Posted: Jan 16, 2017
Women empowerment and practices regarding use of dual protection among family planning clients in urban Zimbabwe
Introduction: Gender related vulnerability may increase women’s susceptibility to HIV infection and unintended pregnancy. The purpose of the study was to examine the relationship between women empowerment and practices regarding use of dual protection. Methods: A non-experimental descriptive correlational study design was conducted using systematic sampling method to recruit eighty women aged 18-49 years at an urban clinic in Zimbabwe. Data was collected using a structured interview schedule and was analysed and presented using descriptive and inferential statistics. Results: A weak positive significant correlation existed between women empowerment and use of dual protection (r= .242, p=0.03). Findings demonstrated that as women empowerment levels increase practices regarding use of dual protection also increase. The coefficient of determination, R2=.0.058, b=0.293, indicated that the total amount of variation in utilization of dual protection explained by level of women empowerment was 5.8%. The major finding was that use of dual protection was very low (3.8%) and 67.5% had low levels of practices regarding use of dual protection. Additionally, 85.0% were not confident of using the female condom. Conclusion: Gender inequality within sexual relations was associated with low levels of practices regarding use of dual protection. The study provided evidence for the need for a proactive integrated approach to empower women so that they could negotiate for safer sex practices. To increase female condom utilization, manufacturers need to redesign the female condom so that it becomes user friendly. Health personnel need to involve men for any health reproductive program to succeed.
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Mutowo, J., Kasu, C. M., & Mufunda, E. (2014). Women empowerment and practices regarding use of dual protection among family planning clients in urban Zimbabwe. The Pan African Medical Journal, 17, 300. http://doi.org/10.11604/pamj.2014.17.300.3282
Posted: Nov 18, 2016
Community empowerment and involvement of female sex workers in targeted sexual and reproductive health interventions in Africa: a systematic review
Background: Female sex workers (FSWs) experience high levels of sexual and reproductive health (SRH) morbidity, violence and discrimination. Successful SRH interventions for FSWs in India and elsewhere have long prioritised community mobilisation and structural interventions, yet little is known about similar approaches in African settings. We systematically reviewed community empowerment processes within FSW SRH projects in Africa, and assessed them using a framework developed by Ashodaya, an Indian sex worker organisation.
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Methods: In November 2012 we searched Medline and Web of Science for studies of FSW health services in Africa, and consulted experts and websites of international organisations. Titles and abstracts were screened to identify studies describing relevant services, using a broad definition of empowerment. Data were extracted on
service-delivery models and degree of FSW involvement, and analysed with reference to a four-stage framework developed by Ashodaya. This conceptualises community empowerment as progressing from (1) initial engagement with the sex worker community, to (2) community involvement in targeted activities, to (3) ownership, and finally,(4) sustainability of action beyond the community.
Results: Of 5413 articles screened, 129 were included, describing 42 projects. Targeted services in FSW ‘hotspots’ were generally isolated and limited in coverage and scope, mostly offering only free condoms and STI treatment. Many services were provided as part of research activities and offered via a clinic with associated community outreach. Empowerment processes were usually limited to peer-education (stage 2 of framework). Community mobilisation as an activity in its own right was rarely documented and while most projects successfully engaged communities, few progressed to involvement, community ownership or sustainability. Only a few interventions had evolved to facilitate collective action through formal democratic structures (stage 3). These reported improved sexual negotiating power and community solidarity, and positive behavioural and clinical outcomes. Sustainability of many projects was weakened by disunity within transient communities, variable commitment of programmers, low human resource capacity and general resource limitations.
Conclusions: Most FSW SRH projects in Africa implemented participatory processes consistent with only the earliest stages of community empowerment, although isolated projects demonstrate proof of concept for successful empowerment interventions in African settings.
Moore, L., Chersich, M. F., Steen, R., Reza-Paul, S., Dhana, A., Vuylsteke, B., … Scorgie, F. (2014). Community empowerment and involvement of female sex workers in targeted sexual and reproductive health interventions in Africa: a systematic review. Globalization and Health, 10, 47
Posted: Jul 27, 2016
Managing men: women’s dilemmas about overt and covert use of barrier methods for HIV prevention
Women in sub-Saharan Africa are at high risk of HIV infection and may struggle to negotiate condom use. This has led to a focus on the development of female-controlled barrier methods such as the female condom, microbicides and the diaphragm. One of the advantages of such products is their contribution to female empowerment through attributes that make covert use possible. We used focus groups to discuss covert use of barrier methods with a sample of South African women aged 18-50 years from Eastern Johannesburg. Women’s attitudes towards covert use of HIV prevention methods were influenced by the overarching themes of male dislike of HIV and pregnancy prevention methods, the perceived untrustworthiness of men and social interpretations of female faithfulness. Women’s discussions ranged widely from overt to covert use of barrier methods for HIV prevention and were influenced by partner characteristics and previous experience with contraception and HIV prevention. The discussions indicate that challenging gender norms for HIV prevention can be achieved in quite subtle ways, in a manner that suits individual women’s relationships and previous experiences with negotiation of either HIV or pregnancy prevention.
