The Global Impact of Intimate Partner Violence
Intimate partner violence (IPV) is a human rights violation and a public health concern of global magnitude. It affects an estimated 35 percent of women worldwide during their lifetime and has numerous health consequences, including homicide, suicide, and injury; poor reproductive and perinatal health; and mental health disorders such as depression, posttraumatic stress disorder (PTSD), and substance abuse. It also increases the risk of HIV acquisition by limiting women’s ability to consistently use HIV prevention methods.
Numerous factors contribute to the high burden of IPV, including gender norms that support male dominance and aggression in relationships, harmful alcohol use, and prior history of abuse. Given the multi-faceted drivers and consequences of IPV, there is a need to apply a variety of approaches to tackle the issue. In pursuit of this goal, RTI’s Women’s Global Health Imperative (WGHI) designed and evaluated three distinct approaches to IPV prevention—targeting women and couples in community and clinic settings across South Africa, Kenya, and India.
Three Region-Specific Approaches to Addressing Intimate Partner Violence
Taking a collaborative, evidence-informed, and often creative approach to this work, WGHI initiated the process of addressing IPV with in-country partners through a formative research process. In all three settings, this phase of research was used to identify manifestations of violence and how it interacted with other behaviors—such as PrEP use or men’s alcohol use—and to identify and adapt intervention components.
In Kenya, for example, WGHI worked with the Impact Research and Development Organization (IRDO) to identify critical ways in which violence inhibits adolescent girls and young women’s (AGYW) PrEP use through use of a storytelling technique. The team asked for solutions from these AGYW and fed back information and ideas to a youth advisory board that helped to shape the development of Tu’Washindi na PrEP, a community-based intervention incorporating peer support clubs for AGYW, couples’ education about PrEP, and sensitization activities for men in the community.
In South Africa, together with Wits Reproductive Health and HIV Institute (Wits RHI), a similar process was used to design CHARISMA, a clinic-based intervention for women seeking PrEP that provides counseling modules tailored to the individual woman’s relationship dynamics.
In India, with the St Johns Research Institute (SJRI) and ideas42, collaborative formative research informed the design of the Beautiful Home intervention, providing couples counselling combined with economic incentives for alcohol reduction to couples experiencing issues with both men’s alcohol use and IPV.
While research-based intervention design is critical, further evaluations are still needed to ensure intervention acceptability, feasibility and intended effect on IPV. In both Kenya and India, these evaluations were conducted through pilot randomized controlled trials—efforts that included the involvement of more than 100 AGYW in Siaya County, Kenya, and 60 couples in Bangalore, India. The evaluation of CHARISMA in Johannesburg, South Africa, started with a longitudinal pilot study among 95 women to assess acceptability and feasibility, followed by a larger randomized controlled trial to test effectiveness with 407 women.
Intimate Partner Violence Interventions Show Promising Results
What did we learn from this work? Pilot findings from these three studies have reported high feasibility and acceptability in all settings, with some indications of effectiveness in preventing IPV.
In South Africa, the CHARISMA intervention was perceived as helpful and relevant to participants and staff. Women felt it taught them skills to decide how much to disclose about their PrEP use to male partners or others and heightened their awareness of abuse and sources of support.
In Kenya, AGYW felt Tu’Washindi na PrEP improved their relationships, leading to greater male partner support for PrEP use and safety from violence. Data supported this, with reported IPV episodes in the intervention arm 34 percent lower overall than in the control and 80 percent lower for events causing injury.
In India, Beautiful Home had similar success with findings showing a 50 percent reduction in violence reported by intervention couples, a result that was sustained for four months after the intervention ended.
Intimate partner violence is increasingly recognized as a global public health issue because of both its magnitude and its harmful effects on health. WGHI’s work aims to better identify and address IPV for women globally and has contributed to the development and testing of three promising approaches. We intend to further test and refine the interventions developed through CHARISMA, Tu’Washindi and Beautiful Home through larger trials and implementation work in a range of global settings.