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Reducing Partner Violence Against Women who Exchange Sex and use Drugs through a Combination Microfinance and HIV Risk Reduction Intervention: A Cluster Randomized Trial

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Abstract

Women who exchange sex and use drugs (WESUD) are at high risk for HIV infection and partner violence. The few tested interventions at the intersection of HIV and IPV show mixed results. This analysis examined the impact of a combination HIV risk reduction (HIVRR) and microfinance (MF) intervention on reported paying and intimate partner violence against WESUD in Kazakhstan. This cluster randomized controlled trial enrolled 354 women from 2015 to 2018 and randomized them to either a combination of HIVRR and MF intervention or HIVRR alone. Outcomes were assessed at four time points over 15 months. Logistic regression within a Bayesian approach assessed change in odds ratio (OR) of recent physical, psychological, or sexual violence perpetrated by current or past intimate partners; and paying partners/clients by study arm over time. Compared to the control arm, the combination intervention decreased the odds of participants experiencing physical violence from past intimate partners by 14% (OR = 0.861, p = 0.049). Women in the intervention group reported significantly lower rates of sexual violence from paying partners (HIVRR + MF - HIVRR: 25.9%; OR = 0.741, p = 0.019) at 12-month follow-up. No significant differences in rates from current intimate partners were found. A combination HIVRR and microfinance intervention may reduce gender-based violence from paying and intimate partners among WESUD above and beyond HIVRR interventions alone. Future research should examine how microfinance reduces partner violence and how to implement combination interventions in diverse settings.

Resumen

Las mujeres que intercambian sexo y consumen drogas (WESUD) tienen un alto riesgo de infección por VIH y violencia por parte de sus parejas. Las pocas intervenciones que se han probado en la intersección del VIH y la violencia de pareja muestran resultados mixtos. Este ensayo controlado aleatorio por grupos inscribió a 354 mujeres de 2015 a 2018 y las asignó al azar a una intervención combinada de HIVRR y MF o HIVRR sola. Los resultados se evaluaron en 4 puntos temporales durante 15 meses. La regresión logística dentro de un enfoque bayesiano evaluó el cambio en la violencia reciente perpetrada por las parejas que pagan y/o las parejas y ex-parejas (p.ej. esposos, novios) por brazo de estudio, a través del tiempo. En comparación con el grupo de control, la intervención combinada disminuyó las probabilidades de que los participantes sufrieran violencia física por parte de sus parejas íntimas anteriores en un 14% (OR = 0,861, p = 0,049). Las mujeres en el grupo de intervención informaron tasas significativamente más bajas de violencia sexual por parte de parejas que pagan (HIVRR + MF - HIVRR: 25,9%; OR = 0,741, p = 0,019) a los 12 meses de seguimiento. No se encontraron diferencias significativas en las tasas de parejas íntimas actuales. La combinación de HIVRR y microfinanzas puede ofrecer mayores reducciones en la violencia de las parejas que pagan y las ex-parejas en esta población.

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Acknowledgements

We thank our research assistants and intervention facilitators, as well as all the participants who gave their time to our study. We also thank our partners at the NGOs “Moi Dom” and “Doverie” for their support and cooperation.

Funding

This study was funded by the National Institute on Drug Abuse (NIDA) to Drs. Witte and El Bassel (R01DA036514). The funder was not involved in study design or analysis. Additionally, Trena I. Mukherjee is supported by the National Institute of Allergy and Infectious Diseases (T32AI114398); and Tara McCrimmon is supported by the National Institute on Drug Abuse (T32DA037801).

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Authors and Affiliations

  1. School of Social Work, Columbia University, New York, NY, USA

    Susan S. Witte, Andrea Norcini Pala, Lyla S. Yang & Nabila El-Bassel

  2. Global Health Research Center of Central Asia, Columbia University School of Social Work, New York, NY, USA

    Susan S. Witte, Gaukhar Mergenova, Assel Terlikbayeva, Sholpan Primbetova & Nabila El-Bassel

  3. Mailman School of Public Health, Columbia University, New York, NY, USA

    Trena I. Mukherjee & Tara McCrimmon

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  1. Susan S. Witte
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Correspondence to Susan S. Witte.

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Witte, S.S., Pala, A.N., Mukherjee, T.I. et al. Reducing Partner Violence Against Women who Exchange Sex and use Drugs through a Combination Microfinance and HIV Risk Reduction Intervention: A Cluster Randomized Trial. AIDS Behav 27, 4084–4093 (2023). https://doi.org/10.1007/s10461-023-04122-z

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