STRIVE Tackling the structural drivers of HIV

Intimate partner violence (IPV) is a global public health and human rights concern, though there is limited evidence on how to prevent it. This secondary analysis of data from the SASA! study assesses the potential of a community mobilisation IPV prevention intervention to reduce overall prevalence of IPV, new onset of abuse (primary prevention) and continuation of prior abuse (secondary prevention).

Methods

A pair-matched cluster randomised controlled trial was conducted in eight communities (four intervention, four control) in Kampala, Uganda from 2007 to 2012. Cross-sectional surveys of community members, 18–49 years old, were undertaken at baseline and four years post-intervention implementation. Outcomes relate to women’s past year experiences of:

• physical and sexual IPV
• emotional aggression
• controlling behaviours
• fear of partner

An adjusted cluster-level intention to-treat analysis compared outcomes in intervention and control communities at follow-up.

Findings

• At follow-up, all types of IPV (including severe forms of each) were lower in intervention communities compared with control communities
• SASA! was associated with lower onset of abuse and lower continuation of prior abuse
• Women in intervention communities were less likely than their control counterparts to have experienced all types of IPV in the 12 months preceding the follow-up survey
• Results were statistically significant at the 5% level for high-intensity emotional aggression and controlling behaviours, and at the 10% level for injuries and severe/repeated physical IPV
• Women in intervention communities were at lower risk than women in control communities of both new onset of all types of IPV (except sexual IPV), and continuation of all types of IPV (where there was prior history of that form of abuse)

What this study adds

Community mobilisation interventions can be an effective means of preventing diverse types of abuse, including physical IPV, sexual IPV, emotional aggression and controlling behaviours. This broad scope of impacts lends support for the more wide scale adoption of interventions which seek to tackle the underlying causes of IPV, such as gender inequality and norms supportive of violence against women, rather than focusing too heavily on specific behaviours. Furthermore, community mobilisation - which uses multiple strategies to engage entire communities - can prevent both new onset of IPV, and continuation of violence where it was already occurring.