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Longitudinal Trajectories of Physical Intimate Partner Violence Among Adolescent Girls in Rural South Africa: Findings From HPTN 068
Abstract
Purpose:
Little is known about temporal patterns of physical intimate partner violence (PIPV) among South African adolescent girls. We sought to identify and describe PIPV risk trajectories and related correlates in this population.
Methods:
Our analytical cohort came from the HPTN 068 Cash Transfer Trial in Mpumalanga Province, South Africa. Cohort members were eighth and ninth graders (median age 14 years) who enrolled in 2011 and had three to four annual, self-reported PIPV measurements. We used group-based trajectory models to identify groups of girls with similar longitudinal patterns of PIPV risk over 4 years and potential correlates of group membership.
Results:
We identified two trajectory groups (n = 907): a higher-risk group (~52.8% of the cohort) with predicted PIPV probabilities of 13.5%-41.1% over time and a lower-risk group (~47.2% of the cohort) with predicted probabilities of 2.3%-10.3%. Baseline correlates of higher-risk group membership were ever having had sex (adjusted odds ratio [aOR]: 4.42, 95% confidence interval [CI]: 1.56-12.57), borrowing money (aOR: 1.95, 95% CI: 1.01-3.79), and older age (aOR per 1-year increase: 1.39, 95% CI: 1.11-1.73), while being in the 068 intervention arm (aOR: .29, 95% CI: .17-.51) and supporting more gender-equitable norms (aOR per 1-unit score increase: .89, 95% CI: .81-.97) were inversely associated.
Conclusions:
A high proportion of adolescent girls experience sustained PIPV risk in rural South Africa, suggesting a need for interventions in late primary school that encourage gender-equitable norms, healthy relationships, and safe ways to earn income during adolescence.
... Given the gender-based violence epidemic in South Africa (World Health Organization, 2021), the myriad of adverse health outcomes associated with elevated stress and IPV (Cohen et al., 2007;Coker et al., 2000), and evidence of associations between IPV, biological stress, and cash transfers (Buller et al., 2018;Fernald & Gunnar, 2009;Yim & Kofman, 2019), we sought to extend our prior work in HPTN 068 (DeLong et al., 2020;Kelly et al., 2023;Stoner et al., 2022). In this current study, we examine how repeated or chronic experiences of physical IPV throughout adolescence and young adulthood (i.e. ...
Background
One in four South African women will experience intimate partner violence (IPV) in their lifetime, potentially increasing their biological stress. In South Africa, limited IPV and stress research has utilized multiple timepoints or examined modifying factors. Cash transfers (CTs) are associated with reduced IPV and stress and may be an intervention target.
Aims
We used data-driven methods to identify longitudinal IPV trajectory groups among South African adolescent girls and young women (AGYW), estimate each group’s association with stress, and assess modification by a CT.
Methods
A total of 2,183 South African AGYW ages 13 to 24 years from the HIV Prevention Trials Network 068 study were randomized to a CT or control group. Physical IPV was measured five times (2011–2017), and stress was captured once (2018–2019). Stress measures included the Cohen Stress Scale and stress biomarkers (C-reactive protein (CRP), cytomegalovirus (CMV), herpes simplex virus type-1 (HSV-1)). Group-based trajectory modeling identified IPV trajectories; ordinal logistic regression estimated the association between trajectory group and stress.
Results
A two-group quadratic trajectory model was identified (higher trajectory group = 26.7% of AGYW; lower trajectory group = 73.3%). In both groups, the probability of IPV increased from ages 13 to 17 years before declining in early adulthood. However, the higher group’s probability peaked later and declined gradually. The higher trajectory group was associated with an increased odds of elevated CRP (OR: 1.41, 95% CI [1.11, 1.80]), but not with other stress measures. The CT modified the relationship with CMV: a positive association was observed among the usual care arm (OR: 1.59, 95% CI [1.11, 2.28]) but not the CT arm (OR: 0.85, 95% CI [0.61, 1.19]).
Conclusions
Sustained IPV risk during adolescence was associated with elevated CRP in young adulthood. The relationship between IPV and elevated CMV was attenuated among those receiving a CT, suggesting that CTs could possibly reduce biological stress due to IPV.
Violence against women is understood as a public health issue that has long-term health consequences for women. Economic inequality and women’s economic dependence on men make women vulnerable to violence. One approach to addressing poverty is through basic income, a cash transfer for all individuals which is not dependent on their employment status. This paper examines the relationship between basic income and violence against women by surveying different forms of cash transfer programs and their association with intimate partner violence, sexual exploitation, and systemic violence. Previous reviews report that cash transfers can be associated with decreased intimate partner violence. This review goes beyond existing systematic reviews by including intimate partner violence, sexual exploitation, and systemic violence for a broader understanding of how cash transfers relate to violence against women. Search databases include EBSCOhost search with Medline, Social Science Abstracts, APA PsychINFO, Social Work Abstracts. Search terms were “basic income” or “cash transfer” and “women” and “violence” or “homicide” or “sexual risk.” Other terms searched were “indigenous” or “colonial” or “systemic”. This search included articles reporting on cash transfers as the exposure and an indicator of violence against women as the outcome. Articles were excluded if it did not fit these criteria and were not written in English. This search yielded 28 articles that described intimate partner violence (emotional, physical, or sexual), 15 articles that described sexual exploitation, and no articles describing systemic violence against women. We used other supplemental articles that did not meet the inclusion criteria to pinpoint gaps in literature on systemic violence. These papers were analyzed through a feminist lens, an intersectional approach in addition to other theories. This search resulted in 43 articles. Consistent with other reviews on this subject matter, many recipients of cash transfers reported feeling empowered by it. A large proportion of articles found that cash transfers have a decreased association with physical forms of IPV overall, however some articles report decreased, increased, or unchanged outcomes for emotional IPV, such as aggression, controlling behaviours, or threats. Cash transfers may also be associated with reduced sexual exploitation as nine out of 11 studies reported that participants reduced their number of sex trade interactions due to having their financial needs met and studies also reported their perceived increased autonomy in sexual decision-making. This article outlines the gaps in literature, including the examination of cash transfers and systemic violence that can guide future research to best understand how cash transfer impact violence against women.
