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Walker DM, Lefebvre RC, Davis A, Shiu-Yee K, Chen S, Jackson RD, Helme DW, Oga EA, Oser CB, Stotz C, Balvanz P, Asman K, Holloway J, Lewis N, Knudsen HK. Differences in perceptions of community stigma towards opioid use disorder between community substance use coalition members and the general public. J Subst Use Addict Treat 2024; 158:209276. [PMID: 38142801 PMCID: PMC10947872 DOI: 10.1016/j.josat.2023.209276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 11/01/2023] [Accepted: 12/15/2023] [Indexed: 12/26/2023]
Abstract
INTRODUCTION To examine differences in perceptions about community stigma towards individuals with opioid use disorder (OUD) between community members involved in the opioid response (i.e., coalition members) and the general public, and how community geography may moderate this relationship. METHODS This study administered identical cross-sectional surveys about perceived community opioid-related stigma to two distinct populations in 66 communities participating in the HEALing Communities Study prior to the intervention period (i.e., coalition members, November 2019-January 2020; residents, March-April 2020). Linear-mixed models compared survey responses of populations, including the moderating effect of community rural/urban location. RESULTS A total of 826 coalition members and 1131 residents completed the surveys. The study found no differences between the coalition members and residents for general perceived community opioid-related stigma. In both urban and rural communities, coalition members reported greater perceived community stigma than residents reported towards medication for opioid use disorder (MOUD), naloxone, and drug treatment as an alternative to incarceration. CONCLUSION Our findings suggest similar perceived community opioid-related stigma between coalition members and residents, yet differences emerge related to evidence-based practices (i.e., MOUD, naloxone, and drug treatment as an alternative to incarceration) to reduce opioid overdose deaths. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04111939.
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Affiliation(s)
- Daniel M Walker
- Department of Family and Community Medicine, College of Medicine, The Ohio State University, 700 Ackerman Rd, Suite 4000, Columbus, OH 43202, USA; CATALYST, The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research, College of Medicine, The Ohio State University, 700 Ackerman Rd, Suite 4000, Columbus, OH 43202, USA.
| | - R Craig Lefebvre
- RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC 22709, USA
| | - Alissa Davis
- School of Social Work, Columbia University, 1255 Amsterdam Avenue, New York, NY 10027, USA
| | - Karen Shiu-Yee
- CATALYST, The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research, College of Medicine, The Ohio State University, 700 Ackerman Rd, Suite 4000, Columbus, OH 43202, USA
| | - Sadie Chen
- CATALYST, The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research, College of Medicine, The Ohio State University, 700 Ackerman Rd, Suite 4000, Columbus, OH 43202, USA
| | - Rebecca D Jackson
- Center for Clinical and Translational Science and the Division of Endocrinology, Diabetes, and Metabolism, Department of Internal Medicine, The Ohio State University, 376 W. 10th Ave, Suite 205, Columbus, OH 43210, USA
| | - Donald W Helme
- Department of Communication, College of Communication and Information, University of Kentucky, 263 Blazer Dining, Lexington, KY 40506, USA
| | - Emmanuel A Oga
- RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC 22709, USA
| | - Carrie B Oser
- Department of Sociology, Center for Health Equity Transformation, Center on Drug & Alcohol Research, University of Kentucky, 1531 Patterson Office Tower, Lexington, KY 40508, USA
| | - Caroline Stotz
- Boston Medical Center, One Boston Medical Center Place, Boston, MA 02118, USA
| | - Peter Balvanz
- Boston Medical Center, One Boston Medical Center Place, Boston, MA 02118, USA
| | - Kat Asman
- RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC 22709, USA
| | - JaNae Holloway
- RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC 22709, USA
| | - Nicky Lewis
- Department of Communication, College of Communication and Information, University of Kentucky, 263 Blazer Dining, Lexington, KY 40506, USA
| | - Hannah K Knudsen
- Department of Sociology, Center for Health Equity Transformation, Center on Drug & Alcohol Research, University of Kentucky, 1531 Patterson Office Tower, Lexington, KY 40508, USA; Department of Behavioral Science and Center on Drug and Alcohol Research, University of Kentucky, 845 Angliana Avenue, Room 204, Lexington, KY 40508, USA
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Balvanz P, Singh B, Mwikoko G, Yamanis TJ, Kilonzo MN, Conserve DF, Mulawa MI, Kajuna D, Kajula LJ, Maman S. Development and implementation of a process evaluation for intervention quality improvement of a community-based behavioral HIV intervention trial in Tanzania. Z Gesundh Wiss 2023; 31:877-884. [PMID: 37621988 PMCID: PMC10448665 DOI: 10.1007/s10389-021-01618-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 06/11/2021] [Indexed: 10/21/2022]
Abstract
Aim Process evaluations for social and behavioral interventions are increasingly important as interventions become more complex and multi-faceted. Conducting process evaluations in low-resource international settings can be challenging. Process evaluations in low-resource international settings can help inform and improve quality of ongoing intervention implementation. We conducted a process evaluation of a cluster-randomized controlled trial to assess the efficacy of a microfinance and health leadership program on sexually transmitted infections and intimate partner violence perpetration among young men in Tanzania. Subject and Methods Our trial included 1,491 participants and the intervention lasted two years. We collected process data on microfinance loan uptake and repayment, and health leaders' health conversations with peers to monitor intervention reach and dose received. We developed a database system that allowed offline data collection and synced to a central database when internet was accessible. Research staff in the U.S. accessed data from the central database to analyze and create regular implementation reports. Results Process graphical reports facilitated identification of implementation challenges and enabled us to resolve issues before they worsened. For example, from a group with low microfinance loan repayment we learned area participants perceived the loan to be a grant, and then we clarified the misinformation with participants. Conclusions The process evaluation helped inform ongoing intervention implementation, including approaches to improve reach and uptake of interventions. Field staff time was protected by systemizing the sharing of data processing and analyses across the global team.
