Jennifer Wagman

Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States

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Publications (19)26.95 Total impact

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    ABSTRACT: Intimate partner violence (IPV) is associated with HIV infection. We aimed to assess whether provision of a combination of IPV prevention and HIV services would reduce IPV and HIV incidence in individuals enrolled in the Rakai Community Cohort Study (RCCS), Rakai, Uganda. We used pre-existing clusters of communities randomised as part of a previous family planning trial in this cohort. Four intervention group clusters from the previous trial were provided standard of care HIV services plus a community-level mobilisation intervention to change attitudes, social norms, and behaviours related to IPV, and a screening and brief intervention to promote safe HIV disclosure and risk reduction in women seeking HIV counselling and testing services (the Safe Homes and Respect for Everyone [SHARE] Project). Seven control group clusters (including two intervention groups from the original trial) received only standard of care HIV services. Investigators for the RCCS did a baseline survey between February, 2005, and June, 2006, and two follow-up surveys between August, 2006, and April, 2008, and June, 2008, and December, 2009. Our primary endpoints were self-reported experience and perpetration of past year IPV (emotional, physical, and sexual) and laboratory-based diagnosis of HIV incidence in the study population. We used Poisson multivariable regression to estimate adjusted prevalence risk ratios (aPRR) of IPV, and adjusted incidence rate ratios (aIRR) of HIV acquisition. This study was registered with, number NCT02050763. Between Feb 15, 2005, and June 30, 2006, we enrolled 11 448 individuals aged 15-49 years. 5337 individuals (in four intervention clusters) were allocated into the SHARE plus HIV services group and 6111 individuals (in seven control clusters) were allocated into the HIV services only group. Compared with control groups, individuals in the SHARE intervention groups had fewer self-reports of past-year physical IPV (346 [16%] of 2127 responders in control groups vs 217 [12%] of 1812 responders in intervention groups; aPRR 0·79, 95% CI 0·67-0·92) and sexual IPV (261 [13%] of 2038 vs 167 [10%] of 1737; 0·80, 0·67-0·97). Incidence of emotional IPV did not differ (409 [20%] of 2039 vs 311 [18%] of 1737; 0·91, 0·79-1·04). SHARE had no effect on male-reported IPV perpetration. At follow-up 2 (after about 35 months) the intervention was associated with a reduction in HIV incidence (1·15 cases per 100 person-years in control vs 0·87 cases per 100 person-years in intervention group; aIRR 0·67, 95% CI 0·46-0·97, p=0·0362). SHARE could reduce some forms of IPV towards women and overall HIV incidence, possibly through a reduction in forced sex and increased disclosure of HIV results. Findings from this study should inform future work toward HIV prevention, treatment, and care, and SHARE's ecological approach could be adopted, at least partly, as a standard of care for other HIV programmes in sub-Saharan Africa. Bill & Melinda Gates Foundation, US National Institutes of Health, WHO, President's Emergency Plan for AIDS Relief, Fogarty International Center. Copyright © 2015 Wagman et al. Open Access article distributed under the terms of CC BY-NC-ND. Published by .. All rights reserved.
    The Lancet Global Health. 11/2014;
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    ABSTRACT: Although an increasing number of people living with HIV (PLHIV) in sub-Saharan Africa are benefiting from the rapid scale-up of antiretroviral therapy (ART), retention in HIV care and treatment services remains a major concern. We examined socioeconomic and sociocultural barriers and potential facilitators of retention in ART in Iringa, Tanzania, a region with the second highest prevalence of HIV in the country. In 2012, 116 in-depth interviews were conducted to assess community members' perceptions, barriers and facilitators of HIV treatment in Iringa, including key informants, persons at heightened risk for infection, and HIV service-delivery users. Data were transcribed, translated, entered into Atlas.ti, coded, and analyzed for key themes. In order to provide the full range of perspectives across the community on issues that may affect retention, we report findings from all 116 participants, but draw on verbatim quotes to highlight the experiences of the 14 PLHIV who reported that they were receiving HIV care and treatment services. Despite the growing availability of HIV care and treatment services in Iringa, participants reported significant barriers to retention, including lack of knowledge and misperceptions of treatment, access problems that included difficulties in reaching distant clinics and pervasive poverty that left PLHIV unable to cope with out-of-pocket costs associated with their care, persistent stigmatization of PLHIV and frequent reliance on alternative healing systems instead of biomedical treatment. Positive perceptions of the efficacy of ART, improved ART availability in the region, improved access to care through supplemental aid, and social support were perceived to enhance treatment continuation. Our findings suggest that numerous socioeconomic and sociocultural barriers inhibit retention in HIV care and treatment services in this setting. Intervention strategies that improve ART accessibility, incorporate supplemental aid, enhance social support, reduce stigma, and develop partnerships with alternative healers are needed to improve HIV-related outcomes.
