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      The Stepping Stones and Creating Futures intervention to prevent intimate partner violence and HIV-risk behaviours in Durban, South Africa: study protocol for a cluster randomized control trial, and baseline characteristics

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          Abstract

          Background

          Preventing intimate partner violence (IPV) remains a global public health challenge. Studies suggest urban informal settlements have particularly high levels of IPV and HIV-prevalence and these settlements are rapidly growing. The current evidence base of effective approaches to preventing IPV recognizes the potential of combining economic strengthening and gender transformative interventions. However, few of these interventions have been done in urban informal settlements, and almost none have included men as direct recipients of these interventions.

          Methods

          Stepping Stones and Creating Futures intervention is a participatory gender transformative and livelihoods strengthening intervention. It is being evaluated through a cluster randomized control trial amongst young women and men (18–30) living in urban informal settlements in eThekwini Municipality, South Africa. The evaluation includes a qualitative process evaluation and cost-effectiveness analysis. A comparison of baseline characteristics of participants is also included.

          Discussion

          This is one of the first large trials to prevent IPV and HIV-vulnerability amongst young women and men in urban informal settlements. Given the mixed methods evaluation, the results of this trial have the ability to develop a stronger understanding of what works to prevent violence against women and the processes of change in interventions.

          Trial registration

          NCT03022370. Registered 13 January 2017, retrospectively registered.

          Electronic supplementary material

          The online version of this article (doi:10.1186/s12889-017-4223-x) contains supplementary material, which is available to authorized users.

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          Most cited references44

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          Intimate Partner Violence and Incident Depressive Symptoms and Suicide Attempts: A Systematic Review of Longitudinal Studies

          Karen Devries and colleagues conduct a systematic review of longitudinal studies to evaluate the direction of association between symptoms of depression and intimate partner violence. Please see later in the article for the Editors' Summary
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            Effect of a structural intervention for the prevention of intimate-partner violence and HIV in rural South Africa: a cluster randomised trial.

            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 ClinicalTrials.gov, 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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              Alcohol and intimate partner violence: a meta-analytic review.

              The link between alcohol use/abuse and partner violence attracted increasing research attention in the past decade. Some studies reported a null or weak association between alcohol use and intimate partner violence, whereas other studies reported a moderate or large association. Using a meta-analytic approach, the link between alcohol use/abuse and male-to-female partner violence as well as female-to-male partner violence was examined herein. The results indicate that there is a small to moderate effect size for the association between alcohol use/abuse and male-to-female partner violence and a small effect size for the association between alcohol use/abuse and female-to-male partner violence. For men only, several moderators were also examined and the magnitude of the effect sizes varied significantly as a function of the type of sample and type of alcohol measure selected. Specifically, there was a larger association of alcohol and aggression in clinical versus non-clinical samples and when measures assessed more severe alcohol problems.
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                Author and article information

                Contributors
                Andrew.gibbs@mrc.ac.za
                Journal
                BMC Public Health
                BMC Public Health
                BMC Public Health
                BioMed Central (London )
                1471-2458
                20 April 2017
                20 April 2017
                2017
                : 17
                : 336
                Affiliations
                [1 ]ISNI 0000 0000 9155 0024, GRID grid.415021.3, Gender and Health Research Unit, , South African Medical Research Council, ; Pretoria, South Africa
                [2 ]ISNI 0000 0001 0723 4123, GRID grid.16463.36, Health Economics and HIV/AIDS Research Division (HEARD), , University of KwaZulu-Natal, ; Durban, South Africa
                [3 ]GRID grid.430079.9, , Project Empower, ; Durban, South Africa
                [4 ]ISNI 0000 0004 0425 469X, GRID grid.8991.9, , London School of Hygiene and Tropical Medicine, ; London, UK
                Author information
                http://orcid.org/0000-0003-2812-5377
                Article
                4223
                10.1186/s12889-017-4223-x
                5397780
                28427380
                8de473fd-166b-4fc6-ae64-5e7bca1ef83b
                © The Author(s). 2017

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 18 January 2017
                : 1 April 2017
                Funding
                Funded by: What Works to Prevent Violence Against Women and Girls Global Programme
                Categories
                Study Protocol
                Custom metadata
                © The Author(s) 2017

                Public health
                Public health

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