONALE AND OBJECTIVES Despite a recent proliferation of interventions to improve health, education, and livelihoods for girls in low and middle income countries, psychosocial wellbeing has been neglected. This oversight is particularly problematic as attending to psychosocial development may be important not only for psychosocial but also physical wellbeing. This study examines the physical health effects of Girls First, a combined psychosocial (Girls First Resilience Curriculum [RC]) and adolescent physical health (Girls First Health Curriculum [HC]) intervention (RC + HC) versus its individual components (i.e., RC, HC) and a control group. We expected Girls First to improve physical health versus HC and controls. METHODS Over 3000 girls in 76 government middle schools in rural Bihar, India participated. Interventions were delivered through in-school peer-support groups, facilitated by pairs of local women. Girls were assessed before and after program participation on two primary outcomes (health knowledge and gender equality attitudes) and nine secondary outcomes (clean water behaviors, hand washing, menstrual hygiene, health communication, ability to get to a doctor when needed, substance use, nutrition, safety, vitality and functioning). Analyses included Difference-in-Difference Ordinary Least-Squares Regressions and F-tests for equality among conditions. RESULTS Girls First significantly improved both primary and eight secondary outcomes (all except nutrition) versus controls. Additionally, Girls First demonstrated significantly greater effects, improving both primary and six secondary outcomes (clean water behaviors, hand washing, health communication, ability to get to a doctor, nutrition, safety) versus HC. CONCLUSIONS This study is among the first to assess the impact of a combined psychosocial and adolescent health program on physical health. We found that combining these curricula amplified effects achieved by either curriculum alone. These findings suggest that psychosocial wellbeing should receive much broader attention, not only from those interested in improving psychosocial outcomes but also from those interested in improving physical health outcomes.
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Affiliation(s)
| | - Lisa M DeMaria
- QURE Healthcare, 1000 Fourth St., Suite 300, San Rafael, CA, USA.
| | - Jane E Gillham
- Department of Psychology, Swarthmore College, 500 College Avenue, Swarthmore, PA, USA.
| | - Gracy Andrew
- CorStone, A 91, Amritpuri, First Floor, Opp. Isckon Temple, East of Kailash, New Delhi, 110065, India.
| | - John Peabody
- QURE Healthcare, 1000 Fourth St., Suite 300, San Rafael, CA, USA.
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Krishnan S, Gambhir S, Luecke E, Jagannathan L. Impact of a workplace intervention on attitudes and practices related to gender equity in Bengaluru, India. Glob Public Health 2016; 11:1169-84. [PMID: 27002859 DOI: 10.1080/17441692.2016.1156140] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
We describe the evaluation of a participatory, garment factory-based intervention to promote gender equity. The intervention comprised four campaigns focused on gender and violence against women, alcoholism, sexual and reproductive health, and HIV/AIDS, which were implemented using information displays (standees and posters) and interactive methods (street play, one-to-one interactions, experience-sharing, and health camps). Each campaign lasted six days and the entire intervention was implemented over 10 months. We evaluated the intervention using a quasi-experimental design in which one factory served as the intervention site and a second as a delayed control. Two mobile-phone-based cross-sectional surveys were conducted at baseline and 12 months with separate systematic random samples of employees from each site. Data on socio-demographic characteristics and knowledge and attitudes related to gender equity, intimate partner violence (IPV) and alcohol use were assessed, and differences in these variables associated with the intervention were examined using difference-in-difference estimation. Analyses of data from 835 respondents revealed substantial, statistically significant improvements in attitudes related to gender equity, unacceptability of IPV, and awareness of IPV and alcohol-related support services. In conclusion, our study offers compelling evidence on the effectiveness of workplace-based interventions in advancing gender equity.
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Affiliation(s)
- Suneeta Krishnan
- a Women's Global Health Imperative, RTI International , San Francisco , CA , USA.,b St. John's Research Institute , Bengaluru , India
| | | | - Ellen Luecke
- a Women's Global Health Imperative, RTI International , San Francisco , CA , USA
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Withers M, Dworkin SL, Onono M, Oyier B, Cohen CR, Bukusi EA, Newmann SJ. Men's Perspectives on Their Role in Family Planning in Nyanza Province, Kenya. Stud Fam Plann 2015; 46:201-15. [PMID: 26059990 DOI: 10.1111/j.1728-4465.2015.00024.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Research has indicated that gender dynamics-and in particular men's disapproval of family planning-have had an influence on the low levels of contraceptive use in sub-Saharan Africa. Limited evidence exists, however, on effective strategies to increase male approval. We conducted 12 focus group discussions with married men aged 20-66 (N = 106) in Kenya to explore FP perceptions. Men's disapproval of FP was associated with anxieties regarding male identity and gender roles. Men often distrusted FP information provided by their wives because they suspected infidelity or feared being viewed as "herded." Men also feared that providers might pressure them into vasectomies or into disclosing extramarital sexual activity or HIV diagnoses to their wives. Suggested strategies include programs targeting couples jointly and FP education for men provided by male outreach workers. To encourage men's acceptance, community-based programs directly targeting men are needed to reduce stigma and misconceptions and to increase awareness of the benefits of FP.