    AIDS Care 11/2013; · 1.60 Impact Factor
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    ABSTRACT: Sexually active young women bear the brunt of the HIV epidemic in Sub-Saharan Africa. Information is needed on risk and protective correlates at the family, partner and individual level for the design of programs to encourage safer sexual behaviors and reduce HIV risk among young women. The study was conducted among 1,675 sexually experienced women aged 15-24 living in Rakai, Uganda. The sample was taken from an ongoing community cohort study initiated in 1994 in 56 villages by the Rakai Health Sciences Program. Contextual variabless at the family, partner and individual levels were analyzed in relation to three outcome variables: sex before the age of 15, coerced first sex and condom use at first sex. At the family level, young females who did not live with both parents were more likely than those who did to have had sex before the age of 15 and to have experienced sexual coercion at first sex. Those whose mothers had some secondary education and whose female caregiver did not consume alcohol had elevated odds of using a condom at first sex. Having initiated sex at age 15 or older was the strongest individual-level characteristic associated with having used a condom at first sex. Reproductive health interventions should target adolescents and their parents to delay the onset of sexual activity, prevent sexual coercion and encourage condom use. Both adolescents and their parents should be educated about the risks associated with different types of sexual partnerships.
    International perspectives on sexual and reproductive health 09/2013; 39(3):153-62. · 1.06 Impact Factor
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    ABSTRACT: Medical male circumcision (MMC) is a central component of HIV prevention. In this study we examined barriers to and facilitators of MMC in Rakai, Uganda. Interviews and focus groups with MMC acceptors, decliners, and community members were collected and analyzed iteratively. Themes were developed based on immersion, repeated reading, sorting, and coding of data using grounded theory. Pain, medical complications, infertility, lack of empirical efficacy, waiting time before resumption of sex, and religion were identified as obstacles to MMC acceptance. Prevention and healing of sexually transmitted infections (STIs), access to HIV and other ancillary care, penile hygiene, and peer influence were key motivators. Voluntary counseling and testing for HIV, partner influence, and sexual potency were both barriers and motivators. Individual and societal factors, such as pain and religion, might slow MMC scale up. Health benefits, such as HIV/STI prevention and penile hygiene, are essential in motivating men to accept MMC.
    Qualitative Health Research 03/2013; · 2.19 Impact Factor
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    ABSTRACT: Abstract Women's rights and gender empowerment programmes are now part of the international agenda for improving global public health, the benefits of which are well documented. However, the public health community has, yet, to address how people define and understand gender equality and how they enact the process of empowerment in their lives. This study uses safe homes and respect for everyone (SHARE), an anti-violence intervention in rural Rakai, Uganda, as a case study to investigate perceptions of gender equality. Investigators analysed 12 focus groups of adult women and men to explore how macro-level concepts of gender equality are being processed on an interpersonal level and the effects on health outcomes. Respondents generally agreed that women lack basic rights. However, they also expressed widespread disagreement about the meanings of gender equality, and reported difficulties integrating the concepts of gender equality into their interpersonal relationships. Community members reported that equality, with the resulting shift in gender norms, could expose women to adverse consequences such as violence, infidelity and abandonment with increased sexual health risks, and potential adverse effects on education. Efforts to increase women's rights must occur in conjunction with community-based work on understandings of gender equality.
    Global Public Health 03/2013; · 0.92 Impact Factor
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    ABSTRACT: Research from Rakai, Uganda, suggests intimate partner violence (IPV) is common and attitudes condoning it are widespread. We used a public health approach to develop and implement an evidence-based IPV prevention intervention named the Safe Homes and Respect for Everyone (SHARE) Project. SHARE was designed on the Transtheoretical Model of behavior change and adapted IPV prevention strategies from Raising Voices and Stepping Stones. SHARE was implemented in four regions of Rakai. This article describes the design and implementation of SHARE, provides details on strategies and activities used, discusses challenges and lessons learned, and provides recommendations for other violence prevention programmers.