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Affiliation(s)
- Peter Balvanz
- The University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Department of Health Behavior, Rosenau Hall, CB 7440, Chapel Hill, NC 27599
| | - Basant Singh
- Independent Consultant, A-14, SKL Elite, Vaishali Estate. Jaipur, India 302012
| | - Gema Mwikoko
- Muhimbili University of Health and Allied Sciences, Department of Psychiatry and Mental Health, PO Box 65466, Dar es Salaam, Tanzania
| | - Thespina J. Yamanis
- American University, School of International Service, 4400 Massachusetts Avenue, NW, Washington, DC 20016
| | - Mrema N. Kilonzo
- Muhimbili University of Health and Allied Sciences, Department of Psychiatry and Mental Health, PO Box 65466, Dar es Salaam, Tanzania
| | - Donaldson F. Conserve
- University of South Carolina, Arnold School of Public Health, Health Promotion, Education, and Behavior. 921 Assembly St, Columbia, SC 29208
| | - Marta I. Mulawa
- Duke Global Health Institute, Duke University, 310 Trent Dr., Box 90519, Durham, NC 27708
| | - Deus Kajuna
- Muhimbili University of Health and Allied Sciences, Department of Psychiatry and Mental Health, PO Box 65466, Dar es Salaam, Tanzania
| | - Lusajo J. Kajula
- Muhimbili University of Health and Allied Sciences, Department of Psychiatry and Mental Health, PO Box 65466, Dar es Salaam, Tanzania
| | - Suzanne Maman
- The University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Department of Health Behavior, Rosenau Hall, CB 7440, Chapel Hill, NC 27599
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Gangaramany A, Balvanz P, Gichane MW, Goetschius S, Sharma S, Sharma K, Mulhausen J, Noble-Campbell P, Wamoyi J, Maman S, Prasad R. Developing a framework for cash transfer programs that foster sustained economic empowerment to reduce sexual risk among adolescent girls and young women: a qualitative study. BMC Public Health 2021; 21:122. [PMID: 33430861 PMCID: PMC7802135 DOI: 10.1186/s12889-020-10130-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 12/25/2020] [Indexed: 11/10/2022] Open
Abstract
Background Transactional sexual relationships contribute to a high incidence of HIV infection among adolescent girls and young women (AGYW) living in low-resource settings. Cash transfers (CT) are a structural approach to reduce sexual risk behaviors, but their positive economic effects frequently fade after the program ends. We aimed to understand AGYW’s decision-making processes related to sexual, relationship, and financial decisions, in order to design a framework for a CT program that could lead to long-term financial independence and reduced transactional sex among AGYW. Methods We conducted qualitative research with AGYW participating in a CT program in Tanzania. Phase one was formative research to understand the context and experiences of AGYW regarding sexual behavior, relationships, and finances. Participants included 36 AGYW (15–23 years old), 15 influencers of AGYW (mothers and male partners) and 10 financially empowered women (FEW – women aged 20–30 with a sustained, reliable source of income independent of their partner). Decisions and decision-making contexts of AGYW that we identified in phase one informed the content of phase two. In phase two we simulated scenarios for decision-making and economic goals with 80 AGYW and 40 FEW, in order to identify key principles or intervention opportunities to guide development of a CT program framework. Results Through phases one and two of our research we identified three key themes in AGYW’s vision of their desired future economic state: 1) positive social image, 2) power balance and respect, and 3) emotional and economic security. An important theme distinguishing AGYW from FEW was that AGYW lacked a vision to build self-agency. Conclusions Our findings suggest that providing economic resources to AGYW through CT without ensuring self-agency is unlikely to be an effective long-term intervention for economic empowerment. Using these findings we developed a framework for CT programs with three key pillars for developing self-agency: 1) emotional efficacy, to increase AGYW’s perception of rewards associated with developing self-agency; 2) social efficacy, to build constructive relationships and exit negative relationships that inhibit self-agency, and 3) economic efficacy, to help AGYW build a resilient stream of financial resources. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-020-10130-8.
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Affiliation(s)
- Alok Gangaramany
- Final Mile Consulting LLC, 141 W. Jackson Blvd, Suite 3302, Chicago, IL, 60604, USA.
