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Background Intimate partner violence (IPV) is pervasive throughout the world, with profound consequences for women’s health. While women’s ‘economic empowerment’ is touted as a potential means to reduce IPV, evidence is mixed as to the role of different economic factors in determining women’s risk. This paper explores associations and potential pathways between women’s income and experience of IPV, in Mwanza city, Tanzania. Methods We use data from married/cohabiting women ( N  = 740) enrolled in the MAISHA study, a cluster randomised trial of an IPV prevention intervention. Women were interviewed at baseline and 29-months later. We use logistic regression to model cross-sectional (baseline) and longitudinal associations between: a woman’s monthly income (quartiles) and her past year risk of physical IPV, sexual IPV and economic abuse; and a woman’s relative financial contribution to the household (same/less than partner; more than partner) and past year physical IPV and sexual IPV. Results At baseline, 96% of respondents reported earning an income and 28% contributed more financially to the household than their partner did. Higher income was associated with lower past-year physical IPV risk at baseline and longitudinally, and lower sexual IPV at baseline only. No clear associations were seen between income and economic abuse. Higher relative financial contribution was associated with increased physical IPV and sexual IPV among all women at baseline, though only among control women longitudinally. Higher income was associated with several potential pathways to reduced IPV, including reduced household hardship, fewer arguments over the partner’s inability to provide for the family, improved relationship dynamics, and increased relationship dissolution. Those contributing more than their partner tended to come from more disadvantaged households, argue more over their partner’s inability to provide, and have worse relationship dynamics. Conclusions While women’s income was protective against IPV, women who contributed more financially than their partners had greater IPV risk. Poverty and tensions over men’s inability to provide emerge as potentially important drivers of this association. Interventions to empower women should not only broaden women’s access to economic resources and opportunities, but also work with women and men to address men’s livelihoods, male gender roles and masculinity norms. Trial registration ClinicalTrials.gov #NCT02592252 , registered retrospectively (13/08/2015).

Introduction We assessed the impact of a personal agency-based training for refugee women and their male partners on their economic and social empowerment, rates of intimate partner violence (IPV), and non-partner violence (NPV). Methods We conducted an individually randomized controlled trial with 1061 partnered women (aged 18–45) living in a refugee camp in Rwanda. Women received two days of training, and their partners received one day of training. The follow-up survey where all relevant outcomes were assessed was carried out at 6–9 months post-intervention. Results At follow up, women in the intervention arm were more likely to report partaking in income generating activities (aIRR 1.27 (1.04–1.54), p  < 0.05) and skill learning (aIRR 1.59 (1.39–1.82), p  < 0.001) and reported a reduction in experience of physical or sexual NPV in the past six months (aIRR 0.65 (0.39–1.07), p  < 0.09). While improved, no statistically significant impacts were seen on physical or sexual IPV (aIRR 0.80 (0.58–1.09), p  = 0.16), food insecurity (β 0.98 (0.93 to 1.03), p  = 0.396), or clean cookstove uptake (aIRR 0.95 (0.88 to 1.01), p  = 0.113) in the past six months. We found statistically significant reduction in physical and sexual IPV amongst those experiencing IPV at baseline (aIRR 0.72 (0.50 to 1.02), p  < 0.07). Small improvements in self-efficacy scores and our indicator of adapting to stress were seen in the intervention arm. Some challenges were also seen, such as higher prevalence of probable depression and/or anxiety (aIRR 1.79 (1.00-3.22), p  = 0.05) and PTSD (aIRR 2.07 (1.10–3.91), p  < 0.05) in the intervention arm compared to the control arm. Conclusion Our findings echo previous research showing personal agency training can support economic well-being of women. We also find potentially promising impacts on gender-based violence. However, there is some evidence that integration of evidence-based mental health support is important when enhancing agency amongst conflict-affected populations. Trial registration number The trial was registered with ClinicalTrials.gov, Identifier: NCT04081441 on 09/09/2019. Key message What is known? • There are limited impacts of economic interventions in humanitarian settings on gender-based violence. • Outside of humanitarian settings, agency-based training interventions, both with/or without male partner engagement, have been shown to improve economic impacts, however IPV impacts are not known. • Integrated multi-component interventions that economically empower women and engage male partners hold promise in conflict-affected populations. What are the new findings? • An abbreviated two-day personal agency training for women and one-day training for their male partners led to significant increases in uptake of income generating activities and skill building for women. • Promising trends suggest reduction in non-partner violence for the full study sample and a reduction in intimate partner violence for women who reported IPV at baseline. • Increased rates of probable anxiety and/or depression and post-traumatic stress disorder (PTSD) were identified in the intervention group. What do the new findings imply? • Promising impacts on livelihoods and experience of violence are possible despite the abbreviated nature of this training. • Despite improvements in livelihoods and reduction in experience of violence, more concerted efforts are needed to prevent the increased risk of anxiety, depression, and PTSD found in conflict-affected populations.