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Affiliation(s)
- Mellissa Withers
- Assistant Professor, Institute for Global Health, Keck School of Medicine, University of Southern California, 2001 North Soto Street, Los Angeles, CA, 90033.
| | - Shari L Dworkin
- Professor and Associate Dean, Department of Social and Behavioral Sciences, School of Nursing, University of California, San Francisco
| | - Maricianah Onono
- Research Officer, Beryl Oyier is Assistant Research Officer, and Elizabeth A. Bukusi is Deputy Director Research and Training, Centre for Microbiology Research, Kenya Medical Research Institute
| | - Beryl Oyier
- Research Officer, Beryl Oyier is Assistant Research Officer, and Elizabeth A. Bukusi is Deputy Director Research and Training, Centre for Microbiology Research, Kenya Medical Research Institute
| | - Craig R Cohen
- Professor and Sara J. Newmann is Assistant Professor, Department of Obstetrics, Gynecology, and Reproductive Sciences, School of Medicine, University of California, San Francisco
| | - Elizabeth A Bukusi
- Research Officer, Beryl Oyier is Assistant Research Officer, and Elizabeth A. Bukusi is Deputy Director Research and Training, Centre for Microbiology Research, Kenya Medical Research Institute
| | - Sara J Newmann
- Professor and Sara J. Newmann is Assistant Professor, Department of Obstetrics, Gynecology, and Reproductive Sciences, School of Medicine, University of California, San Francisco
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12
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Harrington EK, Dworkin S, Withers M, Onono M, Kwena Z, Newmann SJ. Gendered power dynamics and women's negotiation of family planning in a high HIV prevalence setting: a qualitative study of couples in western Kenya. CULTURE, HEALTH & SEXUALITY 2015; 18:453-69. [PMID: 26503879 PMCID: PMC5726384 DOI: 10.1080/13691058.2015.1091507] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
In sub-Saharan Africa, high burdens of HIV and unmet need for contraception often coexist. Research emphasises the need to engage men and couples in reproductive health, yet couples' negotiations around fertility and family planning in the context of HIV have been sparsely studied. This study examined the gendered power dynamics that frame women's and couples' negotiations of contraceptive use in western Kenya. We conducted 76 in-depth interviews with 38 couples, of whom 22 couples were concordant HIV-positive. Qualitative data were analysed using a grounded theory approach. Direct communication around contraception with men was often challenging due to perceived or expressed male resistance. A substantial minority of women avoided male reproductive decision-making authority through covert contraceptive use, with concern for severe consequences when contraceptive use was discovered. Many men assumed that family planning use signified female promiscuity and that infidelity motivated covert use. Men were more willing to use condoms to avoid HIV re-infection or on the recommendation of HIV care providers, which allowed some women leverage to insist on condom use. Our findings highlight the tension between male dominated reproductive decision making and women's agency and point to the need for gender transformative approaches seeking to challenge masculinities that negatively impact health.
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Affiliation(s)
| | - Shari Dworkin
- epartment of Social and Behavioral Sciences, University of California, San Francisco, USA
| | - Mellissa Withers
- Institute for Global Health, University of Southern California Keck School of Medicine, Los Angeles, USA
| | - Maricianah Onono
- Research, Care, and Training Program, Center for Microbiology Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Zachary Kwena
- Research, Care, and Training Program, Center for Microbiology Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Sara J. Newmann
- Department of OB/GYN and Reproductive Sciences, San Francisco General Hospital, University of California, San Francisco, USA
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13
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Dworkin SL, Fleming PJ, Colvin CJ. The promises and limitations of gender-transformative health programming with men: critical reflections from the field. CULTURE, HEALTH & SEXUALITY 2015; 17 Suppl 2:S128-43. [PMID: 25953008 PMCID: PMC4637253 DOI: 10.1080/13691058.2015.1035751] [Citation(s) in RCA: 133] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2014] [Accepted: 03/26/2015] [Indexed: 05/04/2023]
Abstract
Since the 1994 International Conference on Population and Development, researchers and practitioners have engaged in a series of efforts to shift health programming with men from being gender-neutral to being more gender-sensitive and gender-transformative. Efforts in this latter category have been increasingly utilised, particularly in the last decade, and attempt to transform gender relations to be more equitable in the name of improved health outcomes for both women and men. We begin by assessing the conceptual progression of social science contributions to gender-transformative health programming with men. Next, we briefly assess the empirical evidence from gender-transformative health interventions with men. Finally, we examine some of the challenges and limitations of gender-transformative health programmes and make recommendations for future work in this thriving interdisciplinary area of study.
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Affiliation(s)
- Shari L. Dworkin
- Department of Social and Behavioral Sciences, School of Nursing, University of California, San Francisco, USA
- Center for AIDS Prevention Studies, School of Medicine, University of California, San Francisco, USA
| | - Paul J. Fleming
- Department of Health Behavior, University of North Carolina, Chapel Hill, USA
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14
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Withers M, Dworkin SL, Zakaras JM, Onono M, Oyier B, Cohen CR, Bukusi EA, Grossman D, Newmann SJ. 'Women now wear trousers': men's perceptions of family planning in the context of changing gender relations in western Kenya. CULTURE, HEALTH & SEXUALITY 2015; 17:1132-46. [PMID: 26032620 DOI: 10.1080/13691058.2015.1043144] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Gender inequity has been closely linked with unmet need for family planning among women in sub-Saharan Africa but the factors related to male family planning disapproval are not well-understood. This qualitative study explored men's perspectives of gender roles and cultural norms as they pertain to family planning. Twelve small group meetings were held with 106 married men in Nyanza Province, Kenya. Shifting gender relations made the definitions of manhood more tenuous than ever. Men's previous identities as sole breadwinners, which gave them significant control over decision-making, were being undermined by women's increasing labour force participation. While many men viewed family planning positively, fears that family planning would lead to more female sexual agency and promiscuity or that male roles would be further jeopardised were widespread and were major deterrents to male family planning approval. By addressing such fears, gender-sensitive programmes could help more men to accept family planning. Increased family planning education for men is needed to dispel misconceptions regarding family planning side-effects. Focusing on the advantages of family planning, namely financial benefits and reduced conflict among couples, could resonate with men. Community leaders, outreach workers and healthcare providers could help shift men's approval of joint decision-making around family size to other reproductive domains, such as family planning use.