| | - Peter Balvanz
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Dr, Chapel Hill, NC, 27599, USA
| | - Margaret Waruguru Gichane
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Dr, Chapel Hill, NC, 27599, USA
| | - Stephan Goetschius
- Final Mile Consulting LLC, 141 W. Jackson Blvd, Suite 3302, Chicago, IL, 60604, USA
| | - Saransh Sharma
- Final Mile Consulting LLC, 141 W. Jackson Blvd, Suite 3302, Chicago, IL, 60604, USA
| | - Krittika Sharma
- Final Mile Consulting LLC, 141 W. Jackson Blvd, Suite 3302, Chicago, IL, 60604, USA
| | - Jeff Mulhausen
- Upstream Thinking LLC, 1400 Lavaca Street, 8th Floor, Austin, TX, 78701, USA
| | - Paul Noble-Campbell
- Upstream Thinking LLC, 1400 Lavaca Street, 8th Floor, Austin, TX, 78701, USA
| | - Joyce Wamoyi
- National Institute of Medical Research, MITU, Isamilo Street, P.O. Box 11936, Mwanza, Tanzania
| | - Suzanne Maman
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Dr, Chapel Hill, NC, 27599, USA
| | - Ram Prasad
- Final Mile Consulting LLC, 141 W. Jackson Blvd, Suite 3302, Chicago, IL, 60604, USA
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Wamoyi J, Balvanz P, Atkins K, Gichane M, Majani E, Pettifor A, Maman S. Conceptualization of Empowerment and Pathways Through Which Cash Transfers Work to Empower Young Women to Reduce HIV Risk: A Qualitative Study in Tanzania. AIDS Behav 2020; 24:3024-3032. [PMID: 32236739 PMCID: PMC7728638 DOI: 10.1007/s10461-020-02850-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Although cash transfers (CT) are hypothesized to reduce AGYW’s HIV risk, little is known about the mechanisms through which CT empower AGYW. We explored the impact of a CT intervention on AGYW’s sexual decision-making in order to describe the pathways through which the cash may influence risk behavior. The study employed qualitative methods involving: 20 longitudinal in-depth interviews (IDIs), 40 cross-sectional IDIs, 20 narrative IDIs, and two focus group discussions with AGYW ages 15–23 participating in a CT intervention. AGYW’s conceptualized empowerment as: “independence”, “hope and aspiration”. Potential pathways through which CT empowered AGYW were: economic, hope and aspiration for a better future, and access to knowledge. As a result of this empowerment, AGYW reported reductions in transactional sex, experiences of intimate partner violence, and risky-sexual behaviour. A sense of responsibility developed through economic empowerment, enhanced participants’ self-esteem and confidence in decision-making leading to changes in AGYW’s sexual risk behaviors.
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Gichane MW, Wamoyi J, Atkins K, Balvanz P, Maman S, Majani E, Pettifor A. The influence of cash transfers on engagement in transactional sex and partner choice among adolescent girls and young women in Northwest Tanzania. Cult Health Sex 2020; 24:1-15. [PMID: 32935625 DOI: 10.1080/13691058.2020.1811890] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 08/14/2020] [Indexed: 06/11/2023]
Abstract
Cash transfers are theorised to reduce adolescent girls and young women's economic vulnerability and engagement in transactional sex; however, the processes involved remain unclear. We conducted longitudinal cross-sectional, and narrative timeline in-depth interviews with young women aged 15-23 years in northern Tanzania enrolled in a cash transfer intervention. We analysed data using a thematic approach guided by the transactional sex framework. We summarised data and compared findings to the domains of the framework. Participants reported relationships in the 'sex and material expression of love' domain characterised by emotional intimacy and loose ties between material support and sex, and the 'sex for basic needs' domain characterised by limited emotional intimacy, economic vulnerability, and a clear exchange between material support and sex. Some participants expressed that cash transfers provided business capital and savings which enabled them to decrease 'sex for basic needs'. Cash transfers influenced transactional sex engagement by altering partner selection criteria such as from an emphasis on what men could provide to a focus on relationship stability. Findings suggest that cash transfers have the potential to reduce young women's transactional relationships motivated by economic vulnerability.
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Affiliation(s)
- Margaret W Gichane
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC, USA
| | - Joyce Wamoyi
- Department of Sexual and Reproductive Health, National Institute for Medical Research, Mwanza Centre, Mwanza, Tanzania
| | - Kaitlyn Atkins
- Social and Behavioral Interventions Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Peter Balvanz
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC, USA
| | - Suzanne Maman
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC, USA
| | | | - Audrey Pettifor
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC, USA
- Carolina Population Center, University of North Carolina at Chapel Hill, NC, USA
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Maman S, Mulawa MI, Balvanz P, McNaughton Reyes HL, Kilonzo MN, Yamanis TJ, Singh B, Kajula LJ. Results from a cluster-randomized trial to evaluate a microfinance and peer health leadership intervention to prevent HIV and intimate partner violence among social networks of Tanzanian men. PLoS One 2020; 15:e0230371. [PMID: 32196514 PMCID: PMC7083321 DOI: 10.1371/journal.pone.0230371] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 02/26/2020] [Indexed: 11/19/2022] Open
Abstract
Despite calls to engage men in HIV and intimate partner violence (IPV) prevention efforts, effective approaches to reach and engage men in low-resource, high-HIV prevalence settings are limited. We identified and engaged social networks of mostly young men in a study designed to evaluate the efficacy of a combined microfinance and peer health leadership intervention to prevent HIV and IPV. We conducted a cluster-randomized trial among 60 social networks locally referred to as “camps” within Dar es Salaam, Tanzania. Camps were randomly assigned (1:1) to a microfinance and peer health leadership intervention or a control condition that received a brief delayed intervention after the study’s conclusion. Allocation was not masked to participants or researchers. Behavioral assessments were conducted at baseline and 30-months post-intervention launch, with biological samples drawn at 30-months to test for sexually-transmitted infections (STIs). Primary outcomes included prevalence of STIs and past-year IPV perpetration. Secondary outcomes included STI sexual risk behaviors and past-year HIV testing. Proximal intervention targets included inequitable gender norm attitudes and hope. A modified Poisson regression approach was used to estimate intention-to-treat intervention effects on outcomes assessed at the 30-month follow-up. We enrolled 1,258 men within 60 camps. Of these men, 1,029 (81.8%) completed the 30-month follow-up. There were no differences by condition in STI prevalence, IPV perpetration, or sexual risk behaviors at the 30-month follow-up. Intervention participants reported greater levels of past-year HIV testing, controlling for baseline testing (aRR 1.13 95% CI 1.005–1.28). They also reported significantly lower levels of inequitable gender norm attitudes (adjusted effect -0.11, 95% CI -0.21–0.003). We successfully engaged and retained social networks of men in this multilevel intervention study. While we did not see an effect on the primary outcomes, our intervention successfully improved HIV testing and reduced inequitable gender norm attitudes.