Intimate partner violence (IPV) is a global public health crisis with long-term adverse consequences for both victims and perpetrators. Patterns of violence often begin during adolescence, yet most interventions target adult relationships. A systematic review was conducted to identify correlates of IPV victimization and perpetration among adolescents and young adults in sub-Saharan Africa (SSA). Eligible studies included participants 10 to 24 years old, took place in SSA, and tested a statistical association between a correlate and an IPV outcome. Correlates were defined as any condition or characteristic associated with statistically significant increased or decreased risk of IPV victimization or perpetration. PsycInfo, PubMed, Embase, and African Index Medicus were searched and included studies published between January 1, 2000 and February 4, 2022. The search resulted in 3,384 original studies, of which 55 met inclusion criteria and were analyzed. Correlates were first qualitatively synthesized by developmental period (e.g., early adolescence, older adolescence, and young adulthood) and then organized in a conceptual framework by correlate type (e.g., socio-demographic; health, behavior, and attitudes; relational; or contextual). Over two decades of literature reveals variability in evidence by developmental period but also substantial overlap in the correlates of victimization and perpetration. This review identifies multiple points for intervention and results suggest the urgent need for earlier, developmentally appropriate prevention efforts among younger adolescents as well as combined approaches that target both victimization and perpetration of IPV.
Un grupo creciente de investigaciones ha sugerido la existencia de diferentes patrones de violencia en las relaciones de pareja durante la adolescencia. El objetivo de este estudio fue revisar y sintetizar la evidencia científica respecto a patrones de violencia en las relaciones de pareja en adolescentes, a través de una revisión sistemática de la literatura. La búsqueda se realizó en las bases de datos Pubmed, Scopus, Scielo, ebsco, Web of Science, Sage Journals, Taylor andFrancis Journals, Wiley, y el motor de búsqueda Google Académico; no hubo restricciones en el año de publicación. Se incluyeron investigaciones que analizaron la violencia desde una perspectiva centrada en la persona (e.g., uso de análisis de clases latentes). Para evaluar la calidad de los estudios transversales se usó la herramienta Axis de 20 ítems, y para los estudios longitudinales, la lista de verificación de Tooth et al. (2005) de 33 ítems. Se identificaron 212 estudios y después de elegir por criterios de elegibilidad, se incluyeron 27. Los patrones de violencia con mayor frecuencia fueron: violencia multiforme (34 %), victimización o perpetración por violencia psicológica y física (26%), violencia bidireccional psicológica/verbal (26 %), baja violencia (26 %) y alta violencia (23 %). Los patrones de violencia se relacionaron con diferentes variables tales como experiencias adversas en la infancia, variables sociodemográficas, relación familiar e indicadores de salud mental. Estos patrones evidencian que la violencia en las relaciones de pareja durante la adolescenciason un fenómeno complejo y multifactorial.
O objetivo foi estimar a prevalência e analisar a associação do consumo de álcool e drogas ilícitas com indicadores de violência física em adolescentes. Estudo transversal repetido com estudantes do Ensino Médio em escolas da rede pública em Pernambuco, Brasil (2006, n = 4.207; 2011, n = 6.264). Os dados foram obtidos por questionário. Os indicadores de violência física fo-ram: vitimização por violência física; envolvimento em brigas. As variáveis independentes foram: consumo de álcool e uso de drogas ilícitas. A regressão logística binária foi utilizada para verificar a associação entre o consumo de álcool e drogas e ter sofrido violência física. A prevalência do consumo de ál-cool por adolescentes que sofreram violência física reduziu em cinco anos, po-rém, nenhuma alteração foi constatada no uso de drogas ilícitas. As variáveis comportamentais estiveram associadas aos diferentes indicadores de violência, apresentando em geral uma tendência de aumento. Em 2006, adolescentes que usavam drogas ilícitas apresentaram uma chance 2,12 maior de sofrer vio-lência física, e em 2011 este valor foi de 2,41 (IC95%: 1,80; 3,22). A chance de adolescentes que consumiam bebida alcoólica ter envolvimento em brigas aumentou de 1,96 (IC95%: 1,64; 2,34) em 2006, para 2,11 (IC95%: 1,78; 2,51) em 2011. O consumo de álcool pelos adolescentes que sofreram violência física diminuiu em cinco anos, entretanto, o risco de os adolescentes que consumiram bebida alcoólica ou usaram drogas ilícitas sofrerem violência física aumentou ao longo de cinco anos.
There is increasing evidence that cash transfer (CT) programs decrease intimate partner violence (IPV). However, little is known about how CTs achieve this impact. We conducted a mixed-method review of studies in low- and middle-income countries (LMICs). Fourteen quantitative and eight qualitative studies met our inclusion criteria, of which eleven and five, respectively, demonstrated evidence that CTs decrease IPV. We found little support for increases in IPV, with only two studies showing overall mixed or adverse impacts. Drawing on these studies, as well as related bodies of evidence, we developed a program theory proposing three pathways through which CT could impact IPV: (a) economic security and emotional well-being, (b) intra-household conflict, and (c) women's empowerment. The economic security and well-being pathway hypothesizes decreases in IPV, while the other two pathways have ambiguous effects depending on program design features and behavioral responses to program components. Future studies should improve IPV measurement, empirical analysis of program mechanisms, and fill regional gaps. Program framing and complementary activities, including those with the ability to shift intra-household power relations are likely to be important design features for understanding how to maximize and leverage the impact of CTs for reducing IPV, and mitigating potential adverse impacts. Intimate partner violence. Domestic violence. Cash transfers. Women's empowerment.
