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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.

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 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.

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 Responding to intimate partner violence (IPV) and its consequences is made complex by women’s diverse needs, priorities and contexts. Tailored online IPV interventions that account for differences among women have potential to reduce barriers to support and improve key outcomes. Methods Double blind randomized controlled trial of 462 Canadian adult women who experienced recent IPV randomly were assigned to receive either a tailored , interactive online safety and health intervention ( iCAN Plan 4 Safety ) or a static, non-tailored version of this tool. Primary (depressive symptoms, PTSD symptoms) and secondary (helpfulness of safety actions, confidence in safety planning, mastery, social support, experiences of coercive control, and decisional conflict) outcomes were measured at baseline and 3, 6, and 12 months later via online surveys. Generalized Estimating Equations were used to test for differences in outcomes by study arm. Differential effects of the tailored intervention for 4 strata of women were examined using effect sizes. Exit survey process evaluation data were analyzed using descriptive statistics, t-tests and conventional content analysis. Results Women in both tailored and non-tailored groups improved over time on primary outcomes of depression ( p  < .001) and PTSD ( p  < .001) and on all secondary outcomes. Changes over time did not differ by study arm. Women in both groups reported high levels of benefit, safety and accessibility of the online interventions, with low risk of harm, although those completing the tailored intervention were more positive about fit and helpfulness. Importantly, the tailored intervention had greater positive effects for 4 groups of women, those: with children under 18 living at home; reporting more severe violence; living in medium-sized and large urban centers; and not living with a partner. Conclusion This trial extends evidence about the effectiveness of online safety and health interventions for women experiencing IPV to Canadian women and provides a contextualized understanding about intervention processes and effects useful for future refinement and scale up. The differential effects of the tailored intervention found for specific subgroups support the importance of attending to diverse contexts and needs. iCAN is a promising intervention that can complement resources available to Canadian women experiencing IPV. Trial registration Clinicaltrials.gov ID NCT02258841 (Prospectively Registered on Oct 2, 2014).

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.

Background Intimate partner violence (IPV) is highly prevalent and has detrimental effects on the physical and mental health of women across the world. Despite emerging evidence on the impacts of cash transfers on intimate partner violence, the pathways through which reductions in violence occur remain under-explored. A randomised controlled trial of a cash and in-kind food transfer programme on the northern border of Ecuador showed that transfers reduced physical or sexual violence by 30 %. This mixed methods study aimed to understand the pathways that led to this reduction. Methods We conducted a mixed methods study that combined secondary analysis from a randomised controlled trial relating to the impact of a transfer programme on IPV with in-depth interviews and focus group discussions with male and female beneficiaries. A sequential analysis strategy was followed, whereby qualitative results guided the choice of variables for the quantitative analysis and qualitative insights were used to help interpret the quantitative findings. Results We found qualitative and quantitative evidence that the intervention led to reductions in IPV through three pathways operating at the couple, household and individual level: i) reduced day-to-day conflict and stress in the couple; ii) improved household well-being and happiness; and iii) increased women’s decision making, self-confidence and freedom of movement. We found little evidence that any type of IPV increased as a result of the transfers. Discussion While cash and in-kind transfers can be important programmatic tools for decreasing IPV, the positive effects observed in this study seem to depend on circumstances that may not exist in all settings or programmes, such as the inclusion of a training component. Moreover, the programme built upon rather than challenged traditional gender roles by targeting women as transfer beneficiaries and framing the intervention under the umbrella of food security and nutrition – domains traditionally ascribed to women. Conclusions Transfers destined for food consumption combined with nutrition training reduced IPV among marginalised households in northern Ecuador. Evidence suggests that these reductions were realised by decreasing stress and conflict, improving household well-being, and enhancing women’s decision making, self-confidence and freedom of movement. Trial registration ClinicalTrials.gov NCT02526147 . Registered 24 August 2015.