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Affiliation(s)
- Mellissa Withers
- a Institute for Global Health, University of Southern California , Los Angeles , USA
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15
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Falb KL, Annan J, King E, Hopkins J, Kpebo D, Gupta J. Gender norms, poverty and armed conflict in Côte D'Ivoire: engaging men in women's social and economic empowerment programming. HEALTH EDUCATION RESEARCH 2014; 29:1015-1027. [PMID: 25274720 PMCID: PMC4235567 DOI: 10.1093/her/cyu058] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Accepted: 08/28/2014] [Indexed: 06/03/2023]
Abstract
Engaging men is a critical component in efforts to reduce intimate partner violence (IPV). Little is known regarding men's perspectives of approaches that challenge inequitable gender norms, particularly in settings impacted by armed conflict. This article describes men's experiences with a women's empowerment program and highlights men's perceptions of gender norms, poverty and armed conflict, as they relate to achieving programmatic goals. Data are from 32 Ivorian men who participated in indepth interviews in 2012. Interviews were undertaken as part of an intervention that combined gender dialogue groups for both women and their male partners with women's only village savings and loans programs to reduce IPV against women. Findings suggested that in the context of armed conflict, traditional gender norms and economic stressors experienced by men challenged fulfillment of gender roles and threatened men's sense of masculinity. Men who participated in gender dialogue groups discussed their acceptance of programming and identified improvements in their relationships with their female partners. These men further discussed increased financial planning along with their partners, and attributed such increases to the intervention. Addressing men's perceptions of masculinity, poverty and armed conflict may be key components to reduce men's violence against women in conflict-affected settings.
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Affiliation(s)
- K L Falb
- Division of Social and Behavioral Sciences and Department of Chronic Disease Epidemiology, Yale School of Public Health, Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT 06511, Research, Evaluation and Learning Unit, International Rescue Committee, New York, NY 10168, Columbia University School of Social Work, New York, NY 10027, USA and Innovations for Poverty Action, Abidjan Côte d'Ivoire Division of Social and Behavioral Sciences and Department of Chronic Disease Epidemiology, Yale School of Public Health, Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT 06511, Research, Evaluation and Learning Unit, International Rescue Committee, New York, NY 10168, Columbia University School of Social Work, New York, NY 10027, USA and Innovations for Poverty Action, Abidjan Côte d'Ivoire
| | - J Annan
- Division of Social and Behavioral Sciences and Department of Chronic Disease Epidemiology, Yale School of Public Health, Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT 06511, Research, Evaluation and Learning Unit, International Rescue Committee, New York, NY 10168, Columbia University School of Social Work, New York, NY 10027, USA and Innovations for Poverty Action, Abidjan Côte d'Ivoire
| | - E King
- Division of Social and Behavioral Sciences and Department of Chronic Disease Epidemiology, Yale School of Public Health, Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT 06511, Research, Evaluation and Learning Unit, International Rescue Committee, New York, NY 10168, Columbia University School of Social Work, New York, NY 10027, USA and Innovations for Poverty Action, Abidjan Côte d'Ivoire
| | - J Hopkins
- Division of Social and Behavioral Sciences and Department of Chronic Disease Epidemiology, Yale School of Public Health, Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT 06511, Research, Evaluation and Learning Unit, International Rescue Committee, New York, NY 10168, Columbia University School of Social Work, New York, NY 10027, USA and Innovations for Poverty Action, Abidjan Côte d'Ivoire
| | - D Kpebo
- Division of Social and Behavioral Sciences and Department of Chronic Disease Epidemiology, Yale School of Public Health, Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT 06511, Research, Evaluation and Learning Unit, International Rescue Committee, New York, NY 10168, Columbia University School of Social Work, New York, NY 10027, USA and Innovations for Poverty Action, Abidjan Côte d'Ivoire
| | - J Gupta
- Division of Social and Behavioral Sciences and Department of Chronic Disease Epidemiology, Yale School of Public Health, Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT 06511, Research, Evaluation and Learning Unit, International Rescue Committee, New York, NY 10168, Columbia University School of Social Work, New York, NY 10027, USA and Innovations for Poverty Action, Abidjan Côte d'Ivoire Division of Social and Behavioral Sciences and Department of Chronic Disease Epidemiology, Yale School of Public Health, Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT 06511, Research, Evaluation and Learning Unit, International Rescue Committee, New York, NY 10168, Columbia University School of Social Work, New York, NY 10027, USA and Innovations for Poverty Action, Abidjan Côte d'Ivoire
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Amin A, Chandra-Mouli V. Empowering adolescent girls: developing egalitarian gender norms and relations to end violence. Reprod Health 2014; 11:75. [PMID: 25335989 PMCID: PMC4216358 DOI: 10.1186/1742-4755-11-75] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Accepted: 10/06/2014] [Indexed: 12/04/2022] Open
Abstract
On the occasion of the International Day of the Girl Child (October 11), this commentary highlights the problem of violence against adolescent girls. It describes the nature and magnitude of violence faced by adolescent girls, what we know about factors that drive violence against women and against adolescent girls. It highlights the importance of promoting egalitarian gender norms, particularly during adolescence, and empowering women and girls in efforts to end such violence. Finally, it offers lessons learned from some promising interventions in this area.