Introduction:
Evidence has shown that the experience of violence by a partner has important influences on women's risk of HIV acquisition. Using a randomized experiment in northeast South Africa, we found that a conditional cash transfer (CCT) targeted to poor girls in high school reduced the risk of physical intimate partner violence (IPV) in the past 12 months by 34%. The purpose of this analysis is to understand the pathways through which the CCT affects IPV.
Methods:
HPTN 068 was a phase 3, randomized controlled trial in rural Mpumalanga province, South Africa. Eligible young women (aged 13-20) and their parents or guardians were randomly assigned (1:1) to either receive a monthly cash transfer conditional on monthly high school attendance or no cash transfer. Between 2011 and 2015, participants (N = 2,448) were interviewed at baseline, then at annual follow-up visits at 12, 24 and 36 months. The total effect of the CCT on IPV was estimated using a GEE log-binomial regression model. We then estimated controlled direct effects to examine mediation of direct effects through intermediate pathways. Mediators include sexual partnership measures, the sexual relationship power scale, and household consumption measures.
Results:
We found evidence that the CCT works in part through delaying sexual debut or reducing the number of sexual partners. The intervention interacts with these mediators leading to larger reductions in IPV risk compared to the total effect of the CCT on any physical IPV [RR 0.66, CI(95%):0.59-0.74]. The largest reductions are seen when we estimate the controlled direct effect under no sexual debut [RR 0.57, CI(95%):0.48-0.65] or under no sexual partner in the last 12 months [RR 0.53, CI(95%):0.46-0.60].
Conclusions:
Results indicate that a CCT for high school girls has protective effects on their experience of IPV and that the effect is due in part to girls choosing not to engage in sexual partnerships, thereby reducing the opportunity for IPV. As a lower exposure to IPV and safer sexual behaviours also protect against HIV acquisition, this study adds to the growing body of evidence on how cash transfers may reduce young women's HIV risk.
Purpose
The purpose of the study is to explore how gender norms emerge in romantic relationships among early adolescents (EAs) living in five poor urban areas.
Methods
Data were collected as part of the Global Early Adolescent Study. The current research analyzed data from interviews with 30 EAs (aged 11–13 years) living in five poor urban sites: Baltimore, Cuenca, Edinburgh, Ghent, and Nairobi. All interviews were recorded, transcribed, and analyzed in English using Atlas.ti, focusing on how EAs experience and perceive gender norms in romantic relationships.
Results
Across the five sites, only a few respondents described having been in love, the majority of whom were boys. Findings indicate that stereotypical gender norms about romantic relationships prevail across these cultural settings, depicting boys as romantically/sexually active and dominant, and girls as innocent with less (romantic) agency. In spite of the similarities, Nairobi was unique in that respondents referred to how sexual behavior and violence can occur within EA relationships. In all countries, heterosexuality was perceived to be the norm. Nevertheless, there were examples of EAs accepting homosexuality and expressing supportive attitudes toward equality between the sexes.
Conclusions
While EAs across five different cultural settings seem to endorse stereotypical gender norms in romantic relationships, a few stories also illustrate more gender-equal attitudes. As stereotypical gender norms have a demonstrated negative effect on adolescent sexual and reproductive health and well-being, additional research is needed to understand which factors—at the interpersonal and structural level—contribute to the construction of these norms among EAs.
Background:
Cash transfers have been proposed as an intervention to reduce HIV-infection risk for young women in sub-Saharan Africa. However, scarce evidence is available about their effect on reducing HIV acquisition. We aimed to assess the effect of a conditional cash transfer on HIV incidence among young women in rural South Africa.
Methods:
We did a phase 3, randomised controlled trial (HPTN 068) in the rural Bushbuckridge subdistrict in Mpumalanga province, South Africa. We included girls aged 13-20 years if they were enrolled in school grades 8-11, not married or pregnant, able to read, they and their parent or guardian both had the necessary documentation necessary to open a bank account, and were residing in the study area and intending to remain until trial completion. Young women (and their parents or guardians) were randomly assigned (1:1), by use of numbered sealed envelopes containing a randomisation assignment card which were numerically ordered with block randomisation, to receive a monthly cash transfer conditional on school attendance (≥80% of school days per month) versus no cash transfer. Participants completed an Audio Computer-Assisted Self-Interview (ACASI), before test HIV counselling, HIV and herpes simplex virus (HSV)-2 testing, and post-test counselling at baseline, then at annual follow-up visits at 12, 24, and 36 months. Parents or guardians completed a Computer-Assisted Personal Interview at baseline and each follow-up visit. A stratified proportional hazards model was used in an intention-to-treat analysis of the primary outcome, HIV incidence, to compare the intervention and control groups. This study is registered at ClinicalTrials.gov (NCT01233531).
Findings:
Between March 5, 2011, and Dec 17, 2012, we recruited 10 134 young women and enrolled 2537 and their parents or guardians to receive a cash transfer programme (n=1225) or not (control group; n=1223). At baseline, the median age of girls was 15 years (IQR 14-17) and 672 (27%) had reported to have ever had sex. 107 incident HIV infections were recorded during the study: 59 cases in 3048 person-years in the intervention group and 48 cases in 2830 person-years in the control group. HIV incidence was not significantly different between those who received a cash transfer (1·94% per person-years) and those who did not (1·70% per person-years; hazard ratio 1·17, 95% CI 0·80-1·72, p=0·42).
Interpretation:
Cash transfers conditional on school attendance did not reduce HIV incidence in young women. School attendance significantly reduced risk of HIV acquisition, irrespective of study group. Keeping girls in school is important to reduce their HIV-infection risk.