Introduction: Intimate partner violence (IPV) is a major public health concern worldwide, with significant repercussions for women's health. In some parts of the world, IPV is considered an acceptable practice, especially in rural areas. Attitudes supportive of IPV have been reported as one of the foremost predictors of IPV, and a shift in the attitudes that permit, promote, and perpetuate IPV is required to substantially reduce its occurrence. Community-based interventions are a feasible strategy to engage community members in efforts to prevent IPV. This study tested a community mobilisation intervention to challenge attitudes towards IPV and prevent violence within intimate relationships. Methods: This randomised community trial was conducted in selected rural communities in Oyo State, Nigeria, between January 2019 and April 2021. The study employed a convergent parallel mixed-methods design and a three-stage sampling technique in selecting two local government areas, eight communities, and the study participants. The 6-month community mobilisation intervention, focused on creating awareness and challenging attitudes supportive of IPV, was evaluated using two cross-sectional surveys (pre-and post-intervention), 12 in-depth interviews, and nine focus group discussions. The outcomes for this study, assessed using the WHO Women's Health Questionnaire, included attitudes supportive of IPV, women's experiences of IPV, and men's perpetration of IPV. Difference indifferences (DID) regression models were estimated to compare changes in IPV levels in the intervention and control arms, while qualitative data were analysed using a thematic approach. Results: At baseline, 628 men and 667 women responded to the survey, and 640 men and 658 women responded to the survey at endline. The median age of the respondents was 35 years at baseline and 40 years at endline. In the intervention group, the proportion of women with attitudes supportive of IPV reduced between baseline and endline from 65.2% to 35.1% versus 45.2% to 32.7% in the control group (DIDequivalent-0.116, pequivalent0.039). Women's past year experience of IPV also reduced from 30.3% to 1.2% versus 48.4% to 33.2% in the control group (DIDequivalent-0.131, pequivalent0.006). Changes in the proportion of men who had attitudes supportive of IPV or perpetrated IPV did not follow this trend. In the intervention group, the proportion of men with attitudes supportive of IPV increased between baseline and endline from 40.1% to 44.6%, as they did in the control group - from 43.7% to 45.8% (DIDequivalent0.015, pequivalent0.805). Men's past-year perpetration of IPV reduced from 29.9% to 19.9% versus 43.2% to 10.2% in the control group (DIDequivalent-0.050, pequivalent0.155). Respondents to the qualitative interviews in both the intervention and control groups at baseline were aware of the various forms of IPV in their communities, and had attitudes supportive of physical violence; however, those in the intervention group alluded to a reduction in IPV at endline. Conclusion: This trial demonstrates the potential of community mobilisation as an intervention that can reduce the proportion of women who have attitudes supportive of IPV, and had experienced IPV in the previous year.

Background Men’s perpetration of intimate partner violence (IPV) limits gains in health and wellbeing for populations globally. Largely informal, rapidly expanding peri-urban settlements, with limited basic services such as electricity, have high prevalence rates of IPV. Evidence on how to reduce men’s perpetration, change social norms and patriarchal attitudes within these settings is limited. Our cluster randomised controlled trial aimed to determine the effectiveness of the Sonke CHANGE intervention in reducing use of sexual and/or physical IPV and severity of perpetration by men aged 18–40 years over 2 years. Methodology The theory-based intervention delivered activities to bolster community action, including door-to-door discussions, workshops, drawing on the CHANGE curriculum, and deploying community action teams over 18 months. In 2016 and 2018, we collected data from a cohort of men, recruited from 18 clusters; nine were randomised to receive the intervention, while the nine control clusters received no intervention. A self-administered questionnaire, using audio-computer assisted software, asked about sociodemographics, gender attitudes, mental health, and the use and severity of IPV. We conducted an intention-to-treat analysis at the cluster level comparing the expected risk to observed risk of using IPV while controlling for baseline characteristics. A secondary analysis used latent classes (LCA) of men to see whether there were differential effects of the intervention for subgroups of men. Results Of 2406 men recruited, 1458 (63%) were followed to 2 years. Overall, we saw a reduction in men’s reports of physical, sexual and severe IPV from baseline to endpoint (40.2% to 25.4%, 31.8% to 15.8%, and 33.4% to 18.2%, respectively). Intention-to-treat analysis showed no measurable differences between intervention and control clusters for primary IPV outcomes. Difference in the cluster-level proportion of physical IPV perpetration was 0.002 (95% confidence interval [CI] − 0.07 to 0.08). Similarly, differences between arms for sexual IPV was 0.01 (95% CI − 0.04 to 0.06), while severe IPV followed a similar pattern (Diff = 0.01; 95% CI − 0.05 to 0.07). A secondary analysis using LCA suggests that among the men living in intervention communities, there was a greater reduction in IPV among less violent and more law abiding men than among more highly violent men, although the differences did not reach statistical significance. Conclusion The intervention, when implemented in a peri-urban settlement, had limited effect in reducing IPV perpetrated by male residents. Further analysis showed it was unable to transform entrenched gender attitudes and use of IPV by those men who use the most violence, but the intervention showed promise for men who use violence less. Trial registration ClinicalTrials.gov, NCT02823288 . Registered on 30 June 2016.

Commonly used dating violence prevention programs assume that promotion of more egalitarian gender role attitudes will prevent dating violence perpetration. Empirical research examining this assumption, however, is limited and inconsistent. The current study examined the longitudinal association between gender role attitudes and physical dating violence perpetration among adolescent boys (n = 577; 14 % Black, 5 % other race/ethnicity) and examined whether injunctive (i.e., acceptance of dating violence) and descriptive (i.e., beliefs about dating violence prevalence) normative beliefs moderated the association. As expected, the findings suggest that traditional gender role attitudes at T1 were associated with increased risk for dating violence perpetration 18 months later (T2) among boys who reported high, but not low, acceptance of dating violence (injunctive normative beliefs) at T1. Descriptive norms did not moderate the effect of gender role attitudes on dating violence perpetration. The results suggest that injunctive norms and gender role attitudes work synergistically to increase risk for dating violence perpetration among boys; as such, simultaneously targeting both of these constructs may be an effective prevention approach.