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Affiliation(s)
- Suzanne Maman
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, United States of America
- * E-mail:
| | - Marta I. Mulawa
- Duke Global Health Institute, Duke University, Durham, NC, United States of America
| | - Peter Balvanz
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, United States of America
| | - H. Luz McNaughton Reyes
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, United States of America
| | - Mrema N. Kilonzo
- Department of Psychiatry and Mental Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Thespina J. Yamanis
- School of International Service, American University, Washington, DC, United States of America
| | - Basant Singh
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, United States of America
| | - Lusajo J. Kajula
- Department of Psychiatry and Mental Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
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Wamoyi J, Balvanz P, Gichane MW, Maman S, Mugunga S, Majani E, Pettifor A. Decision-making and cash spending patterns of adolescent girls and young women participating in a cash-transfer intervention in Tanzania: Implications for sexual health. Glob Public Health 2019; 15:587-597. [PMID: 31809640 DOI: 10.1080/17441692.2019.1692891] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Although cash transfers (CT) have been recommended as a strategy to address structural drivers of HIV, the evidence of the effects of CT on sexual risk and HIV outcomes is mixed. This could partly be due to CT implementation dynamics and beneficiary interpersonal factors. We conducted an assessment of CT component of the DREAMS programme in Tanzania. We explored how AGYW spent their CT over time, to whom they disclosed cash receipt, and where they sought advice on CT use. The study employed qualitative research methods including: 20 longitudinal in-depth interviews (IDIs) and 60 cross-sectional IDIs with AGYW in the CT programme. Data were analysed thematically. AGYW use of CT fell into five categories: business development, survival, self-care, helping family, and savings. The primary uses of CT funds were investment in businesses and livestock for savings. AGYW use of cash changed over instalments. AGYW consulted a variety of sources when deciding on how to use the cash, primarily mothers, programme personnel, and long-term partners/husbands. CT programmes that give cash directly to AGYW and have a strong entrepreneurial mentorship component could have implications for HIV prevention, SRH, and overall social and economic development.
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Affiliation(s)
- Joyce Wamoyi
- National Institute of Medical Research, Mwanza, Tanzania
| | - Peter Balvanz
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Margaret W Gichane
- 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
| | - Samuel Mugunga
- National Institute of Medical Research, Mwanza, Tanzania
| | - Esther Majani
- Sauti Program USAID Grantee, Dar Es Salaam, Tanzania
| | - Audrey Pettifor
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Kajula LJ, Kilonzo MN, Conserve DF, Mwikoko G, Kajuna D, Balvanz P, Yamanis TJ, Mulawa MI, Hill LM, Mbwambo JK, Maman S. Engaging Young Men as Community Health Leaders in an STI and Intimate Partner Violence Prevention Trial in Dar es Salaam, Tanzania. Glob Soc Welf 2019; 6:259-266. [PMID: 31857942 PMCID: PMC6921932 DOI: 10.1007/s40609-018-00134-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND This article presents lessons learned from a microfinance and health intervention for young men designed to prevent sexually transmitted infections (STI) and intimate partner violence (IPV) in Dar es Salaam, Tanzania. We describe the different strategies we used to identify and train young men to become change agents within their social networks. DESCRIPTION A cluster-randomized trial with 60 camps was undertaken in the Kinondoni District of Dar es Salaam. A total of 170 members from 30 intervention camps were trained in March 2014 as popular opinion leaders (POLs), whom we call Camp Health Leaders (CHLs). We describe the process of nominating, training, and retaining CHLs. We also describe our monitoring process, which included the collection of weekly diaries assessing topics discussed, number of peers engaged in conversations, reactions of peers, and challenges faced. LESSONS LEARNED POLs within naturally existing social networks can be engaged in STI and IPV prevention initiatives. Continuous efforts in retention, such as holding community advisory board (CAB) meetings, developing prevention slogans and t-shirts, and offering small grants to POL teams for intervention activities, were important to keeping POLs engaged in the intervention. Further, booster-training sessions were critical to maintain the message of the project and ensure that the challenges POLs face with implementing the programs were addressed in a timely manner. CONCLUSION Recruiting POLs in a Tanzanian urban setting and engaging them in STI and IPV reduction through social networks is possible. Training POLs in health information and interpersonal communication is important. Utilizing booster sessions and a variety of retention strategies for POLs in programs that aim to reduce IPV and STI infections among young men is essential to maintain the health leaders' engagement in the intervention as well as intervention fidelity.