Funding:
National Institute of Allergy and Infectious Diseases, National Institute of Mental Health of the National Institutes of Health.
Background:
Intimate partner violence (IPV) among adolescents is common worldwide, but our understanding of perpetration, gender differences and the role of social-ecological factors remains limited.
Objectives:
To explore the prevalence of physical and sexual IPV perpetration and victimisation by gender, and associated risk and protective factors.
Methods:
Young adolescents (N=2 839) from 41 randomly selected public high schools in the Western Cape region of South Africa (SA), participating in the PREPARE study, completed a self-administered questionnaire.
Results:
The participants' mean age was 13.65 years (standard deviation 1.01), with 19.1% (541/2 839) reporting being victims/survivors of IPV and 13.0% (370/2 839) reporting perpetrating IPV. Girls were less likely to report being a victim/survivor of physical IPV (odds ratio (OR) 0.72; 95% confidence interval (CI) 0.57 - 0.92) and less likely to be a perpetrator of sexual IPV than boys (OR 0.33; 95% CI 0.21 - 0.52). Factors associated with perpetration of physical and sexual IPV were similar and included being a victim/survivor (physical IPV: OR 12.42; 95% CI 8.89 - 17.36, sexual IPV: OR 20.76; 95% CI 11.67 - 36.93), being older (physical IPV: OR 1.26; 95% CI 1.08 - 1.47, sexual IPV: OR 1.36; 95% CI 1.14 - 1.62 ), having lower scores on school connectedness (physical IPV: OR 0.59; 95% CI 0.46 - 0.75, sexual IPV: OR 0.56; 95% CI 0.42 - 0.76) and scoring lower on feelings of school safety (physical IPV: OR 0.66; 95% CI 0.57 - 0.77, sexual IPV: OR 0.50; 95% CI 0.40 - 0.62).
Conclusions:
Physical and sexual IPV was commonly reported among young adolescents in SA. Further qualitative exploration of the role of reciprocal violence by gender is needed, and the role of 'school climate'-related factors should be taken into account when developing preventive interventions.
Young women in South Africa are at high risk for HIV infection. Cash transfers offer promise to reduce HIV risk. We present the design and baseline results from HPTN 068, a phase III, individually randomized trial to assess the effect of a conditional cash transfer on HIV acquisition among South African young women. A total of 2533 young women were randomized to receive a monthly cash transfer conditional on school attendance or to a control group. A number of individual-, partner-, household- and school-level factors were associated with HIV and HSV-2 infection. After adjusting for age, all levels were associated with an increased odds of HIV infection with partner-level factors conveying the strongest association (aOR 3.05 95 % CI 1.84-5.06). Interventions like cash transfers that address structural factors such as schooling and poverty have the potential to reduce HIV risk in young women in South Africa.
Background
Intimate partner violence (IPV) is a serious public health problem among adolescents. This study investigated the prevalence of and factors associated with Grade 8 girls' experience and boys' perpetration of IPV in South Africa.
Methods
Participants were interviewed using interviewer-administered questionnaires about IPV, childhood violence, bullying, gender attitudes, alcohol use and risky sexual behaviours. Multiple logistic regression analysis was conducted to assess factors associated with girls' experience and boys' perpetration of IPV. Structural equation modelling (SEM) was conducted to assess the pathways to IPV experience and perpetration.
Results
Results show dating relationships are common among girls (52.5%) and boys (70.7%) and high prevalence of sexual or physical IPV experience by girls (30.9%; 95% CI 28.2–33.7) and perpetration by boys (39.5%; 95% CI 36.6–42.3). The logistic regression model showed factors associated with girls' experience of IPV include childhood experience of violence, individual gender inequitable attitudes, corporal punishment at home and in school, alcohol use, wider communication with one's partner and being more negative about school. We found three pathways from childhood trauma to IPV experience and perpetration in both models and these are through inequitable gender attitudes and risky sex, bullying and alcohol use.
Conclusions
Prevention of IPV in children needs to encompass prevention of exposure to trauma in childhood and addressing gender attitudes and social norms to encourage positive disciplining approaches.
The trial is registered on ClinicalTrials.gov as NCT02349321.
Objective: To determine whether an interactive curriculum that integrates dating violence prevention with lessons on healthy relationships, sexual health, and substance use reduces physical dating violence (PDV). Design: Cluster randomized trial with 2.5-year followup; prespecified subgroup analyses by sex. Setting: Grade 9 health classes. Participants: A total of 1722 students aged 14-15 from 20 public schools (52.8% girls). Intervention: A 21-lesson curriculum delivered during 28 hours by teachers with additional training in the dynamics of dating violence and healthy relationships. Dating violence prevention was integrated with core lessons about healthy relationships, sexual health, and substance use prevention using interactive exercises. Relationship skills to promote safer decision making with peers and dating partners were emphasized. Control schools targeted similar objectives without training or materials. Main Outcome Measures: The primary outcome at 2.5 years was self-reported PDV during the previous year. Secondary outcomes were physical peer violence, substance use, and condom use. Analysis was by intention-to-treat. Results: The PDV was greater in control vs intervention students (9.8% vs 7.4%; adjusted odds ratio, 2.42; 95% confidence interval, 1.00-6.02; P=.05). A significant group x sex interaction effect indicated that the intervention effect was greater in boys (PDV: 7.1% in controls vs 2.7% in intervention students) than in girls (12.1% vs 11.9%). Main effects for secondary outcomes were not statistically significant; however, sex x group analyses showed a significant difference in condom use in sexually active boys who received the intervention (114 of 168; 67.9%) vs controls (65 of 111 [58.6%]) (P <. 01). The cost of training and materials averaged CA$16 per student. Conclusion: The teaching of youths about healthy relationships as part of their required health curriculum reduced PDV and increased condom use 2.5 years later at a low per-student cost.
