Intimate partner violence (IPV) is a precursor to and consequence of HIV infection. While interventions that aim to reduce IPV hold potential for reducing HIV transmission, few have been conducted and evaluated and none has significantly decreased both outcomes.
Between 2005 and 2009 a primary IPV prevention intervention, named the Safe Homes And Respect for Everyone (SHARE) Project was integrated into ongoing HIV prevention work conducted by the Rakai Health Sciences Program (RHSP) in rural Uganda. RHSP operates in 11 regions of the Rakai district which is characterized by a mature HIV epidemic and relatively high rates of IPV against women. The combined IPV/HIV prevention approach was evaluated through a cluster-randomized trial (CRT) conducted via the Rakai Community Cohort Study (RCCS). Intervention arm clusters (n=4) were exposed to the SHARE Project, enhanced HIV testing and treatment and RHSP’s routine HIV services. Control arm clusters (n=7) received standard of care HIV services alone.
Results found that SHARE reduced IPV among women and HIV incidence in the population. Analysis suggests SHARE’s greatest impact on HIV risk behaviors was the reduction of women’s experiences of forced sex and improved rates of HIV results disclosure. We did not find, however, any effect of exposure to SHARE and reduced rates of alcohol use with sex. This is an important finding because use of alcohol has been identified as a risk factor for both IPV and HIV infection broadly, and in Rakai.
Next steps in Rakai are to assess the magnitude of alcohol (add SHARE campaign image of marchers with banner other drug) use in the setting and develop and evaluate a tailored substance reduction intervention among a population of drug using men and women. In similar African settings we plan to build on the SHARE/RHSP experience by replicating the HIV and IPV prevention model and conducting evaluation research to measure program impact.
The Rakai Community Cohort Study (RCCS) was funded by the Bill & Melinda Gates Foundation (22006.02) and the US National Institutes of Health (U1AI51171). Measurement of the effect of the intervention on intimate partner violence was funded through a grant from the WHO’s Department of Reproductive Health and Research (A55085). The SHARE intervention was funded by the President’s Emergency Plan for AIDS Relief (CoAg GH000817). Analysis of the research was supported by a Ruth L Kirschstein National Research Service Award from the National Institute of Mental Health (F31MH095649) and a training grant from the National Institute on Drug Abuse (T32DA023356).
- Wagman JA, Paul A, Namatovu F, Ssekubugu R, Nalugoda F. Ethical Challenges of Randomized Violence Intervention Trials: Examining the SHARE intervention in Rakai, Uganda. Psychol Violence. 2016 Jul;6(3):442-451
- King EJ, Maman S, Namatovu F, Kiwanuka D, Kairania R, Ssemanda JB, Nalugoda F, Wagman JA. Addressing intimate partner violence among female clients accessing HIV testing and counseling services: Pilot testing tools in Rakai, Uganda. Violence Against Women. 2016 Sep 1. pii: 1077801216663657. [Epub ahead of print]. PMID: 27586170.
- Wagman JA, King EJ, Namatovu F, Kiwanuka D, Kairania R, Nalugoda F, Serwadda D, Wawer MJ, Gray RH, Brahmbhatt H. Combined Intimate Partner Violence and HIV/AIDS Prevention in rural Uganda: Design of the SHARE Intervention Strategy. Health Care Women Int. 2015 Jun 18:1-24. [Epub ahead of print]
- Wagman JA, Gray RH, Campbell J, Thoma M, Ndyanabo A, Ssekasanvu J, Nalugoda F, Kagaayi J, Nakigozi G, Serwadda D, Brahmbhatt H. Effectiveness of an integrated intimate partner violence and HIV prevention intervention in Rakai, Uganda: analysis of an intervention in an existing cluster randomised cohort. Lancet Glob Health. 2015 Jan;3(1):e23-33. doi: 10.1016/S2214-109X(14)70344-4. Epub 2014 Nov 28.