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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    • "Downloaded from financial services for the poor, including savings, insurance, and money transfers (Goldberg and Karlan, 2006; Khawari, 2004). A growing body of literature has found microfinance interventions to be effective in reducing the sexual risk behavior of women engaged in sex work (Cui et al., 2013; Odek et al., 2009; Pronyk et al., 2006, 2008). However, only a handful of studies have addressed the economic impact of participation in microfinance interventions among women engaged in sex work. "
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    • "Research on how women change has also highlighted the importance of change in the structural nature of relations between men and women through economically empowering women (Jewkes, Flood, and Lang 2014). For example, interventions such as the IMAGE microfinance and gender intervention in South Africa, which addressed the material insecurity of women and their gendered subordination, have been shown to enable women to protect themselves from intimate partner violence two years after the intervention, whereas, by contrast, just engaging women in microfinance (or elsewhere gender interventions alone) is not effective (Pronyk et al. 2006). "
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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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