MacPhail C, Terris-Prestholt F, Kumaranayake L, Ngoako P, Watts C, Rees H.
Culture, health & sexuality. 2009;11(5):485-97., Culture, health & sexuality. 2009;11(5):485-97.
Posted: Jul 27, 2016
Jobs, food, taxis and journals: complexities of implementing Stepping Stones and Creating Futures in urban informal settlements in South Africa
This paper seeks to refocus debates on structural interventions away from ‘assessing’ their effectiveness towards understanding processes around how such interventions are implemented. Implementation Science is focused on understanding potential challenges of translating interventions from highly controlled conditions into ‘real life’ settings. Using the case study of Stepping Stones and Creating Futures a structural and behavioural intervention to reduce intimate partner violence and HIV risk behaviours amongst young women and men in urban informal settlements, we explore the challenges of implementing such an approach. We move beyond simply describing challenges of implementing, to understand how these challenges had an impact on the safe social space the intervention seeks to create as its underlying theory of change. We identify four major challenges of implementation: taxi fares, food provided during the intervention, young people’s ongoing need to work and journals provided during the intervention. We suggest that, in different ways, these factors all impinged on the emergence of a safe social space. Understanding the challenges of implementing the intervention is critical for reflecting on scaling up interventions. Central to this is the need to work with participants to help them negotiate the challenges of participating in interventions.
Gibbs A, Jewkes R, Mbatha N, Washington L, Willan S.
Afr J AIDS Res. 2014;13(2):161-7. doi: 10.2989/16085906.2014.927777., Afr J AIDS Res. 2014;13(2):161-7. doi: 10.2989/16085906.2014.927777.
Posted: Jul 27, 2016
Stepping Stones and Creating Futures intervention: shortened interrupted time series evaluation of behavioural and structural health promotion and violence prevention intervention for young people in informal settlements in Durban, South Africa
Background: Gender-based violence and HIV are highly prevalent in the harsh environment of informal settlements and reducing violence here is very challenging. The group intervention Stepping Stones has been shown to reduce men’s perpetration of violence in more rural areas, but violence experienced by women in the study was not affected. Economic empowerment interventions with gender training can protect older women from violence, but microloan interventions have proved challenging with young women. We investigated whether combining a broad economic empowerment intervention and Stepping Stones could impact on violence among young men and women. The intervention, Creating Futures, was developed as a new generation of economic empowerment intervention, which enabled livelihood strengthening though helping participants find work or set up a business, and did not give cash or make loans.
Methods: We piloted Stepping Stones with Creating Futures in two informal settlements of Durban with 232 out of school youth, mostly aged 18-30 and evaluated with a shortened interrupted time series of two baseline surveys and at 28 and 58 weeks post-baseline. 94/110 men and 111/122 women completed the last assessment, 85.5% and 90.2% respectively of those enrolled. To determine trend, we built random effects regression models with each individual as the cluster for each variable, and measured the slope of the line across the time points.
Results: Men’s mean earnings in the past month increased by 247% from R411 (~$40) to R1015 (~$102, and women’s by 278% R 174 (~$17) to R 484 (about $48) (trend test, p < 0.0001). There was a significant reduction in women’s experience of the combined measure of physical and/or sexual IPV in the prior three months from 30.3% to 18.9% (p = 0.037). This was not seen for men. However both men and women scored significantly better on gender attitudes and men significantly reduced their controlling practices in their relationship. The prevalence of moderate or severe depression symptomatology among men and suicidal thoughts decreased significantly (p < 0.0001 and p = 0.01).
Conclusions: These findings are very positive for an exploratory study and indicate that the Creating Futures/Stepping Stones intervention has potential for impact in these difficult areas with young men and women. Further evaluation is needed.
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Jewkes R, Gibbs A, Jama-Shai N, Willan S, Misselhorn A, Mushinga M, et al. BMC public health. 2014;14:1325.