    Violence Against Women 12/2012; 18(12):1390-412. · 1.33 Impact Factor
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    ABSTRACT: Retaining victims of intimate partner violence (IPV) in longitudinal research is challenging, as abused women often face safety concerns, housing and employment instability, poverty, and major life transitions, making it difficult to locate and retain participants at follow-up time points. This article builds on past research to describe individualized, technology-based retention strategies for hard-to-reach populations, which minimize participant loss while maintaining participant safety. These techniques have resulted in retention rates of 94% at 6-, 12-, and 18-month follow-up interviews in a sample of 278 women experiencing both IPV and housing instability. The authors discuss the ethical use of appropriate technology for maximizing retention of participants as well as the importance of adjusting retention activities to meet the individual safety needs of each participant.
    Field Methods 01/2011; 23(1):86-101. · 1.11 Impact Factor
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    ABSTRACT: Latinas experiencing intimate partner violence (IPV) often avoid formal resources due to fear, distrust, and cultural and language barriers, yet little research addresses culturally appropriate interventions for abused Latinas. To develop effective interventions, we must include abused Latinas' voices in research and collaborate with the community-based organizations (CBOs) that serve them. This article's team of academics and CBOs used a community-based participatory research (CBPR) approach to inform development of a culturally and linguistically appropriate IPV intervention for Latinas. The authors were able to reach abused Latinas (n = 114) with a relatively low mean acculturation level in a state that is only 8% Latino. The authors share six recommendations from their successful experience to engage, enhance, and sustain research partnerships with CBOs, including strategies to share power and knowledge, and demonstrate accountability to the partnership and the community.
    Hispanic Journal of Behavioral Sciences 02/2009; 31(2):244-257. · 0.50 Impact Factor
  • The Journal of clinical ethics 02/2009; 20(2):141-9. · 0.47 Impact Factor
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    ABSTRACT: Limited data from low-income countries are available on the continuum of coercive experiences, the contexts in which they occur, and how adolescent women perceive and respond to coercion. This article presents results from focus group discussions and in-depth interviews with pregnant and never pregnant sexually active female adolescents, aged 15 to 17, residing in Rakai District, Uganda, to examine sexual coercion, its context, and the links between coercion and adolescent reproductive health outcomes, including early sexual debut and pregnancy. Informants described multiple forms of sexual coercion, including coerced or forced intercourse, unwanted sexual touching, verbal harassment, and transactional sex. Sexual coercion was perceived to be a normal part of intimate relationships; in particular, informants felt that a woman’s lack of decision-making authority, including choices on sexual encounters, was implicit to marriage. This information may help violence prevention programs develop a range of strategies for addressing sexual coercion among adolescents.
    Journal of Interpersonal Violence 01/2009; 24(12):2073-2095. · 1.64 Impact Factor
  • The Journal of clinical ethics 02/2008; 19(4):371-80. · 0.47 Impact Factor
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    ABSTRACT: To assess what individuals in low-income countries perceive as benefits and harms of population-based HIV/STD research. A total of 811 research participants, research decliners, and community opinion leaders in the Rakai District, Uganda were surveyed. Types of personal and community benefits and harms, as well as rates of reporting great personal and community benefit were assessed. Using logistic regression, demographic characteristics, participant and opinion leader status, use of Rakai Health Sciences Program (RHSP) services, and perceived research effects were entered as predictors of reported great personal and great community benefit. Most respondents thought that RHSP research was of great personal (85%) and community (88%) benefit. The perception that the RHSP was a great personal benefit was correlated with female sex, post-secondary education, frequent use of RHSP-sponsored medical services, health knowledge gains, and increased hope for future health improvements. Persons of non-Baganda ethnicity and 30-39 year-olds were less likely to believe research was personally beneficial. Regarding research as a great community benefit was associated with reported health knowledge gains, greater hope for Rakai residents' future health, and local economic benefit. Decliners were the most likely to report a personal harm, while community opinion leaders identified community harms at the highest rates. The majority of Rakai residents report that HIV/STD research has enhanced their own and their communities' welfare. Different factors were associated with the belief that research is a personal versus community benefit. Variations in participant, decliner, and community opinion leader perceptions highlight inadequacies of current community consultation mechanisms.