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Affiliation(s)
- Lusajo J. Kajula
- Department of Psychiatry, Muhimbili University of Health
and Allied Sciences (MUHAS), Off United Nations Road, Dar es Salaam, Tanzania
- UNICEF Office of Research- Innocenti
| | - Mrema N. Kilonzo
- Department of Psychiatry, Muhimbili University of Health
and Allied Sciences (MUHAS), Off United Nations Road, Dar es Salaam, Tanzania
| | | | - Gema Mwikoko
- Department of Psychiatry, Muhimbili University of Health
and Allied Sciences (MUHAS), Off United Nations Road, Dar es Salaam, Tanzania
| | - Deus Kajuna
- Department of Psychiatry, Muhimbili University of Health
and Allied Sciences (MUHAS), Off United Nations Road, Dar es Salaam, Tanzania
| | | | | | | | | | - Jessie K. Mbwambo
- Department of Psychiatry, Muhimbili University of Health
and Allied Sciences (MUHAS), Off United Nations Road, Dar es Salaam, Tanzania
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Pettifor A, Wamoyi J, Balvanz P, Gichane MW, Maman S. Cash plus: exploring the mechanisms through which a cash transfer plus financial education programme in Tanzania reduced HIV risk for adolescent girls and young women. J Int AIDS Soc 2019; 22 Suppl 4:e25316. [PMID: 31328425 PMCID: PMC6643075 DOI: 10.1002/jia2.25316] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 05/08/2019] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION Cash transfers have been promoted as a means to reduce HIV risk for adolescent girls and young women (AGYW) in sub-Saharan Africa. One of the main mechanisms whereby they are hypothesized to reduce risk is by deterring transactional sex. In this paper, we use qualitative methods to explore participant experiences, perspectives and reported behaviours of a cash transfer plus financial education programme among out of school, 15- to 23-year-old AGYWs in rural Tanzania with a focus on partner choice and transactional sex. METHODS We conducted 60 in-depth interviews (IDIs) and 20 narrative timeline interviews with participants of the PEPFAR DREAMS Sauti/WORTH+ cash transfer programme between June 2017 and July 2018. Interviews were taped, transcribed and translated from Kiswahili to English. Transcripts were coded and analysed for key themes. RESULTS We found that participants in a cash transfer plus programme discussed behaviours that could reduce HIV risk through decreasing their dependence on male sex partners. There appeared to be two main mechanisms for this. One, young women discussed the cash transfer providing for basic needs (e.g. food, toiletries) which appeared to reduce their dependence on male sex partners who previously provided these goods (e.g. transactional sex). This experience was more pronounced among the poorest participants. Two, young women discussed how the financial education/business development aspect of the programme empowered them to refuse some sex partners; unmarried women discussed these experiences more than married women. Social support from family and programme mentors appeared to strengthen young women's ability to successful start businesses, produce income and thus be less dependent on partners. CONCLUSIONS The cash transfer programme may have reduced AGYW engagement in transactional sex that occurred to meet basic needs (one form of transactional sex). The financial education/business development and mentorship elements of the programme appeared important in building AGYW agency, self-esteem and future orientation which may support AGYWs in refusing unwanted sex partners. Future cash plus programmes should consider adding or strengthening financial education and job skills training, mentorship and future orientation to see stronger and perhaps sustainable outcomes for HIV prevention.
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Affiliation(s)
- Audrey Pettifor
- Department of EpidemiologyGillings School of Global Public HealthUniversity of North Carolina at Chapel HillChapel HillNCUSA
- Carolina Population CenterUniversity of North Carolina at Chapel HillChapel HillNCUSA
| | - Joyce Wamoyi
- National Institute of Medical ResearchMwanzaTanzania
| | - Peter Balvanz
- Department of Health BehaviorGillings School of Global Public HealthUniversity of North Carolina at Chapel HillChapel HillNCUSA
| | - Margaret W Gichane
- Department of Health BehaviorGillings School of Global Public HealthUniversity of North Carolina at Chapel HillChapel HillNCUSA
| | - Suzanne Maman
- Department of Health BehaviorGillings School of Global Public HealthUniversity of North Carolina at Chapel HillChapel HillNCUSA
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Mulawa MI, Yamanis TJ, Kajula LJ, Balvanz P, Maman S. Structural Network Position and Performance of Health Leaders Within an HIV Prevention Trial. AIDS Behav 2018; 22:3033-3043. [PMID: 29705931 DOI: 10.1007/s10461-018-2126-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
The effectiveness of peer leaders in promoting health may depend on the position they occupy within their social networks. Using sociocentric (whole network) and behavioral data from the intervention arm of a cluster-randomized HIV prevention trial in Dar es Salaam, Tanzania, we used generalized linear models with standardized predictors to examine the association between heath leaders' baseline structural network position (i.e., in-degree and betweenness centrality) and their 12-month self-reported (1) confidence in educating network members about HIV and gender-based violence (GBV) and (2) number of past-week conversations about HIV and GBV. As in-degree centrality increased, leaders reported fewer HIV-related conversations. As betweenness centrality increased, leaders reported greater number of conversations about GBV. Network position was not significantly associated with confidence in discussing either topic. Our results suggest that peer leaders who occupy spaces between sub-groups of network members may be more effective in engaging their peers in sensitive or controversial topics like GBV than more popular peer leaders.