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Affiliation(s)
- Avni Amin
- Department for Reproductive Health Research, World Health Organization, Avenue Appia 20, 1211 Geneva 27, Switzerland
| | - Venkatraman Chandra-Mouli
- Department for Reproductive Health Research, World Health Organization, Avenue Appia 20, 1211 Geneva 27, Switzerland
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17
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Njie-Carr V. Violence experiences among HIV-infected women and perceptions of male perpetrators' roles: a concurrent mixed method study. J Assoc Nurses AIDS Care 2014. [PMID: 24503500 DOI: 10.1016/jjana.2013.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2023]
Abstract
HIV disproportionately affects women, which propagates the disparities gap. This study was designed to (a) explore the personal, cognitive, and psychosocial factors of intimate partner violence among women with HIV; (b) explore the perceptions of male perpetrators' roles in contributing to violence; and (c) determine the implications for methodological and data source triangulation. A concurrent Mixed Method study design was used, including 30 African American male and female participants. Quantitative data were analyzed using descriptive statistics. Eleven themes were identified in the qualitative data from the female (n = 15) and 9 themes from the male (n = 15) participant interviews using Giorgi's technique. Data sources and methodological approaches were triangulated with relative convergence in the results. Preliminary data generated from this study could inform gender-based feasibility research studies. These studies could focus on integrating findings from this study in HIV/intimate partner violence prevention interventions and provide clinical support for women.
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18
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Grose RG, Grabe S. The Explanatory Role of Relationship Power and Control in Domestic Violence Against Women in Nicaragua. Violence Against Women 2014; 20:972-93. [PMID: 25125492 DOI: 10.1177/1077801214546231] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study offers a feminist psychology analysis of various aspects of relationship power and control and their relative explanatory contribution to understanding physical, psychological, and sexual violence against women. Findings from structured interviews with 345 women from rural Nicaragua ( Mage = 44) overwhelmingly demonstrate that measures of power and control reflecting interpersonal relationship dynamics have the strongest predictive power for explaining violence when compared in multivariate analyses to several of the more commonly used measures. These findings have implications for future research and the evaluation of interventions designed to decrease levels of violence against women.
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19
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Lippman SA, Treves-Kagan S, Gilvydis JM, Naidoo E, Khumalo-Sakutukwa G, Darbes L, Raphela E, Ntswane L, Barnhart S. Informing comprehensive HIV prevention: a situational analysis of the HIV prevention and care context, North West Province South Africa. PLoS One 2014; 9:e102904. [PMID: 25028976 PMCID: PMC4100930 DOI: 10.1371/journal.pone.0102904] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2013] [Accepted: 06/25/2014] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Building a successful combination prevention program requires understanding the community's local epidemiological profile, the social community norms that shape vulnerability to HIV and access to care, and the available community resources. We carried out a situational analysis in order to shape a comprehensive HIV prevention program that address local barriers to care at multiple contextual levels in the North West Province of South Africa. METHOD The situational analysis was conducted in two sub-districts in 2012 and guided by an adaptation of WHO's Strategic Approach, a predominantly qualitative method, including observation of service delivery points and in-depth interviews and focus groups with local leaders, providers, and community members, in order to recommend context-specific HIV prevention strategies. Analysis began during fieldwork with nightly discussions of findings and continued with coding original textual data from the fieldwork notebooks and a select number of recorded interviews. RESULTS We conducted over 200 individual and group interviews and gleaned four principal social barriers to HIV prevention and care, including: HIV fatalism, traditional gender norms, HIV-related stigma, and challenges with communication around HIV, all of which fuel the HIV epidemic. At the different levels of response needed to stem the epidemic, we found evidence of national policies and programs that are mitigating the social risk factors but little community-based responses that address social risk factors to HIV. CONCLUSIONS Understanding social and structural barriers to care helped shape our comprehensive HIV prevention program, which address the four 'themes' identified into each component of the program. Activities are underway to engage communities, offer community-based testing in high transmission areas, community stigma reduction, and a positive health, dignity and prevention program for stigma reduction and improve communication skills. The situational analysis process successfully shaped key programmatic decisions and cultivated a deeper collaboration with local stakeholders to support program implementation.
