Pronyk PM, Hargreaves JR, Kim JC, Morison LA, Phetla G, Watts C, et al. Effect of a structural intervention for the prevention of intimate partner violence and HIV in rural South Africa: a cluster randomized trial

Rural AIDS and Development Action Research Programme, School of Public Health, University of the Witwatersrand, Acornhoek, South Africa.
The Lancet (Impact Factor: 45.22). 01/2007; 368(9551):1973-83. DOI: 10.1016/S0140-6736(06)69744-4
Source: PubMed


HIV infection and intimate-partner violence share a common risk environment in much of southern Africa. The aim of the Intervention with Microfinance for AIDS and Gender Equity (IMAGE) study was to assess a structural intervention that combined a microfinance programme with a gender and HIV training curriculum.
Villages in the rural Limpopo province of South Africa were pair-matched and randomly allocated to receive the intervention at study onset (intervention group, n=4) or 3 years later (comparison group, n=4). Loans were provided to poor women who enrolled in the intervention group. A participatory learning and action curriculum was integrated into loan meetings, which took place every 2 weeks. Both arms of the trial were divided into three groups: direct programme participants or matched controls (cohort one), randomly selected 14-35-year-old household co-residents (cohort two), and randomly selected community members (cohort three). Primary outcomes were experience of intimate-partner violence--either physical or sexual--in the past 12 months by a spouse or other sexual intimate (cohort one), unprotected sexual intercourse at last occurrence with a non-spousal partner in the past 12 months (cohorts two and three), and HIV incidence (cohort three). Analyses were done on a per-protocol basis. This trial is registered with, number NCT00242957.
In cohort one, experience of intimate-partner violence was reduced by 55% (adjusted risk ratio [aRR] 0.45, 95% CI 0.23-0.91; adjusted risk difference -7.3%, -16.2 to 1.5). The intervention did not affect the rate of unprotected sexual intercourse with a non-spousal partner in cohort two (aRR 1.02, 0.85-1.23), and there was no effect on the rate of unprotected sexual intercourse at last occurrence with a non-spousal partner (0.89, 0.66-1.19) or HIV incidence (1.06, 0.66-1.69) in cohort three.
A combined microfinance and training intervention can lead to reductions in levels of intimate-partner violence in programme participants. Social and economic development interventions have the potential to alter risk environments for HIV and intimate-partner violence in southern Africa.

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    • "The IMAGE Study, which used MF combined with gender training, was conducted in mining communities in rural South Africa, and found a reduction in gender-based violence but no impact on reductions in HIV transmission. A article based on these findings was published in the Lancet (Pronyk et al. 2006). The SHAZ Study, based in Harare, was conducted with young female orphans and combined gender training with microfinance. "
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    • "Hidrobo and Fernald (2013), Angelucci (2008), Bobonis and Castro (2010) and Bobonis, Gonzalez and Castro (2013) and Perova et al.), microfinance and training programs (e.g. Pronyk et al. (2006) and Bandiera et al. (2014)) where most of these policies are negatively associated with domestic violence except for the important short-run and long-run separation as in Bobonis et al. (2010). Regarding employment, an interesting trend we observe is that while employment and domestic violence has a negative relationship in developed countries, the evidence from developing countries point toward positive relationship. "
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