AIDS and Behavior

, Volume 14, Issue 2, pp 431–439 | Cite as

Integrating HIV Prevention into Services for Abused Women in South Africa

  • Kathleen J. Sikkema
  • Sharon A. Neufeld
  • Nathan B. Hansen
  • Rakgadi Mohlahlane
  • Madri Jansen Van Rensburg
  • Melissa H. Watt
  • Ashley M. Fox
  • Mary Crewe
Original paper

Abstract

The relationship between intimate partner violence (IPV) and HIV risk is well documented, but few interventions jointly address these problems. We developed and examined the feasibility of an intervention to reduce HIV risk behaviors among 97 women seeking services for IPV from a community-based NGO in Johannesburg, South Africa. Two versions of the intervention (a 6-session group and a 1-day workshop) were implemented, both focusing on HIV prevention strategies integrated with issues of gender and power imbalance. Attendance was excellent in both intervention groups. Assessments were conducted at baseline, post-intervention and two-month follow-up to demonstrate the feasibility of an intervention trial. Women in both groups reported reductions in HIV misperceptions and trauma symptoms, and increases in HIV knowledge, risk reduction intentions, and condom use self-efficacy. The 6-session group showed greater improvements in HIV knowledge and decreases in HIV misperceptions in comparison to the 1-day workshop. The study demonstrated the feasibility and potential benefit of providing HIV prevention intervention to women seeking assistance for IPV.