    AIDS (London, England) 12/2007; 21(18):2493-501. · 6.56 Impact Factor
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    ABSTRACT: Although there is increasing recognition of the scope and significance of sexual coercion experienced by adolescent women in developing countries, evidence on its consequences for reproductive health remains limited. A sample of 575 sexually experienced 15-19-year-old women were interviewed in 2001-2002 as part of the ongoing Rakai surveillance project in rural Uganda. Chi-square tests and logistic regressions were used to investigate associations between coerced first intercourse and selected reproductive health behaviors and outcomes. Fourteen percent of young women reported that their first sexual intercourse had been coerced. After the effects of respondents' demographic characteristics were accounted for, young women who reported coerced first intercourse were significantly less likely than those who did not to be currently using modern contraceptives, to have used condoms at last intercourse and to have used them consistently during the preceding six months; they were more likely to report their current or most recent pregnancy as unintended (among ever-pregnant women) and to report one or more genital tract symptoms. Coerced first intercourse is an important social and public health problem that has potentially serious repercussions for young women's reproductive health and well-being. Interventions to improve adolescent women's reproductive health should directly address the issue of sexual coercion.
    International Perspectives on Sexual and Reproductive Health 01/2005; 30(4):156-63. · 1.43 Impact Factor
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    ABSTRACT: Despite growing recognition of the problem, relatively little is known about the issue of coercive sex in developing countries. This study presents findings from a community-based survey of 4279 reproductive-aged women in current partnerships in the Rakai District of Uganda carried out in 1998-99. One in four women in our study report having experienced coercive sex with their current male partner, with most women reporting its occasional occurrence. In a regression analysis of risk factors for coercive sex, conventional socio-demographic characteristics emerged as largely unpredictive of the risk of coercive sex. Behavioral risk factors-most notably, younger age of women at first intercourse and alcohol consumption before sex by the male partner-were strongly and positively related to the risk of coercive sex. Coercive sex was also strongly related to perceptions of the male partner's HIV risk, with women who perceived their partner to be at highest risk experiencing almost three times the risk of coercive sex relative to low risk partnerships. Supplemental analysis of 1-year longitudinal data provides additional support for the hypothesis that coercive sex may frequently be a consequence of women's perceptions of increased HIV risk for their male partner. The findings of this study are discussed in terms of the need for sexual violence prevention programs more generally in settings such as Uganda, and in terms of the possible importance of incorporating issues of sexual and physical violence within current HIV prevention programs.
    Social Science [?] Medicine 03/2004; 58(4):787-98. · 2.56 Impact Factor
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    ABSTRACT: Although domestic violence is an increasing public health concern in developing countries, evidence from representative, community-based studies is limited. In a survey of 5109 women of reproductive age in the Rakai District of Uganda, 30% of women had experienced physical threats or physical abuse from their current partner--20% during the year before the survey. Three of five women who reported recent physical threats or abuse reported three or more specific acts of violence during the preceding year, and just under a half reported injuries as a result. Analysis of risk factors highlights the pivotal roles of the male partner's alcohol consumption and his perceived human immunodeficiency virus (HIV) risk in increasing the risk of male against female domestic violence. Most respondents--70% of men and 90% of women--viewed beating of the wife or female partner as justifiable in some circumstances, posing a central challenge to preventing violence in such settings.
    Bulletin of the World Health Organisation 02/2003; 81(1):53-60. · 5.11 Impact Factor
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    IRB Ethics and Human Research 30(2):1-7.
  • Tom Lutalo, Fred Nalugoda, Jennifer Wagman, Ron Gray
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    ABSTRACT: CONTEXTO: Si bien hay un mayor reconocimiento del ámbito y significado del sexo forzado entre las adolescentes en los países en desarrollo, son limitadas las pruebas que existen sobre sus consecuencias con relación a la salud reproductiva.

Publication Stats

329 Citations
26.95 Total Impact Points


  • 2012
    • Johns Hopkins Bloomberg School of Public Health
      Baltimore, Maryland, United States
  • 2003–2009
    • Johns Hopkins University
      • Department of Population, Family and Reproductive Health
      Baltimore, Maryland, United States
  • 2004
    • Columbia University
      • Department of Population and Family Health
      New York City, New York, United States