Community mobilization (CM) interventions show promise in changing gender norms and preventing HIV, but few have been based on a defined mobilization model or rigorously evaluated. The purpose of this paper is to describe the intervention design and implementation and present baseline findings of a Cluster Randomized Controlled Trial (RCT) of a two-year, theory-based CM intervention that aimed to change gender norms and reduce HIV risk in rural Mpumalanga province, South Africa.
Community Mobilizers and volunteer Community Action Teams (CATs) implemented two-day workshops, a range of outreach activities, and leadership engagement meetings. All activities were mapped onto six theorized mobilization domains. The intervention is being evaluated by a randomized design in 22 communities (11 receive intervention). Cross-sectional, population-based surveys were conducted with approximately 1,200 adults ages 18-35 years at baseline and endline about two years later.
This is among the first community RCTs to evaluate a gender transformative intervention to change norms and HIV risk using a theory-based, defined mobilization model, which should increase the potential for impact on desired outcomes and be useful for future scale-up if proven effective.
ClinicalTrials.gov NCT02129530.
Background.
Early sexual debut, voluntary or coerced, increases risks to sexual and reproductive health. Sexual coercion is increasingly
receiving attention as an important public health issue owing to its association with adverse health and social outcomes.
Objective.
To describe voluntary and coerced experience at sexual debut.
Methods.
A longitudinal perspective among 2 216 adolescents (1 149 females, 1 067 males) in a birth cohort study in South Africa, analysing
data collected on six occasions between 11 and 18 years.
Results.
The median age of sexual debut was 16 years for females and 15 for males. Reported coerced sexual debut included children <11 years of age.
Males reported earlier sexual debut, with both voluntary and coerced sexual experience, than females (
p
<0.0001). Sexual coercion at early sexual debut
among both male and female adolescents occurred mostly through sexual intercourse with older adolescents and partners of the same age.
Conclusion.
The identified time periods and age groups need to be targeted for interventions to delay sexual debut and prevent sexual
coercion among young people. More research is needed to understand underlying predisposing risk factors for sexual coercion at sexual
debut, both early and not early.
Globally, adolescent women are at risk for gender-based violence (GBV) including sexual violence and intimate partner violence (IPV). Those in economically distressed settings are considered uniquely vulnerable.Methods
Female adolescents aged 15–19 from Baltimore, Maryland, USA; New Delhi, India; Ibadan, Nigeria; Johannesburg, South Africa; and Shanghai, China (n = 1,112) were recruited via respondent-driven sampling to participate in a cross-sectional survey. We describe the prevalence of past-year physical and sexual IPV, and lifetime and past-year non-partner sexual violence. Logistic regression models evaluated associations of GBV with substance use, sexual and reproductive health, mental health, and self-rated health.ResultsAmong ever-partnered women, past-year IPV prevalence ranged from 10.2% in Shanghai to 36.6% in Johannesburg. Lifetime non-partner sexual violence ranged from 1.2% in Shanghai to 12.6% in Johannesburg. Where sufficient cases allowed additional analyses (Baltimore and Johannesburg), both IPV and non-partner sexual violence were associated with poor health across domains of substance use, sexual and reproductive health, mental health, and self-rated health; associations varied across study sites.Conclusions
Significant heterogeneity was observed in the prevalence of IPV and non-partner sexual violence among adolescent women in economically distressed urban settings, with upwards of 25% of ever-partnered women experiencing past-year IPV in Baltimore, Ibadan, and Johannesburg, and more than 10% of adolescent women in Baltimore and Johannesburg reporting non-partner sexual violence. Findings affirm the negative health influence of GBV even in disadvantaged urban settings that present a range of competing health threats. A multisectoral response is needed to prevent GBV against young women, mitigate its health impact, and hold perpetrators accountable.
Gender-based violence (GBV) is widespread globally and has myriad adverse health effects but is vastly underreported. Few
studies address the extent of reporting bias in existing estimates. We provide bounds for underestimation of reporting of
GBV to formal and informal sources conditional on having experienced GBV and characterize differences between women who report
and those who do not. We analyzed Demographic and Health Survey data from 284,281 women in 24 countries collected between
2004 and 2011. We performed descriptive analysis and multivariate logistic regressions examining characteristics associated
with reporting to formal sources. Forty percent of women experiencing GBV previously disclosed to someone; however, only 7%
reported to a formal source (regional variation, 2% in India and East Asia to 14% in Latin America and the Caribbean). Formerly
married and never married status, urban residence, and increasing age were characteristics associated with increased likelihood
of formal reporting. Our results imply that estimates of GBV prevalence based on health systems data or on police reports
may underestimate the total prevalence of GBV, ranging from 11- to 128-fold, depending on the region and type of reporting.
In addition, women who report GBV differ from those who do not, with implications for program targeting and design of interventions.
This article introduces a new SAS procedure written by the authors that analyzes longitudinal data (developmental trajectories) by fitting a mixture model. The TRAJ procedure fits semiparametric (discrete) mixtures of censored normal, Poisson, zero-inflated Poisson, and Bernoulli distributions to longitudinal data. Applications to psychometric scale data, offense counts, and a dichotomous prevalence measure in violence research are illustrated. In addition, the use of the Bayesian information criterion to address the problem of model selection, including the estimation of the number of components in the mixture, is demonstrated.