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Affiliation(s)
- Sheri A. Lippman
- University of California San Francisco, Center for AIDS Prevention Studies, San Francisco, California, United States of America
| | - Sarah Treves-Kagan
- University of California San Francisco, Center for AIDS Prevention Studies, San Francisco, California, United States of America
| | - Jennifer M. Gilvydis
- University of Washington, International Training and Education Center for Health (ITECH) – South Africa, Pretoria, South Africa
| | - Evasen Naidoo
- University of Washington, International Training and Education Center for Health (ITECH) – South Africa, Pretoria, South Africa
| | - Gertrude Khumalo-Sakutukwa
- University of California San Francisco, Center for AIDS Prevention Studies, San Francisco, California, United States of America
| | - Lynae Darbes
- University of California San Francisco, Center for AIDS Prevention Studies, San Francisco, California, United States of America
| | - Elsie Raphela
- University of Washington, International Training and Education Center for Health (ITECH) – South Africa, Pretoria, South Africa
| | - Lebogang Ntswane
- University of Washington, International Training and Education Center for Health (ITECH) – South Africa, Pretoria, South Africa
| | - Scott Barnhart
- University of Washington, International Training and Education Center for Health, Seattle, Washington, United States of America
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20
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Upadhyay UD, Dworkin SL, Weitz TA, Foster DG. Development and validation of a reproductive autonomy scale. Stud Fam Plann 2014; 45:19-41. [PMID: 24615573 DOI: 10.1111/j.1728-4465.2014.00374.x] [Citation(s) in RCA: 105] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
No validated measures are currently available to assess women's ability to achieve their reproductive intentions, also referred to as "reproductive autonomy." We developed and validated a multidimensional instrument that can measure reproductive autonomy. We generated a pool of 26 items and included them in a survey that was conducted among 1,892 women at 13 family planning and 6 abortion facilities in the United States. Fourteen items were selected through factor analysis and grouped into 3 subscales to form a Reproductive Autonomy Scale: freedom from coercion; communication; and decision-making. Construct validity was demonstrated by a mixed-effects model in which the freedom from coercion subscale and the communication subscale were inversely associated with unprotected sex in the past three months. This new Reproductive Autonomy Scale offers researchers a reliable instrument with which to assess a woman's power to control matters regarding contraceptive use, pregnancy, and childbearing, and to evaluate interventions to increase women's autonomy domestically and globally.
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Affiliation(s)
- Ushma D Upadhyay
- Assistant Professor, Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, 1330 Broadway, Suite 1100, Oakland, CA 94612.
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21
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Schwartz RM, Weber KM, Schechter GE, Connors NC, Gousse Y, Young MA, Cohen MH. Psychosocial correlates of gender-based violence among HIV-infected and HIV-uninfected women in three US cities. AIDS Patient Care STDS 2014; 28:260-7. [PMID: 24724987 DOI: 10.1089/apc.2013.0342] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Gender-based violence (GBV) is common among women with and at risk for HIV, yet little is known about the GBV associated psychological factors that could be modifiable through behavioral interventions. The current study examined the associations between some of these psychological factors (i.e., hopelessness, consideration of future consequences, self esteem), mental health symptoms, substance abuse, and GBV among a sample of 736 HIV-infected and sociodemographically similar uninfected participants in the Women's Interagency HIV Study (WIHS). Results indicated high rates of lifetime GBV among the sample (58%), as well as high rates of childhood sexual abuse (CSA) (22.2%). HIV-infected women were more likely to be hopeless and to experience lower consideration of future consequences as compared to uninfected women. Multivariable analysis indicated that current non-injection drug use and a history of injection drug use were the main correlates of GBV and CSA, even when other psychosocial variables were included in analytic models. Being born outside of the US reduced the likelihood of GBV and CSA. Future research directions and intervention implications are discussed.
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Affiliation(s)
- Rebecca M. Schwartz
- Department of Population Health, North Shore-LIJ Health System, Hofstra North Shore-LIJ School of Medicine, Great Neck, New York
| | - Kathleen M. Weber
- Core Center, Cook County Health and Hospital System, Chicago, Illinois
| | - Gabrielle E. Schechter
- STAR Health Center, Department of Medicine, SUNY Downstate Medical Center, Brooklyn, New York
| | - Nina C. Connors
- STAR Health Center, Department of Medicine, SUNY Downstate Medical Center, Brooklyn, New York
| | - Yolene Gousse
- Department of Community Health Sciences, School of Public Health, SUNY Downstate Medical Center, Brooklyn, New York
| | - Mary A. Young
- Department of Medicine, Division of Infectious Diseases, Georgetown University Medical Center, Washington, District of Columbia
| | - Mardge H. Cohen
- Core Center, Cook County Health and Hospital System, Chicago, Illinois
- Departments of Medicine, Stroger Hospital and Rush University, Chicago, Illinois
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22
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Violence experiences among HIV-infected women and perceptions of male perpetrators' roles: a concurrent mixed method study. J Assoc Nurses AIDS Care 2014; 25:376-91. [PMID: 24503500 DOI: 10.1016/j.jana.2013.11.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2013] [Accepted: 11/13/2013] [Indexed: 11/23/2022]
Abstract
HIV disproportionately affects women, which propagates the disparities gap. This study was designed to (a) explore the personal, cognitive, and psychosocial factors of intimate partner violence among women with HIV; (b) explore the perceptions of male perpetrators' roles in contributing to violence; and (c) determine the implications for methodological and data source triangulation. A concurrent Mixed Method study design was used, including 30 African American male and female participants. Quantitative data were analyzed using descriptive statistics. Eleven themes were identified in the qualitative data from the female (n = 15) and 9 themes from the male (n = 15) participant interviews using Giorgi's technique. Data sources and methodological approaches were triangulated with relative convergence in the results. Preliminary data generated from this study could inform gender-based feasibility research studies. These studies could focus on integrating findings from this study in HIV/intimate partner violence prevention interventions and provide clinical support for women.