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Mulawa M, Kajula LJ, Yamanis TJ, Balvanz P, Kilonzo MN, Maman S. Perpetration and Victimization of Intimate Partner Violence Among Young Men and Women in Dar es Salaam, Tanzania. J Interpers Violence 2018; 33:2486-2511. [PMID: 26802044 PMCID: PMC4956596 DOI: 10.1177/0886260515625910] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
We describe and compare the baseline rates of victimization and perpetration of three forms of intimate partner violence (IPV)-psychological, physical, and sexual-among sexually active men ( n = 1,113) and women ( n = 226) enrolled in an ongoing cluster-randomized HIV and gender-based violence prevention trial in Dar es Salaam, Tanzania. IPV was measured using a modified version of the World Health Organization Violence Against Women instrument. We assess the degree to which men and women report overlapping forms of IPV victimization and perpetration. Sociodemographic and other factors associated with increased risk of victimization and perpetration of IPV are examined. Within the last 12 months, 34.8% of men and 35.8% of women reported any form of IPV victimization. Men were more likely than women to report perpetrating IPV (27.6% vs. 14.6%, respectively). We also found high rates of co-occurrence of IPV victimization and perpetration with 69.7% of male perpetrators and 81.8% of female perpetrators also reporting victimization during the last year. Among men, having ever consumed alcohol and experiencing childhood violence were associated with increased risk of most forms of IPV. Younger women were more likely to report perpetrating IPV than older women. We found evidence of gender symmetry with regard to most forms of IPV victimization, but men reported higher rates of IPV perpetration than women. Given the substantial overlap between victimization and perpetration reported, our findings suggest that IPV may be bidirectional within relationships in this setting and warrant further investigation. Implications for interventions are discussed.
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Affiliation(s)
- Marta Mulawa
- University of North Carolina, Chapel Hill, NC, USA
| | - Lusajo J. Kajula
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | | | | | - Mrema N. Kilonzo
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
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Balvanz P, Yamanis TJ, Mulawa MI, Mwikoko G, Kajuna D, Kilonzo MN, Kajula LJ, Leatherman S, Maman S. Microfinance and health interventions: Factors influencing loan repayment success with young men in Dar es Salaam, Tanzania. Glob Public Health 2018; 14:254-270. [PMID: 30025502 DOI: 10.1080/17441692.2018.1501079] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Poverty is associated with numerous poor health outcomes. Youth unemployment in Tanzania is approximately 13.7%, and concentrates in urban areas. These youth lack relevant job skills and access to financial capital. Microfinance continues to be implemented globally to address poverty, and increasingly has been linked to health interventions. Men less frequently are recipients of microfinance loans. We offered microcredit to young men in an area of Dar es Salaam with high poverty as part of a randomised controlled-trial to assess the efficacy of a microfinance and health leadership intervention in preventing STI acquisition. We used mixed methods to understand predictors of successful loan repayment. Our qualitative sub-study showed that leader influence, prior business experience, personal motivation, and planning facilitated repayment. Using a modified Poisson approach, our quantitative analysis showed that successful repayment was associated with business experience, education, increasing number of children, community of residence, percentage of network members trained in business, and repayment success of peer leaders. Our results suggest that enforcing group accountability and repayment rules, offering ongoing training, and using successful entrepreneurs as role models could increase repayment success in similar populations. These strategies could provide financial opportunity for men while minimising risk for microfinance institutions.
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Affiliation(s)
- Peter Balvanz
- Department of Health Behavior, The University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Thespina J Yamanis
- School of International Service, American University, Washington DC, USA
| | - Marta I Mulawa
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Gema Mwikoko
- Department of Psychiatry and Mental Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Deusdith Kajuna
- Department of Psychiatry and Mental Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Mrema N Kilonzo
- Department of Psychiatry and Mental Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Lusajo J Kajula
- Department of Psychiatry and Mental Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Sheila Leatherman
- Department of Health Policy and Management, The University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Suzanne Maman
- Department of Health Behavior, The University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Chapel Hill, NC, USA
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Mulawa M, Yamanis TJ, Balvanz P, Kajula LJ, Maman S. Comparing Perceptions with Actual Reports of Close Friend's HIV Testing Behavior Among Urban Tanzanian Men. AIDS Behav 2016; 20:2014-22. [PMID: 26880322 DOI: 10.1007/s10461-016-1335-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Men have lower rates of HIV testing and higher rates of AIDS-related mortality compared to women in sub-Saharan Africa. To assess whether there is an opportunity to increase men's uptake of testing by correcting misperceptions about testing norms, we compare men's perceptions of their closest friend's HIV testing behaviors with the friend's actual testing self-report using a unique dataset of men sampled within their social networks (n = 59) in Dar es Salaam, Tanzania. We examine the accuracy and bias of perceptions among men who have tested for HIV (n = 391) and compare them to the perceptions among men who never tested (n = 432). We found that testers and non-testers did not differ in the accuracy of their perceptions, though non-testers were strongly biased towards assuming that their closest friends had not tested. Our results lend support to social norms approaches designed to correct the biased misperceptions of non-testers to promote men's HIV testing.