This study aimed to describe potentially preventable factors in intimate partner violence (IPV) perpetration and victimization among South African 8th grade students. Data were collected during a pilot evaluation of a classroom 8th grade curriculum on gender-based violence prevention in nine public schools in Cape Town through self-completed interviews with 549 8th grade students, 238 boys and 311 girls. Structural equation models (SEM) predicting IPV were constructed with variables a priori hypothesized to be associated. The majority of students (78.5 %) had had a partner in the past 3 months, and they reported high rates of IPV during that period (e.g., over 10 % of boys reported forcing a partner to have sex, and 39 % of girls reported physical IPV victimization). A trimmed version of the hypothesized SEM (CFI = .966; RMSEA = .051) indicated that disagreement with the ideology of male superiority and violence predicted lower risk of IPV (p < .001), whereas the frequency of using negative conflict resolution styles (e.g., walking off angrily, sending angry text messages, or refusing to talk to them) predicted high IPV risk (p < .001) and mediated the impact of heavy alcohol drinking on IPV (Sobel test, z = 3.16; p < .001). The model fit both girls and boys, but heavy drinking influenced negative styles of resolving conflict more strongly among girls than boys. Findings suggest that interventions to reduce IPV among South African adolescents should challenge attitudes supportive of male superiority and violence; encourage use of positive conflict resolution styles; and discourage heavy alcohol use among both boys and girls.
Although research on dating violence is growing, little is known about the distinct developmental trajectories of dating violence during adolescence. The current study identifies trajectories of physical dating violence victimization and perpetration that boys and girls follow from sixth to twelfth grade, examines the overlap of these trajectories, and characterizes them by perceptions of a caring dating relationship and acceptability of dating aggression. The sample consisted of randomly selected sixth graders from nine schools in Northeast Georgia (n = 588; 52 % boys; 49 % White, 36 % African American, 12 % Latino) who completed yearly surveys from Grades 6-12. We used latent class mixture modeling to identify the trajectories and generalized estimating equations models to examine the acceptability of dating aggression by dating violence trajectories. Participants followed two trajectories of dating violence victimization (boys: low and high; girls: low and increasing) and two of perpetration (boys and girls: low and increasing). When examining the joint trajectories of victimization and perpetration, a similar proportion of boys (62 %) and girls (65 %) were in the low victimization and low perpetration group and reported the lowest acceptance of dating aggression. The same proportion of boys and girls (27 %) were in the high/increasing victimization and perpetration group, and reported the highest acceptance of dating aggression. However, acceptance of dating aggression decreased from Grade 6-12 for all groups, even for those whose trajectory of dating violence increased. Victimization and perpetration were associated with reporting a less caring dating relationship. Results highlight the importance of focusing prevention efforts early for adolescents who follow this increasing probability of physical dating violence.
Intimate partner violence (IPV) against women is a global public health and human rights concern. Despite a growing body of research into risk factors for IPV, methodological differences limit the extent to which comparisons can be made between studies. We used data from ten countries included in the WHO Multi-country Study on Women's Health and Domestic Violence to identify factors that are consistently associated with abuse across sites, in order to inform the design of IPV prevention programs.
Standardised population-based household surveys were done between 2000 and 2003. One woman aged 15-49 years was randomly selected from each sampled household. Those who had ever had a male partner were asked about their experiences of physically and sexually violent acts. We performed multivariate logistic regression to identify predictors of physical and/or sexual partner violence within the past 12 months.
Despite wide variations in the prevalence of IPV, many factors affected IPV risk similarly across sites. Secondary education, high SES, and formal marriage offered protection, while alcohol abuse, cohabitation, young age, attitudes supportive of wife beating, having outside sexual partners, experiencing childhood abuse, growing up with domestic violence, and experiencing or perpetrating other forms of violence in adulthood, increased the risk of IPV. The strength of the association was greatest when both the woman and her partner had the risk factor.
IPV prevention programs should increase focus on transforming gender norms and attitudes, addressing childhood abuse, and reducing harmful drinking. Development initiatives to improve access to education for girls and boys may also have an important role in violence prevention.
Group-based trajectory models are increasingly being applied in clinical research to map the developmental course of symptoms and assess heterogeneity in response to clinical interventions. In this review, we provide a nontechnical overview of group-based trajectory and growth mixture modeling alongside a sampling of how these models have been applied in clinical research. We discuss the challenges associated with the application of both types of group-based models and propose a set of preliminary guidelines for applied researchers to follow when reporting model results. Future directions in group-based modeling applications are discussed, including the use of trajectory models to facilitate causal inference when random assignment to treatment condition is not possible.
Research shows that gender power inequity in relationships and intimate partner violence places women at enhanced risk of HIV infection. Men who have been violent towards their partners are more likely to have HIV. Men's behaviours show a clustering of violent and risky sexual practices, suggesting important connections. This paper draws on Raewyn Connell's notion of hegemonic masculinity and reflections on emphasized femininities to argue that these sexual, and male violent, practices are rooted in and flow from cultural ideals of gender identities. The latter enables us to understand why men and women behave as they do, and the emotional and material context within which sexual behaviours are enacted.
In South Africa, while gender identities show diversity, the dominant ideal of black African manhood emphasizes toughness, strength and expression of prodigious sexual success. It is a masculinity women desire; yet it is sexually risky and a barrier to men engaging with HIV treatment. Hegemonically masculine men are expected to be in control of women, and violence may be used to establish this control. Instead of resisting this, the dominant ideal of femininity embraces compliance and tolerance of violent and hurtful behaviour, including infidelity.
The women partners of hegemonically masculine men are at risk of HIV because they lack control of the circumstances of sex during particularly risky encounters. They often present their acquiescence to their partners' behaviour as a trade off made to secure social or material rewards, for this ideal of femininity is upheld, not by violence per se, by a cultural system of sanctions and rewards. Thus, men and women who adopt these gender identities are following ideals with deep roots in social and cultural processes, and thus, they are models of behaviour that may be hard for individuals to critique and in which to exercise choice. Women who are materially and emotionally vulnerable are least able to risk experiencing sanctions or foregoing these rewards and thus are most vulnerable to their men folk.
We argue that the goals of HIV prevention and optimizing of care can best be achieved through change in gender identities, rather than through a focus on individual sexual behaviours.