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23
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Hatcher AM, Colvin CJ, Ndlovu N, Dworkin SL. Intimate partner violence among rural South African men: alcohol use, sexual decision-making, and partner communication. CULTURE, HEALTH & SEXUALITY 2014; 16:1023-39. [PMID: 24939358 PMCID: PMC4490163 DOI: 10.1080/13691058.2014.924558] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Nearly one-third of South African men report enacting intimate partner violence. Beyond the direct health consequences for women, intimate partner violence is also linked to varied risk behaviours among men who enact it, including alcohol abuse, risky sex, and poor healthcare uptake. Little is known about how to reduce violence perpetration among men. We conducted retrospective, in-depth interviews with men (n = 53) who participated in a rural South African programme that targeted masculinities, HIV risk, and intimate partner violence. We conducted computer-assisted thematic qualitative coding alongside a simple rubric to understand how the programme may lead to changes in men's use of intimate partner violence. Many men described new patterns of reduced alcohol intake and improved partner communication, allowing them to respond in ways that did not lead to the escalation of violence. Sexual decision-making changed via reduced sexual entitlement and increased mutuality about whether to have sex. Men articulated the intertwined nature of each of these topics, suggesting that a syndemic lens may be useful for understanding intimate partner violence. These data suggest that alcohol and sexual relationship skills may be useful levers for future violence prevention efforts, and that intimate partner violence may be a tractable issue as men learn new skills for enacting masculinities in their household and in intimate relationships.
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Affiliation(s)
- Abigail M Hatcher
- a Bixby Centre for Global Reproductive Health, University of California , San Francisco , USA
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24
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Dworkin SL, Treves-Kagan S, Lippman SA. Gender-transformative interventions to reduce HIV risks and violence with heterosexually-active men: a review of the global evidence. AIDS Behav 2013; 17:2845-63. [PMID: 23934267 DOI: 10.1007/s10461-013-0565-2] [Citation(s) in RCA: 174] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Emerging out of increased attention to gender equality within HIV and violence prevention programming has been an intensified focus on masculinities. A new generation of health interventions has attempted to shift norms of masculinity to be more gender equitable and has been termed "gender-transformative." We carried out a systematic review of gender-transformative HIV and violence prevention programs with heterosexually-active men in order to assess the efficacy of this programming. After reviewing over 2,500 abstracts in a systematic search, a total of 15 articles matched review criteria. The evidence suggests that gender-transformative interventions can increase protective sexual behaviors, prevent partner violence, modify inequitable attitudes, and reduce STI/HIV, though further trials are warranted, particularly in establishing STI/HIV impacts. In the conclusion, we discuss the promises and limitations of gender-transformative work with men and make suggestions for future research focused on HIV and/or violence prevention.
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Affiliation(s)
- Shari L Dworkin
- Department of Social and Behavioral Sciences, University of California at San Francisco, 3333 California Street, LHTS #455, San Francisco, CA, 94118, USA,
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25
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Dworkin SL, Grabe S, Lu T, Hatcher AM, Hatcher A, Kwena Z, Bukusi E, Mwaura-Muiru E. Property rights violations as a structural driver of women's HIV risks: a qualitative study in Nyanza and Western Provinces, Kenya. ARCHIVES OF SEXUAL BEHAVIOR 2013; 42:703-13. [PMID: 23179234 PMCID: PMC3753176 DOI: 10.1007/s10508-012-0024-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2011] [Revised: 06/19/2012] [Accepted: 07/28/2012] [Indexed: 05/03/2023]
Abstract
While access to and control over assets can minimize women's HIV risk, little is known about the processes through which property rights violations increase the sexual transmission of HIV. The current study focused on two rural areas in Nyanza and Western Province, Kenya where HIV prevalence was high (23.8-33 %) and property rights violations were common. The current work drew on in-depth interview data collected from 50 individuals involved in the development and implementation of a community-led land and property rights program. The program was designed to respond to property rights violations, prevent disinheritance and asset stripping, and reduce HIV risk among women. In our findings, we detailed the social and economic mechanisms through which a loss of property rights was perceived to influence primary and secondary prevention of HIV. These included: loss of income, loss of livelihood and shelter, and migration to slums, markets, or beaches where the exchange of sex for food, money, shelter, clothing, or other goods was common. We also examined the perceived influence of cultural practices, such as wife inheritance, on HIV risk. In the conclusions, we made recommendations for future research in the science-base focused on the development of property ownership as a structural HIV prevention and treatment intervention.