Background Intimate partner violence (IPV) is recognised as an important public health and social problem, with far reaching consequences for women’s physical and emotional health and social well-being. Furthermore, controlling behaviour by a partner has a similar impact on women’s well-being, yet little is known about the prevalence of this type of behaviour and other related abuses in Tanzania and in other sub-Saharan African countries. Methods We conducted a cross-sectional study to determine the lifetime and past 12-month prevalence of physical and sexual IPV, economic abuse, emotional abuse and controlling behaviour among ever-partnered women in Mwanza, Tanzania. Women ( N  = 1049) were enrolled in an ongoing trial (Maisha study) to assess the impact of microfinance combined with gender training on participants’ experience IPV, and other related outcomes. Interviews were conducted by same sex interviewers to collect information about socio-demographic characteristics, experiences of specific acts of IPV and abuse, and symptoms of poor mental health status. Results Overall, about 61% of women reported ever experiencing physical and/or sexual IPV (95% CI: 58–64%) and 27% (95% CI: 24–29%) experienced it in the past 12 months. Partner controlling behaviour was the most prevalent type of abuse with 82% experiencing it in their lifetime and 63% during the past 12 months. Other types of abuses were also common, with 34% of women reporting economic abuse and 39% reporting emotional abuse during the past 12 months. The prevalence of IPV and abuses varied by socio-demographic characteristics, showing much higher prevalence rates among younger women, women with young partners and less educated women. After we adjusted for age and socio-economic status, physical violence (OR = 1.8; 95% CI: 1.3–2.7) and sexual violence (OR = 2.8; 95% CI: 1.9–4.1) were associated with increased reporting of symptoms of poor mental health. Similarly, experience of abuse during the past 12 months was associated with increased reporting of symptoms of poor mental health. Conclusions The high prevalence of IPV and abuses and its strong links with symptoms of poor mental health underline the urgent need for developing and testing appropriate interventions in settings like Tanzania to tackle both violence and abusive behaviours among intimate partners. Trial registration ClinicalTrials.gov – ID NCT02592252 , registered retrospectively on 13 August 2015.

PurposeTeen dating violence (TDV) is a global public health and safety issue causing health impacts to youth people. This study aimed to examine: (1) the impact of the pandemic on TDV victimisation rates and (2) socioecological factors associated with sustained risk for TDV victimisation during the first year of COVID-19.MethodsData are from an ongoing randomised controlled trial of a TDV prevention programme in Texas (n=2768). We conducted annual assessments in 2019–2021. We used regression modelling to assess demographic, individual, peer and family factors associated with TDV risks.ResultsTDV rates declined from 11.9% in 2019 to 5.2% in 2021. While demographic, peer and family/household factors were not associated with TDV victimisation during the pandemic, individual-level factors (ie, early sexual debut, substance use, acceptance of violence and prior TDV involvement) were related to COVID-era risks. Only early sexual debut was uniquely linked to TDV victimisation risk the first year of COVID-19.ConclusionsWhile TDV rates declined during the pandemic, previous victimisation, substance use and early sexual debut remained potent risks for relationship harm.

Background Little is known about the prevalence and correlates of intimate partner violence (IPV) among gay, bisexual and other men who have sex with men (GBMSM) in the UK. The aim of this study was to investigate the prevalence of IPV, associations of socio-economic and psychosocial factors with IPV, and the association of IPV with depression and sexual behaviour, among GBMSM in the PROUD trial of pre-exposure prophylaxis (PrEP). Methods PROUD enrolled 544 HIV-negative participants in England from 2012 to 2014; participants were randomised to immediate or deferred PrEP. This analysis included 436 GBMSM who had IPV data at month-12 and/or 24. Prevalence of IPV victimization and perpetration (lifetime, and in the past year) was assessed at these time-points. Generalized estimating equations were used to investigate associations with IPV, using pooled data from both time-points. Results At month-12 ( N  = 410), 44.9% of men reported ever being a victim of IPV, 15.6% in the last year, and 19.5% reported ever perpetrating IPV, 7.8% in the last year. At month-24 ( N  = 333), the corresponding prevalence was 40.2 and 14.7% for lifetime and past year IPV victimization and 18.0 and 6.9% for lifetime and past year IPV perpetration. IPV prevalence did not differ by randomised arm. Men reporting internalized homophobia and sexualized drug use were more likely to report IPV. Lifetime and last year experience of IPV victimization and perpetration were strongly associated with depressive symptoms (PHQ-9 ≥ 10) (adjusted for socio-demographics: lifetime IPV victimization PR 2.57 [95% CI: 1.71, 3.86]; past year IPV victimization PR 2.93 [95% CI: 1.96, 4.40]; lifetime IPV perpetration PR 2.87 [95% CI: 1.91, 4.32]; past year IPV perpetration PR 3.47 [95% CI: 2.13, 5.64], p  < 0.001 for all); IPV was not consistently associated with measures of condomless anal sex or high partner numbers. Conclusions GBMSM at high-risk of HIV who are seeking/taking PrEP may experience a high burden of IPV, which may be linked to depression. Training on awareness of and enquiry for IPV among GBMSM in sexual health clinics is recommended. Trial registration ClinicalTrials.gov identifier: NCT02065986 . Registered 19 February 2014 (retrospectively registered).