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Balvanz P, Dodgen L, Quinn J, Holloway T, Hudspeth S, Eng E. From Voice to Choice: African American Youth Examine Childhood Obesity in Rural North Carolina. Prog Community Health Partnersh 2016; 10:293-303. [PMID: 27346776 DOI: 10.1353/cpr.2016.0036] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Childhood obesity continues to be a prominent health concern in the United States. Certain demographics of youth have a higher prevalence of obesity, including those living in rural settings, and African American females. Multiple determinants contribute to the childhood obesity epidemic, yet few studies have partnered with youth to investigate community-level determinants and solutions. OBJECTIVES This study involved youth to assess contextual determinants of childhood obesity in a community, create an action plan for the community, and report findings and actions pursued in partnership with a community-based organization (CBO) and a university. METHODS Seven African American female high school students were recruited to investigate factors that contribute to childhood obesity using photovoice, a methodology used in community-based participatory research (CBPR). RESULTS Through photography and guided discussion, youth partners found a lack of access to healthy food and lack of safe recreation as primary contributors to obesity within their community. Social support from friends was believed to help prevent obesity. In response to findings, two projects were envisioned and implemented in the community, a walkability assessment and an intergenerational community garden. CONCLUSIONS Throughout this study, youth proved to be reliable partners in research, provided unique perspectives while examining local factors perceived to contribute to childhood obesity, and offered thoughtful solutions.
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Kajula L, Balvanz P, Kilonzo MN, Mwikoko G, Yamanis T, Mulawa M, Kajuna D, Hill L, Conserve D, Reyes HLM, Leatherman S, Singh B, Maman S. Vijana Vijiweni II: a cluster-randomized trial to evaluate the efficacy of a microfinance and peer health leadership intervention for HIV and intimate partner violence prevention among social networks of young men in Dar es Salaam. BMC Public Health 2016; 16:113. [PMID: 26842360 PMCID: PMC4738785 DOI: 10.1186/s12889-016-2774-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 01/22/2016] [Indexed: 12/01/2022] Open
Abstract
Background Intimate partner violence (IPV) and sexually transmitted infections (STIs), including HIV, remain important public health problems with devastating health effects for men and women in sub-Saharan Africa. There have been calls to engage men in prevention efforts, however, we lack effective approaches to reach and engage them. Social network approaches have demonstrated effective and sustained outcomes on changing risk behaviors in the U.S. Our team has identified and engaged naturally occurring social networks comprised mostly of young men in Dar es Salaam in an intervention designed to jointly reduce STI incidence and the perpetration of IPV. These stable networks are locally referred to as “camps.” In a pilot study we demonstrated the feasibility and acceptability of a combined microfinance and peer health leadership intervention within these camp-based peer networks. Methods design We are implementing a cluster-randomized trial to evaluate the efficacy of an intervention combining microfinance with health leadership training in 60 camps in Dar es Salaam, Tanzania. Half of the camps have been randomized to the intervention arm, and half to a control arm. The camps in the intervention arm will receive a combined microfinance and health leadership intervention for a period of two years. The camps in the control arm will receive a delayed intervention. We have enrolled 1,258 men across the 60 study camps. Behavioral surveys will be conducted at baseline, 12-months post intervention launch and 30-month post intervention launch and biological samples will be drawn to test for Neisseria gonorrhea (NG), Chlamydia trachomatis (CT), and Trichomonas vaginalis (TV) at baseline and 30-months. The primary endpoints for assessing intervention impact are IPV perpetration and STI incidence. Discussion This is the first cluster-randomized trial targeting social networks of men in sub-Saharan Africa that jointly addresses HIV and IPV perpetration and has both biological and behavioral endpoints. Effective approaches to engage men in HIV and IPV prevention are needed in low resource, high prevalence settings like Tanzania. If we determine that this approach is effective, we will examine how to adapt and scale up this approach to other urban, sub-Saharan African settings. Trial registration Clinical Trials.gov: NCT01865383. Registration date: May 24, 2013.
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Affiliation(s)
- Lusajo Kajula
- Department of Psychiatry and Mental Health, Muhimbili University of Health and Allied Sciences, PO Box 65466, Dar es Salaam, Tanzania.
| | - Peter Balvanz
- Department of Health Behavior, The University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Rosenau Hall, CB 7440, Chapel Hill, NC, 27599, USA
| | - Mrema Noel Kilonzo
- Department of Psychiatry and Mental Health, Muhimbili University of Health and Allied Sciences, PO Box 65466, Dar es Salaam, Tanzania
| | - Gema Mwikoko
- Department of Psychiatry and Mental Health, Muhimbili University of Health and Allied Sciences, PO Box 65466, Dar es Salaam, Tanzania
| | - Thespina Yamanis
- American University, School of International Service, 4400 Massachusetts Avenue, NW, Washington, DC 20016, USA
| | - Marta Mulawa
- Department of Health Behavior, The University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Rosenau Hall, CB 7440, Chapel Hill, NC, 27599, USA
| | - Deus Kajuna
- Department of Psychiatry and Mental Health, Muhimbili University of Health and Allied Sciences, PO Box 65466, Dar es Salaam, Tanzania
| | - Lauren Hill
- Department of Health Behavior, The University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Rosenau Hall, CB 7440, Chapel Hill, NC, 27599, USA
| | - Donaldson Conserve
- Department of Health Behavior, The University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Rosenau Hall, CB 7440, Chapel Hill, NC, 27599, USA
| | - Heathe Luz McNaughton Reyes
- Department of Health Behavior, The University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Rosenau Hall, CB 7440, Chapel Hill, NC, 27599, USA
| | - Sheila Leatherman