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Affiliation(s)
- Shari L Dworkin
- Social and Behavioral Sciences and Center for AIDS Prevention Studies, University of California at San Francisco, 3333 California Street, LHTS #455, San Francisco, CA 94118,
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26
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Lotfi R, Ramezani Tehrani F, Merghati Khoei E, Yaghmaei F, Dworkin SL. How do women at risk of HIV/AIDS in Iran perceive gender norms and gendered power relations in the context of safe sex negotiations? ARCHIVES OF SEXUAL BEHAVIOR 2013; 42:873-881. [PMID: 23224750 DOI: 10.1007/s10508-012-0040-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2011] [Revised: 06/26/2012] [Accepted: 09/15/2012] [Indexed: 06/01/2023]
Abstract
Sexual transmission of HIV/AIDS among women is growing in the Middle East region. Despite the fact that there are numerous gender-related sociocultural factors influencing HIV/AIDS protective behaviors, little gender-specificity is carried out in HIV prevention in Iran. In order to close this gap, we aimed to provide preliminary work that explored the perceptions that women at risk of HIV had about gender norms and gendered power and their ability to protect themselves against HIV/AIDS. Twenty-five semi-structured in-depth interviews were conducted with women at risk of HIV/AIDS, aged 21-49 years, at Voluntary Counseling and Testing Centers or Drop in Centers in Tehran, Iran. Results showed that perceived gender norms were essential barriers of protective behavior through sexual socialization, male control over condom use and sexual decision-making, male pleasure predominating in sexual encounters and sexual double standards, and economic dependencies. In the conclusions, we consider how HIV/AIDS preventive programs can be structured to be gender-sensitive and empowering in Iran.
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Affiliation(s)
- Razieh Lotfi
- Department of Midwifery, School of Nursing and Midwifery, Alborz University of Medical Sciences, Karaj, Iran
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27
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Stern E, Buikema R. The relational dynamics of hegemonic masculinity among South African men and women in the context of HIV. CULTURE, HEALTH & SEXUALITY 2013; 15:1040-1054. [PMID: 23805918 DOI: 10.1080/13691058.2013.805817] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
In South Africa, the frequent positioning of men's sexual behaviours as a prime driver of the HIV epidemic has generated much interest in men's sexuality. However, the relational nature of dominant male norms that exacerbate the risk of HIV transmission is inadequately understood. This study used sexual biographies to explore how men and women negotiate gendered norms and how this affects their sexual and reproductive health (SRH). A total of 50 sexual-history interviews and 10 focus group discussions were conducted with men, and 25 sexual-history interviews with women, with participants sampled from three age categories (ages 18-24, 25-55 and 55+years), a range of cultural and racial backgrounds and urban and rural sites across five provinces in South Africa. The narratives illustrate that men and women's SRH is largely dependent on the type and quality of their relationships. Men's sexuality was regularly depicted as being detached from intimacy and uncontrollable, which was premised as being opposite from and/or superior to women's sexuality and could justify men's high-risk sexual behaviours. Yet many participants also supported gender equitable relationships and endorsed accountable and healthy SRH behaviours. The narratives reveal that HIV-risky dominant male norms should be addressed relationally for the sake of better SRH outcomes.
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Affiliation(s)
- Erin Stern
- a Women's Health Research Unit , School of Public Health, University of Cape Town , Cape Town , South Africa
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Dworkin SL, Hatcher AM, Colvin C, Peacock D. Impact of a Gender-Transformative HIV and Antiviolence Program on Gender Ideologies and Masculinities in Two Rural, South African Communities. MEN AND MASCULINITIES 2013; 16:10.1177/1097184X12469878. [PMID: 24311940 PMCID: PMC3848879 DOI: 10.1177/1097184x12469878] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
"One Man Can" (OMC) is a rights-based gender equality and health program implemented by Sonke Gender Justice Network (Sonke) in South Africa. The program seeks to reduce the spread and impact of HIV and AIDS and reduce violence against women and men. To understand how OMC workshops impact masculinities, gender norms, and perceptions of women's rights, an academic/non-governmental organization (NGO) partnership was carried out with the University of Cape Town, the University of California at San Francisco, and Sonke. Sixty qualitative, in-depth interviews were carried out with men who had completed OMC workshops and who were recruited from Sonke's partner organizations that were focused on gender and/or health-related services. Men were recruited who were over age 18 and who participated in OMC workshops in Limpopo and Eastern Cape Provinces, South Africa. Results reveal how men reconfigured notions of hegemonic masculinity both in terms of beliefs and practices in relationships, households, and in terms of women's rights. In the conclusions, we consider the ways in which the OMC program extends public health research focused on masculinities, violence, and HIV/AIDS. We then critically assess the ways in which health researchers and practitioners can bolster men's engagement within programs focused on gender equality and health.
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Affiliation(s)
- Shari L. Dworkin
- Department of Social and Behavioral Sciences, University of California at San Francisco, San Francisco, CA, USA
| | - Abigail M. Hatcher
- Bixby Center for Global Reproductive Health, University of California at San Francisco, San Francisco, CA, USA
| | - Chris Colvin
- Centre for Infectious Disease Epidemiology and Research (CIDER), School of Public Health and Family Medicine, University of Cape Town, South Africa
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Tanzanian Couples' Perspectives on Gender Equity, Relationship Power, and Intimate Partner Violence: Findings from the RESPECT Study. AIDS Res Treat 2012; 2012:187890. [PMID: 23320151 PMCID: PMC3540749 DOI: 10.1155/2012/187890] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2012] [Revised: 11/29/2012] [Accepted: 11/29/2012] [Indexed: 11/21/2022] Open
Abstract
Intimate partner violence (IPV) is widely prevalent in Tanzania. Inequitable gender norms manifest in men's and women's attitudes about power and decision making in intimate relationships and are likely to play an important role in determining the prevalence of IPV. We used data from the RESPECT study, a randomized controlled trial that evaluated an intervention to prevent sexually transmitted infections in a cohort of young Tanzanian men and women, to examine the relationship between couples' attitudes about IPV, relationship power, and sexual decision making, concordance on these issues, and women's reports of IPV over 12 months. Women expressed less equitable attitudes than men at baseline. Over time, participants' attitudes tended to become more equitable and women's reports of IPV declined substantially. Multivariable logistic regression analyses suggested that inequitable attitudes and couple discordance were associated with higher risk of IPV. Our findings point to the need for a better understanding of the role that perceived or actual imbalances in relationship power have in heightening IPV risk. The decline in women's reports of IPV and the trend towards gender-equitable attitudes indicate that concerted efforts to reduce IPV and promote gender equity have the potential to make a positive difference in the relatively short term.