To determine whether an interactive curriculum that integrates dating violence prevention with lessons on healthy relationships, sexual health, and substance use reduces physical dating violence (PDV).
Cluster randomized trial with 2.5-year follow-up; prespecified subgroup analyses by sex.
Grade 9 health classes.
A total of 1722 students aged 14-15 from 20 public schools (52.8% girls). Intervention A 21-lesson curriculum delivered during 28 hours by teachers with additional training in the dynamics of dating violence and healthy relationships. Dating violence prevention was integrated with core lessons about healthy relationships, sexual health, and substance use prevention using interactive exercises. Relationship skills to promote safer decision making with peers and dating partners were emphasized. Control schools targeted similar objectives without training or materials.
The primary outcome at 2.5 years was self-reported PDV during the previous year. Secondary outcomes were physical peer violence, substance use, and condom use. Analysis was by intention-to-treat.
The PDV was greater in control vs intervention students (9.8% vs 7.4%; adjusted odds ratio, 2.42; 95% confidence interval, 1.00-6.02; P = .05). A significant group x sex interaction effect indicated that the intervention effect was greater in boys (PDV: 7.1% in controls vs 2.7% in intervention students) than in girls (12.1% vs 11.9%). Main effects for secondary outcomes were not statistically significant; however, sex x group analyses showed a significant difference in condom use in sexually active boys who received the intervention (114 of 168; 67.9%) vs controls (65 of 111 [58.6%]) (P < .01). The cost of training and materials averaged CA$16 per student.
The teaching of youths about healthy relationships as part of their required health curriculum reduced PDV and increased condom use 2.5 years later at a low per-student cost.
To assess the impact of Stepping Stones, a HIV prevention programme, on incidence of HIV and herpes simplex type 2 (HSV-2) and sexual behaviour.
Cluster randomised controlled trial.
70 villages (clusters) in the Eastern Cape province of South Africa.
1360 men and 1416 women aged 15-26 years, who were mostly attending schools.
Stepping Stones, a 50 hour programme, aims to improve sexual health by using participatory learning approaches to build knowledge, risk awareness, and communication skills and to stimulate critical reflection. Villages were randomised to receive either this or a three hour intervention on HIV and safer sex. Interviewers administered questionnaires at baseline and 12 and 24 months and blood was tested for HIV and HSV-2.
Primary outcome measure: incidence of HIV. Other outcomes: incidence of HSV-2, unwanted pregnancy, reported sexual practices, depression, and substance misuse.
There was no evidence that Stepping Stones lowered the incidence of HIV (adjusted incidence rate ratio 0.95, 95% confidence interval 0.67 to 1.35). The programme was associated with a reduction of about 33% in the incidence of HSV-2 (0.67, 0.46 to 0.97; P=0.036)-that is, Stepping Stones reduced the number of new HSV-2 infections over a two year period by 34.9 (1.6 to 68.2) per 1000 people exposed. Stepping Stones significantly improved a number of reported risk behaviours in men, with a lower proportion of men reporting perpetration of intimate partner violence across two years of follow-up and less transactional sex and problem drinking at 12 months. In women desired behaviour changes were not reported and those in the Stepping Stones programme reported more transactional sex at 12 months.
Stepping Stones did not reduce incidence of HIV but had an impact on several risk factors for HIV-notably, HSV-2 and perpetration of intimate partner violence.
Clinical Trials NCT00332878.
Early coital debut is a risk factor for HIV. In this paper we investigate the predictors of young adolescents' transition
to first intercourse using a social cognition theoretical framework. The analyses reported here were based on a longitudinal
study of 2360 students in the schools allocated to the control arm of a cluster-randomized controlled trial to investigate
the effect of a school-based HIV prevention programme among Grade 8 students in Cape Town. Structural equation modelling was
performed with Mplus version 3.11. Of the 1440 students who were virgins at baseline, 1144 remained virgins 15 months later
and 296 (20.6%) reported having had their first sexual intercourse. Transition to first sexual intercourse was more likely
among males than females, among older students and among students with a lower socio-economic status. Transition to first
sexual intercourse was significantly associated with intentions to have sexual intercourse, poor self-efficacy to negotiate
delayed sex and intimate partner violence. The model predicted 35% of the variance in intentions and 16% of the variance in
transition. These findings indicate some of the factors that influence young adolescent's transition to first intercourse
and that need to be addressed when designing effective interventions.
Chapter 2 dealt with aspects of modeling such as transformations of predictors, relaxing linearity assumptions, modeling interactions, and examining lack of fit. Chapter 3 dealt with missing data, focusing on utilization of incomplete predictor information. All of these areas are important in the overall scheme of model development, and they cannot be separated from what is to follow. In this chapter we concern ourselves with issues related to the whole model, with emphasis on deciding on the amount of complexity to allow in the model and on dealing with large numbers of predictors. The chapter concludes with three default modeling strategies depending on whether the goal is prediction, estimation, or hypothesis testing.
This study identified classes of developmental trajectories of physical dating violence victimization from grades 8 to 12 and examined theoretically-based risk factors that distinguished among trajectory classes. Data were from a multi-wave longitudinal study spanning 8th through 12th grade (n = 2,566; 51.9 % female). Growth mixture models were used to identify trajectory classes of physical dating violence victimization separately for girls and boys. Logistic and multinomial logistic regressions were used to identify situational and target vulnerability factors associated with the trajectory classes. For girls, three trajectory classes were identified: a low/non-involved class; a moderate class where victimization increased slightly until the 10th grade and then decreased through the 12th grade; and a high class where victimization started at a higher level in the 8th grade, increased substantially until the 10th grade, and then decreased until the 12th grade. For males, two classes were identified: a low/non-involved class, and a victimized class where victimization increased slightly until the 9th grade, decreased until the 11th grade, and then increased again through the 12th grade. In bivariate analyses, almost all of the situational and target vulnerability risk factors distinguished the victimization classes from the non-involved classes. However, when all risk factors and control variables were in the model, alcohol use (a situational vulnerability) was the only factor that distinguished membership in the moderate trajectory class from the non-involved class for girls; anxiety and being victimized by peers (target vulnerability factors) were the factors that distinguished the high from the non-involved classes for the girls; and victimization by peers was the only factor distinguishing the victimized from the non-involved class for boys. These findings contribute to our understanding of the heterogeneity in physical dating violence victimization during adolescence and the malleable risk factors associated with each trajectory class for boys and girls.