The complex relationship between intimate partner violence and psychological distress warrants an integrated intervention approach. In this study we examined the relevance, acceptability, and feasibility of evaluating a multi-sectoral integrated violence- and mental health-focused intervention (Nguvu). We enrolled 311 Congolese refugee women from Nyarugusu refugee camp in Tanzania with past-year intimate partner violence and elevated psychological distress in a feasibility cluster randomized trial. Women were recruited from local women's groups that were randomized to the Nguvu intervention or usual care. Participants from women's groups randomized to Nguvu received 8 weekly sessions delivered by lay refugee incentive workers. Psychological distress, intimate partner violence, other wellbeing, and process indicators were assessed at baseline and 9-weeks post-enrollment to evaluate relevance, acceptability, and feasibility of implementing and evaluating Nguvu in refugee contexts. We found that Nguvu was relevant to the needs of refugee women affected by intimate partner violence. We found reductions in some indicators of psychological distress, but did not identify sizeable changes in partner violence over time. Overall, we found that Nguvu was acceptable and feasible. However, challenges to the research protocol included baseline imbalances between study conditions, differential intervention completion related to intimate partner violence histories, differences between Nguvu groups and facilitators, and some indication that Nguvu may be less beneficial for participants with more severe intimate partner violence profiles. We found evidence supporting the relevance of Nguvu to refugee women affected by partner violence and psychological distress and moderate evidence supporting the acceptability and feasibility of evaluating and implementing this intervention in a complex refugee setting. A definitive cluster randomized trial requires further adaptations for recruitment and eligibility screening, randomization, and retention. ISRCTN65771265, June 27, 2016.

Intimate partner violence (IPV) is a significant global public health problem. Understanding risk factors is crucial for developing prevention programmes. Yet, little evidence exists on population-based prevalence and risk factors for IPV in West Africa. Our objective was to measure both lifetime and past year prevalence of IPV and to determine factors associated with past year physical or sexual IPV experience. This population-based survey involved 2000 randomly selected women aged 18 to 49 years living in 40 localities within four districts of the Central Region of Ghana. Questionnaires were interviewer-administered from February to May 2016. Respondents were currently or ever-partnered, and resident in study area ≥12months preceding the survey. Data collected included: socio-demographics; sexual behavior; mental health and substance use; employment status; 12-month and lifetime experience of violence; household food insecurity; gender norms/attitudes; partner characteristics and childhood trauma. Logistic regression modelling was used to determine factors associated with sexual or physical IPV, adjusting for age and survey design. About 34% of respondents had experienced IPV in the past year, with 21.4% reporting sexual and or physical forms. Past year experience of emotional and economic IPV were 24.6% and 7.4% respectively. Senior high school education or higher was protective of IPV (AOR = 0.51[0.30-0.86]). Depression (AOR = 1.06[1.04-1.08], disability (AOR = 2.30[1.57-3.35]), witnessing abuse of mother (AOR = 2.1.98[1.44-2.72]), experience of childhood sexual abuse (AOR = 1.46[1.07-1.99]), having had multiple sexual partners in past year (AOR = 2.60[1.49-4.53]), control by male partner (AOR = 1.03[1.00-1.06]), male partner alcohol use in past year (AOR = 2.65[2.12-3.31]) and male partner infidelity (AOR = 2.31[1.72-3.09]) were significantly associated with increased odds of past year physical or sexual IPV experience. Male perpetrated IPV remains a significant public health issue in Ghana. Evidence-based interventions targeting women's mental health, disabilities, exposure to violence in childhood, risky sexual behavior and unequal power in relationships will be critical in reducing IPV in this setting.