Keywords

Intimate partner violence HIV prevention Women Group intervention South Africa 

References

  1. 1.
    Coker AL. Does physical intimate partner violence affect sexual health? A systematic review. Trauma Violence Abuse. 2007;8(2):149–77.CrossRefPubMedGoogle Scholar
  2. 2.
    World Health Organization. World Report on Violence and Health. Geneva: WHO; 2002.Google Scholar
  3. 3.
    Jewkes R, Penn-Kekana L, Levin J, Ratsaka M, Schrieber M. “He must give me money, he musn’t beat me”: violence against women in three South African provinces. Pretoria, South Africa: South African Medical Research Council; 1999.Google Scholar
  4. 4.
    Kalichman SC, Simbayi LC. Sexual assault history and risks for sexually transmitted infections among women in an African township in Cape Town, South Africa. AIDS Care. 2004;16(6):681–9.CrossRefPubMedGoogle Scholar
  5. 5.
    Hoffman S, O’Sullivan LF, Harrison A, Dolezal C, Monroe-Wise A. HIV risk behaviors and the context of sexual coercion in young adults’ sexual interactions: results from a diary study in rural South Africa. Sex Transm Dis. 2006;33(1):52–8.CrossRefPubMedGoogle Scholar
  6. 6.
    Wood K, Jewkes R. Violence, rape, and sexual coercion: everyday love in a South African township. Gend Dev. 1997;5(2):41–6.CrossRefGoogle Scholar
  7. 7.
    Jewkes R, Penn-Kekana L, Levin J, Ratsaka M, Schrieber M. Prevalence of emotional, physical and sexual abuse of women in three South African provinces. S Afr Med J. 2001;91(5):421–8.PubMedGoogle Scholar
  8. 8.
    Wood K, Maforah F, Jewkes R. “He forced me to love him”: putting violence on adolescent sexual health agendas. Soc Sci Med. 1998;47(2):233–42.CrossRefPubMedGoogle Scholar
  9. 9.
    Wood K, Lambert H, Jewkes R. “Showing roughness in a beautiful way”: talk about love, coercion, and rape in South African youth sexual culture. Med Anthropol Q. 2007;21(3):277–300.CrossRefPubMedGoogle Scholar
  10. 10.
    Ragnarsson A, Onya HE, Thorson A, Ekstrom AM, Aaro LE. Young males’ gendered sexuality in the era of HIV and AIDS in Limpopo Province, South Africa. Qual Health Res. 2008;18(6):739–46.CrossRefPubMedGoogle Scholar
  11. 11.
    Abrahams N, Jewkes R, Laubsher R. “I do not believe in democracy in the home”: men’s relationships with and abuse of women. Pretoria, South Africa: South African Medical Research Council; 1999.Google Scholar
  12. 12.
    UNAIDS 2008 Report on the global AIDS epidemic. Geneva; 2008.Google Scholar
  13. 13.
    South African Department of Health. The national HIV and syphilis prevalence survey of South Africa. Pretoria, South Africa: South African Department of Health; 2007.Google Scholar
  14. 14.
    European Study Group on Heterosexual Transmission of HIV. Comparison of female to male and male to female transmission of HIV in 563 stable couples. BMJ. 1992;304(6830):809–13.CrossRefGoogle Scholar
  15. 15.
    Turmen T. Gender and HIV/AIDS. Int J Gynaecol Obstet. 2003;82(3):411–8.CrossRefPubMedGoogle Scholar
  16. 16.
    Atashili J, Poole C, Ndumbe PM, Adimora AA, Smith JS. Bacterial vaginosis and HIV acquisition: a meta-analysis of published studies. AIDS. 2008;22(12):1493–501.CrossRefPubMedGoogle Scholar
  17. 17.
    Martin HL, Richardson BA, Nyange PM, et al. Vaginal lactobacilli, microbial flora, and risk of human immunodeficiency virus type 1 and sexually transmitted disease acquisition. J Infect Dis. 1999;180(6):1863–8.CrossRefPubMedGoogle Scholar
  18. 18.
    Freeman EE, Weiss HA, Glynn JR, Cross PL, Whitworth JA, Hayes RJ. Herpes simplex virus 2 infection increases HIV acquisition in men and women: systematic review and meta-analysis of longitudinal studies. AIDS. 2006;20(1):73–83.CrossRefPubMedGoogle Scholar
  19. 19.
    Gupta G. Gender, sexuality and HIV/AIDS: the what, the why, and the how. Durban, South Africa: plenary address, XIIIth international AIDS conference; 2000.Google Scholar
  20. 20.
    Maman S, Mbwambo JK, Hogan NM, et al. HIV-positive women report more lifetime partner violence: findings from a voluntary counseling and testing clinic in Dar es Salaam, Tanzania. Am J Public Health. 2002;92(8):1331–7.CrossRefPubMedGoogle Scholar
  21. 21.
    Dunkle KL, Jewkes RK, Brown HC, Gray GE, McIntryre JA, Harlow SD. Gender-based violence, relationship power, and risk of HIV infection in women attending antenatal clinics in South Africa. Lancet. 2004;363(9419):1415–21.CrossRefPubMedGoogle Scholar
  22. 22.
    HRW. Deadly delay: South Africa’s efforts to prevent HIV in survivors of sexual violence. Hum Rights Watch. 2004;16(3):75.Google Scholar
  23. 23.
    Karim AQ. Barriers to preventing human immunodeficiency virus in women: experiences from KwaZulu-Natal, South Africa. J Am Med Womens Assoc. 2001;56(4):193–6.PubMedGoogle Scholar
  24. 24.