- Department of Health Policy and Management, The University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Rosenau Hall, CB 7411, Chapel Hill, NC, 27599, USA
| | - Basant Singh
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President Street, Charleston, SC, 29425, USA
| | - Suzanne Maman
- Department of Health Behavior, The University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Rosenau Hall, CB 7440, Chapel Hill, NC, 27599, USA
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Mulawa M, Yamanis TJ, Hill LM, Balvanz P, Kajula LJ, Maman S. Evidence of social network influence on multiple HIV risk behaviors and normative beliefs among young Tanzanian men. Soc Sci Med 2016; 153:35-43. [PMID: 26874081 DOI: 10.1016/j.socscimed.2016.02.002] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Revised: 01/08/2016] [Accepted: 02/01/2016] [Indexed: 10/22/2022]
Abstract
Research on network-level influences on HIV risk behaviors among young men in sub-Saharan Africa is severely lacking. One significant gap in the literature that may provide direction for future research with this population is understanding the degree to which various HIV risk behaviors and normative beliefs cluster within men's social networks. Such research may help us understand which HIV-related norms and behaviors have the greatest potential to be changed through social influence. Additionally, few network-based studies have described the structure of social networks of young men in sub-Saharan Africa. Understanding the structure of men's peer networks may motivate future research examining the ways in which network structures shape the spread of information, adoption of norms, and diffusion of behaviors. We contribute to filling these gaps by using social network analysis and multilevel modeling to describe a unique dataset of mostly young men (n = 1249 men and 242 women) nested within 59 urban social networks in Dar es Salaam, Tanzania. We examine the means, ranges, and clustering of men's HIV-related normative beliefs and behaviors. Networks in this urban setting varied substantially in both composition and structure and a large proportion of men engaged in risky behaviors including inconsistent condom use, sexual partner concurrency, and intimate partner violence perpetration. We found significant clustering of normative beliefs and risk behaviors within these men's social networks. Specifically, network membership explained between 5.78 and 7.17% of variance in men's normative beliefs and between 1.93 and 15.79% of variance in risk behaviors. Our results suggest that social networks are important socialization sites for young men and may influence the adoption of norms and behaviors. We conclude by calling for more research on men's social networks in Sub-Saharan Africa and map out several areas of future inquiry.
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Affiliation(s)
- Marta Mulawa
- The University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Department of Health Behavior, Rosenau Hall, CB 7440, Chapel Hill, NC 27599, United States.
| | - Thespina J Yamanis
- American University, School of International Service, 4400 Massachusetts Avenue, NW, Washington DC 20016, United States.
| | - Lauren M Hill
- The University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Department of Health Behavior, Rosenau Hall, CB 7440, Chapel Hill, NC 27599, United States.
| | - Peter Balvanz
- The University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Department of Health Behavior, Rosenau Hall, CB 7440, Chapel Hill, NC 27599, United States.
| | - Lusajo J Kajula
- Muhimbili University of Health and Allied Sciences, Department of Psychiatry and Mental Health, PO Box 65466, Dar es Salaam, Tanzania.
| | - Suzanne Maman
- The University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Department of Health Behavior, Rosenau Hall, CB 7440, Chapel Hill, NC 27599, United States.
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Maman S, Kajula L, Balvanz P, Kilonzo M, Mulawa M, Yamanis T. Leveraging strong social ties among young men in Dar es Salaam: A pilot intervention of microfinance and peer leadership for HIV and gender-based violence prevention. Glob Public Health 2015; 11:1202-1215. [PMID: 26588115 DOI: 10.1080/17441692.2015.1094105] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Gender inequality is at the core of the HIV patterns that are evident in sub-Saharan Africa. Gender-based violence (GBV) and lack of economic opportunity are important structural determinants of HIV risk. We piloted a microfinance and health promotion intervention among social networks of primarily young men in Dar es Salaam. Twenty-two individuals participated in the microfinance component and 30 peer leaders were recruited and trained in the peer health leadership component. We collected and analysed observational data from trainings, monitoring data on loan repayment, and reports of peer conversations to assess the feasibility and acceptability of the intervention. Eighteen of the loan recipients (82%) paid back their loans, and of these 15 (83%) received a second, larger loan. Among the loan defaulters, one died, one had chronic health problems, and two disappeared, one of whom was imprisoned for theft. The majority of conversations reported by peer health leaders focused on condoms, sexual partner selection, and HIV testing. Few peer leaders reported conversations about GBV. We demonstrated the feasibility and acceptability of this innovative HIV and GBV prevention intervention. The lessons learned from this pilot have informed the implementation of a cluster-randomised trial of the microfinance and peer health leadership intervention.
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Affiliation(s)
- Suzanne Maman
- a Department of Health Behavior , The University of North Carolina at Chapel Hill, Gillings School of Global Public Health , Chapel Hill , NC , USA
| | - Lusajo Kajula
- b Department of Psychiatry and Mental Health , Muhimbili University of Health and Allied Sciences , Dar es Salaam , Tanzania
| | - Peter Balvanz
- a Department of Health Behavior , The University of North Carolina at Chapel Hill, Gillings School of Global Public Health , Chapel Hill , NC , USA
| | - Mrema Kilonzo
- b Department of Psychiatry and Mental Health , Muhimbili University of Health and Allied Sciences , Dar es Salaam , Tanzania
| | - Marta Mulawa
- a Department of Health Behavior , The University of North Carolina at Chapel Hill, Gillings School of Global Public Health , Chapel Hill , NC , USA
| | - Thespina Yamanis
- c School of International Service , American University , Washington , DC , USA
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