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Ghanotakis E, Peacock D, Wilcher R. The importance of addressing gender inequality in efforts to end vertical transmission of HIV. J Int AIDS Soc 2012; 15 Suppl 2:17385. [PMID: 22789642 PMCID: PMC3499941 DOI: 10.7448/ias.15.4.17385] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2012] [Revised: 04/13/2012] [Accepted: 05/07/2012] [Indexed: 11/24/2022] Open
Abstract
ISSUES The recently launched "Global Plan towards the Elimination of New HIV Infections among Children by 2015 and Keeping their Mothers Alive" sets forth ambitious targets that will require more widespread implementation of comprehensive prevention of vertical HIV transmission (PMTCT) programmes. As PMTCT policymakers and implementers work toward these new goals, increased attention must be paid to the role that gender inequality plays in limiting PMTCT programmatic progress. DESCRIPTION A growing body of evidence suggests that gender inequality, including gender-based violence, is a key obstacle to better outcomes related to all four components of a comprehensive PMTCT programme. Gender inequality affects the ability of women and girls to protect themselves from HIV, prevent unintended pregnancies and access and continue to use HIV prevention, care and treatment services. LESSONS LEARNED In light of this evidence, global health donors and international bodies increasingly recognize that it is critical to address the gender disparities that put women and children at increased risk of HIV and impede their access to care. The current policy environment provides unprecedented opportunities for PMTCT implementers to integrate efforts to address gender inequality with efforts to expand access to clinical interventions for preventing vertical HIV transmission. Effective community- and facility-based strategies to transform harmful gender norms and mitigate the impacts of gender inequality on HIV-related outcomes are emerging. PMTCT programmes must embrace these strategies and expand beyond the traditional focus of delivering ARV prophylaxis to pregnant women living with HIV. Without greater implementation of comprehensive, gender transformative PMTCT programmes, elimination of vertical transmission of HIV will remain elusive.
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Affiliation(s)
- Elena Ghanotakis
- Elizabeth Glaser Pediatric AIDS Foundation, Washington, DC, USA.
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Fu J, Gavaghan A, Millett G, Walsh T. Replicating PEPFAR’s Success: How Interventions Shown To Be Effective Abroad Can Be Applied To The AIDS Epidemic In The US. Health Aff (Millwood) 2012; 31:1585-92. [DOI: 10.1377/hlthaff.2012.0255] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Joe Fu
- Joe Fu ( ) is a strategic information officer in the Office of the US Global AIDS Coordinator at the Department of State, in Washington, D.C
| | - Ann Gavaghan
- Ann Gavaghan is a senior adviser in the Office of the US Global AIDS Coordinator
| | - Gregorio Millett
- Gregorio Millett is a senior behavioral scientist in the Division of HIV/AIDS Prevention at the Centers for Disease Control and Prevention, in Atlanta, Georgia
| | - Tom Walsh
- Tom Walsh is deputy coordinator for external relations in the Office of the US Global AIDS Coordinator
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Combined structural interventions for gender equality and livelihood security: a critical review of the evidence from southern and eastern Africa and the implications for young people. J Int AIDS Soc 2012; 15 Suppl 1:1-10. [PMID: 22713350 PMCID: PMC3499786 DOI: 10.7448/ias.15.3.17362] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2011] [Revised: 03/21/2012] [Accepted: 04/29/2012] [Indexed: 11/08/2022] Open
Abstract
Background Young people in southern and eastern Africa remain disproportionately vulnerable to HIV with gender inequalities and livelihood insecurities being key drivers of this. Behavioural HIV prevention interventions have had weak outcomes and a new generation of structural interventions have emerged seeking to challenge the wider drivers of the HIV epidemic, including gender inequalities and livelihood insecurities. Methods We searched key academic data bases to identify interventions that simultaneously sought to strengthen people's livelihoods and transform gender relationships that had been evaluated in southern and eastern Africa. Our initial search identified 468 articles. We manually reviewed these and identified nine interventions that met our criteria for inclusion. Results We clustered the nine interventions into three groups: microfinance and gender empowerment interventions; supporting greater participation of women and girls in primary and secondary education; and gender empowerment and financial literacy interventions. We summarise the strengths and limitations of these interventions, with a particular focus on what lessons may be learnt for young people (18–24). Conclusions Our review identified three major lessons for structural interventions that sought to transform gender relationships and strengthen livelihoods: 1) interventions have a narrow conceptualisation of livelihoods, 2) there is limited involvement of men and boys in such interventions, 3) studies have typically been done in stable populations. We discuss what this means for future interventions that target young people through these methods.
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Abstract
Ed Mills and colleagues argue that a more balanced approach to gender is needed so that both men and women are involved in HIV treatment and prevention.
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Affiliation(s)
- Edward J Mills
- Faculty of Health Sciences, University of Ottawa, Ottawa, Canada.
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