Financial incentives have demonstrated effectiveness in improving outcomes for people living with HIV; however, little is known about their impact on intimate partner violence (IPV) in this vulnerable population. A cluster-randomized trial investigating financial incentives and viral suppression was conducted in the Lake Zone of Tanzania (clinicaltrials.gov: NCT0420135). Between May 2021-March 2022, 32 clinics were randomized 1:1 to receive the standard of care (SOC) or to offer 22,500 TZS (~$10 USD) to individuals initiating antiretroviral therapy monthly for up to 6 months, conditional on clinic attendance. An intention-to-treat analysis was conducted to examine the effect of financial incentives on IPV among partnered women at 6 months ( n  = 494), with prevalence differences (PD) and 95% confidence intervals (CI) estimated using generalized estimating equations. Subgroup analyses were conducted among women partnered at 6 months only and women partnered at both baseline and 6 months. Past 6-month IPV was reported by 241 (48.8%) partnered women. Emotional IPV was the most common form of violence (47.8%), followed by physical (7.5%) and sexual IPV (5.1%). There were no significant differences in past 6-month IPV between arms in the primary (49.6% SOC vs. 48.1% incentive, PD: -0.02, 95% CI: -0.18, 0.15) or subgroup analyses. These findings suggest that small, short-term financial incentives used to improve HIV treatment outcomes do not significantly alter IPV risks, however with the width of the CIs it is not possible to rule out small and moderate-sized effects. Further research among larger samples is needed as financial incentive programs are brought to scale for people living with HIV.

Background Intimate partner violence (IPV) is a leading threat to women’s health and safety globally. Women in abusive relationships make critical decisions about safety and harm reduction while weighing multiple competing priorities, such as safety of children, housing and employment. In many low- and middle-income countries (LMIC), IPV prevention and response services are limited and women lack access to safety planning resources. In high-resource settings, an interactive safety decision aid app (myPlan) has been found valuable in reducing decisional conflict and empowering women to take action in accordance with their safety priorities. This paper describes 1) the community-participatory formative process used to adapt the myPlan app content, interface, and implementation for the Kenya context, and 2) the randomized clinical trial study protocol for efficacy evaluation of myPlan Kenya. Methods A community-participatory formative process engaged service providers and stakeholders, as well as IPV survivors for adaptation, followed by an in-depth pilot and final refinements. A randomized clinical trial design will then be used to determine efficacy of the myPlan Kenya app compared to standard care among women reporting IPV or fear of partner and living in an urban settlement. myPlan Kenya app provides and solicits information on a) relationship health; b) safety priorities; and c) severity of relationship violence. Based on the woman’s inputs, the evidence-based algorithm developed for myPlan Kenya generates a tailored safety plan. Outcome measures are assessed at baseline, immediate post-intervention, and 3-month post-baseline. Difference-in-differences analysis compares primary (e.g. safety preparedness, safety behavior, IPV), and secondary outcomes (e.g. resilience, mental health, service utilization, self-blame) across timepoints by group. Discussion Formative phase revealed high feasibility and acceptability of a technology-based intervention for safety planning in this LMIC setting. This phase generated essential refinements to myPlan Kenya app readability, content and implementation, including increased visualization of messaging, and implementation via community health volunteers (CHVs). The resulting trial will be the first to evaluate efficacy of a community-partnered technology-based IPV intervention in a LMIC. Our adaptation process and trial results will inform researchers and interventionists to integrate multiple data sources to adapt IPV intervention content and interface in settings where technology-based interventions for IPV are novel and literacy is limited. Trial registration Pan African Clinical Trial Registry approval received 25 April 2018 ( PACTR201804003321122 ); retrospectively registered.

Despite calls to engage men in HIV and intimate partner violence (IPV) prevention efforts, effective approaches to reach and engage men in low-resource, high-HIV prevalence settings are limited. We identified and engaged social networks of mostly young men in a study designed to evaluate the efficacy of a combined microfinance and peer health leadership intervention to prevent HIV and IPV. We conducted a cluster-randomized trial among 60 social networks locally referred to as \"camps\" within Dar es Salaam, Tanzania. Camps were randomly assigned (1:1) to a microfinance and peer health leadership intervention or a control condition that received a brief delayed intervention after the study's conclusion. Allocation was not masked to participants or researchers. Behavioral assessments were conducted at baseline and 30-months post-intervention launch, with biological samples drawn at 30-months to test for sexually-transmitted infections (STIs). Primary outcomes included prevalence of STIs and past-year IPV perpetration. Secondary outcomes included STI sexual risk behaviors and past-year HIV testing. Proximal intervention targets included inequitable gender norm attitudes and hope. A modified Poisson regression approach was used to estimate intention-to-treat intervention effects on outcomes assessed at the 30-month follow-up. We enrolled 1,258 men within 60 camps. Of these men, 1,029 (81.8%) completed the 30-month follow-up. There were no differences by condition in STI prevalence, IPV perpetration, or sexual risk behaviors at the 30-month follow-up. Intervention participants reported greater levels of past-year HIV testing, controlling for baseline testing (aRR 1.13 95% CI 1.005-1.28). They also reported significantly lower levels of inequitable gender norm attitudes (adjusted effect -0.11, 95% CI -0.21-0.003). We successfully engaged and retained social networks of men in this multilevel intervention study. While we did not see an effect on the primary outcomes, our intervention successfully improved HIV testing and reduced inequitable gender norm attitudes.