    Karim QA, Karim SS, Soldan K, Zondi M. Reducing the risk of HIV infection among South African sex workers: socioeconomic and gender barriers. Am J Public Health. 1995;85(11):1521–5.CrossRefPubMedGoogle Scholar
  25. 25.
    Andersson N, Cockcroft A, Shea B. Gender-based violence and HIV: relevance for HIV prevention in hyperendemic countries in southern Africa. AIDS. 2008;22(s4):S73–86.CrossRefPubMedGoogle Scholar
  26. 26.
    Fuentes CM. Pathways from interpersonal violence to sexually transmitted infections: a mixed-method study of diverse women. J Womens Health (Larchmt). 2008;17(10):1591–603.CrossRefGoogle Scholar
  27. 27.
    Maman S, Campbell J, Sweat MD, Gielen AC. The intersections of HIV and violence: directions for future research and interventions. Soc Sci Med. 2000;50(4):459–78.CrossRefPubMedGoogle Scholar
  28. 28.
    Jewkes R, Nduna M, Levin J, et al. A cluster randomized-controlled trial to determine the effectiveness of Stepping Stones in preventing HIV infections and promoting safer sexual behaviour amongst youth in the rural Eastern Cape, South Africa: trial design, methods and baseline findings. Trop Med Int Health. 2006;11(1):3–16.CrossRefPubMedGoogle Scholar
  29. 29.
    Wechsberg WM, Luseno WK, Lam WK, Parry CD, Morojele NK. Substance use, sexual risk, and violence: HIV prevention intervention with sex workers in Pretoria. AIDS Behav. 2006;10(2):131–7.CrossRefPubMedGoogle Scholar
  30. 30.
    Jewkes R, Nduna M, Levin J, et al. Impact of stepping stones on incidence of HIV and HSV-2 and sexual behaviour in rural South Africa: cluster randomised controlled trial. BMJ. 2008;337:a506.CrossRefPubMedGoogle Scholar
  31. 31.
    Kalichman SC, Simbayi LC, Cloete A, et al. Integrated gender-based violence and HIV risk reduction intervention for South African men: results of a Quasi-Experimental Field Trial. Prev Sci. 2009;10(3):260–9.CrossRefPubMedGoogle Scholar
  32. 32.
    Pronyk PM, Hargreaves JR, Kim JC, et al. Effect of a structural intervention for the prevention of intimate-partner violence and HIV in rural South Africa: a cluster randomised trial. Lancet. 2006;368(9551):1973–83.CrossRefPubMedGoogle Scholar
  33. 33.
    Cluss PA, Chang JC, Hawker L, et al. The process of change for victims of intimate partner violence: support for a psychosocial readiness model. Womens Health Issues. 2006;16(5):262–74.CrossRefPubMedGoogle Scholar
  34. 34.
    Sikkema KJ, Heckman T, Kelly JA, et al. HIV risk behaviors amony women living in low-income, inner-city housing developments. Am J Public Health. 1996;86(8):1123–8.CrossRefPubMedGoogle Scholar
  35. 35.
    Sikkema KJ, Kelly JA, Winett RA, et al. Outcomes of a randomized community-level HIV prevention intervention for women living in 18 low-income housing developments. Am J Public Health. 2000;90(1):57–63.CrossRefPubMedGoogle Scholar
  36. 36.
    Briere J. Psychometric review of the trauma symptom checklist-40. In: Stamm BH, editor. Measurement of stress, trauma and adaptation. Lutherville, MD: Sidran Press; 1996.Google Scholar
  37. 37.
    Straus MA, Hamby SL, Boney-McCoy S, Sugarman DB. The revised conflict tactics scales (CTS2): development and preliminary psychometric data. J Fam Issues. 1996;17(3):283–316.CrossRefGoogle Scholar
  38. 38.
    NIMH-Multisite-HIV-Prevention-Trial. The NIMH multisite HIV prevention trial reducing HIV sexual risk behavior. Science. 1998;280:1889–94.CrossRefGoogle Scholar
  39. 39.
    Fox AM, Jackson SS, Hansen NB, Gasa N, Crewe M, Sikkema KJ. In their own voices: a qualitative study of women’s risk for intimate partner violence and HIV in South Africa. Violence Against Women. 2007;13(6):583–602.CrossRefPubMedGoogle Scholar
  40. 40.
    Wood GG, Roche SE. An emancipatory principle for social work with survivors of male violence. Affilia J Women Soc Work. 2001;16(1):66–79.CrossRefGoogle Scholar
  41. 41.
    Dunkle KL, Jewkes RK, Brown HC, et al. Prevalence and patterns of gender-based violence and revictimization among women attending antenatal clinics in Soweto, South Africa. Am J Epidemiol. 2004;160(3):230–9.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  • Kathleen J. Sikkema
    • 1
  • Sharon A. Neufeld
    • 2
    • 3
  • Nathan B. Hansen
    • 2
  • Rakgadi Mohlahlane
    • 4
  • Madri Jansen Van Rensburg
    • 5
  • Melissa H. Watt
    • 6
  • Ashley M. Fox
    • 7
  • Mary Crewe
    • 4
  1. 1.Department of Psychology and NeuroscienceDuke UniversityDurhamUSA
  2. 2.School of MedicineYale UniversityNew HavenUSA
  3. 3.Department of Social and Developmental PsychologyUniversity of CambridgeCambridgeUK
  4. 4.Centre for the Study of AIDSUniversity of PretoriaPretoriaSouth Africa
  5. 5.People Opposing Women AbuseJohannesburgSouth Africa
  6. 6.Global Health InstituteDuke UniversityDurhamUSA
  7. 7.Mailman School of Public HealthColumbia UniversityNew YorkUSA

Personalised recommendations