Intimate or dating relationships play an important role in young people's psychosocial development and well-being. Yet, we know relatively little about how teenagers conceptualise and experience them. Research knowledge about young people's intimate relationships is largely gleaned from studies whose primary focus has been on adolescent sexuality and violence. This study explored intimate relationships using qualitative data from 12 focus-group discussions and 25 in-depth individual interviews with Grade 8 (mean age = 14.6 years) and Grade 11 (mean age = 17.2 years) young people recruited from Cape Town schools. Although there is overlap between these findings and previous research, this study delved into the microdynamics of teenagers' relationship practices and conceptualisations. Their discussions provide insight into a nebulous dating landscape that is highly gendered and greatly influenced by peer relations. There was a heterogeneity of experience with relationships and sex. Implications for intervention development are discussed.
This study examined gender and racial/ethnic differences in sexual debut.
We analyzed 1999-2007 data from the Youth Risk Behavior Surveillance System (YRBSS), a cross-sectional, nationally representative survey of students in Grades 9-12 established by the Centers for Disease Control and Prevention. The Kaplan-Meier method was used to compute the probability of survival (not having become sexually active) at each year (age 12 through 17), and separate estimates were produced for each level of gender and racial/ethnic group.
African-American males experienced sexual debut earlier than all other groups (all tests of significance at p<.001) and Asian males and females experienced sexual debut later than all groups (all tests of significance at p<.001). By their 17th birthday, the probability for sexual debut was less than 35% for Asians (females 28%, males 33%) and less than 60% for Caucasians (58% females, 53% males) and Hispanic females (59%). The probability for sexual debut by their 17th birthday was greatest for African Americans (74% females, 82% males) and Hispanic males (69%).
These results demonstrate a need for sexual education programs and policy to be sensitive to the roles of race and ethnicity in sexual debut.
This paper reports on a study of heterosexual adolescent dating violence among secondary school students in a South African community. Approximately half of the surveyed males, and just over half of the surveyed females reported involvement in a physically violent dating relationship either as a perpetrator and/or victim. The study found significant associations between the beliefs about violence in a romantic relationship, the witnessing of physical violence in friendship contexts, the use of alcohol and adolescent dating violence. A significant association between familial variables and adolescent dating violence was only found for male participants. No significant association was found between religious participation and adolescent dating violence. The implications for prevention are discussed in an attempt to demonstrate the potential of local information that identifies risk factors for the development of appropriate community- and schools-based intervention programmes.
The Safe Dates Project is a randomized trial for evaluating a school-based adolescent dating violence prevention program. Five waves of data were used to examine the effects of Safe Dates over time including primary and secondary prevention effects, moderators, and mediators of program effects. Using random coefficients models, with multiple imputation of missing data, significant program effects were found at all four follow-up periods on psychological, moderate physical, and sexual dating violence perpetration and moderate physical dating violence victimization. Marginal effects were found on sexual victimization. Effects on severe physical perpetration at all four follow-up periods were moderated by prior involvement in that type of violence. Primary and secondary prevention effects were found and the program was equally effective for males and females and for whites and non-whites. Program effects were mediated by changes in dating violence norms, gender-role norms, and awareness of community services.
Little is known about the prevalence of partner violence among adolescents, nor of the factors with which it is associated. The objectives of this study were to document prevalence rates for partner violence among high school students in Cape Town, and to explore factors that are associated with such violence.
The sample consisted of 596 Grade 8 and 11 students attending public high schools in Cape Town, who were selected using a multistage cluster design. They completed an anonymous and confidential questionnaire. The dependent variable was whether they had ever perpetrated partner violence, or intended to do so. The independent variables, which were derived from a modified version of the Theory of Planned Behaviour (TPB), included attitudes, subjective norms (general and peer social influence and outcome expectancy) and self-efficacy. Separate multiple logistic regression models were developed of partner violence intentions or behaviours on the scales derived from the TPB and demographic variables. Regression coefficients from adjusted models were used to examine the potential mediating role of partner violence intentions in the association between each scale and partner violence behaviours using the Sobel test.
Among participants who reported being in a relationship, 20.7% reported perpetrating partner violence, and 16.4% reported intending to do so. After adjusting for demographic characteristics and other predictor scales, perpetration of partner violence was significantly associated with attitudes and outcome expectancy, while intention to perpetrate partner violence was significantly associated with attitudes and general social influence. The influence of attitude and general social influence on violent behaviours were each partially mediated by partner violence intentions.
There are high levels of partner violence among high school students in Cape Town. Interventions to address this problem should focus on violence-related attitudes and outcome expectancy.
A cluster randomized-controlled trial of a community mobilization intervention to change gender norms and reduce HIV risk in rural South Africa: Study design and intervention.
- Pettifor A.
- Lippman S.A.
- Selin A.M.
Intimate partner violence Surveillance: Uniform definitions and recommended data elements, Version 2.0
Intimate partner violence Surveillance: Uniform definitions and recommended data elements, Version 2.0. Atlanta, GA: Centers for Disease Control
and Prevention; 2015. Available at: https://www.cdc.gov/violenceprevention/
pdf/intimatepartnerviolence.pdf. Accessed November 5, 2019.