HIV Clinical Trial
Official title:
The SASA! Study: a Cluster Randomised Controlled Trial of a Community Mobilisation Intervention to Prevention Violence Against Women and Reduce HIV/AIDS Risk in Kampala, Uganda
The SASA! Study is a cluster randomized trial of a community mobilization intervention for the prevention of HIV and gender based violence. The study is being conducted in Kampala, Uganda.
Background : Physical and sexual violence against women is widespread in Uganda, and is
increasingly recognized as a major global social, public health and human rights problem.
Epidemiological evidence demonstrates that violence may also be intimately tied in with HIV
risk, with violence being both a risk factor for and a consequence of HIV
infection.Behaviours that often form the cornerstone of HIV prevention messages such as
refusal of sex, inquiring about other partners, or suggesting condom use, have all been
identified as triggers of intimate partner violence (IPV) in various settings.
There is now growing interest in integrated HIV/violence prevention strategies to tackle the
underlying notions of masculinity that condone both male infidelity and male control over
women. Promising research from South Africa and Brazil suggests that interventions which
explicitly aim to challenge gender inequalities (either through economic empowerment of women
or discussion with men and women about gender inequalities, norms and their implications),
may influence levels of violence and HIV risk behaviours. However, such interventions remain
few in number, as do scientifically rigorous evaluations of them.
Intervention Design :
SASA! uses a community mobilization approach to address gender inequity and try to change
attitudes and behaviours that support both HIV risk behaviours and the perpetration of
violence against women.
SASA! supports communities through a four-phase process of social change (based on a
social-level adaptation of the Stages of Change Theory):
1. Start to think about violence against women and HIV/AIDS as interconnected issues and
the need to personally address these issues
2. Awareness raising about how communities accept men's use of power over women, fueling
violence against women and HIV/AIDS
3. Support women and men directly affected by/involved in these issues to change
4. Action to prevent violence against women and HIV/AIDS
The intervention team engages with four major groups of actors: community volunteers selected
from the general public; community leaders (e.g. religious, cultural and local council
leaders); resource persons (health care providers, police, etc); and institutional leaders.
The community volunteers are key agents to raise awareness about power imbalances between men
and women, discuss the impacts of HIV and violence against women, discuss the benefits of
non-violence and gender equity, and most importantly to mobilize others in the community to
take action thereby promoting sustainable change.
Study design:
The SASA! Study randomized four pairs of communities that were matched on population density
and stability/transience. The intervention communities received the SASA! intervention from
early 2008. Comparison communities will receive the intervention approximately three years
later.
A cross-sectional survey will be conducted among community members prior to the
implementation of SASA! in their communities. Another cross-sectional survey was initially
planned for three years post-implementation, but later delayed to four years
post-implementation due to political disturbances that caused interruptions to programme
activity. The primary outcomes are: past year experience of physical IPV (among partnered
women); past year experience of sexual IPV (among partnered women); acceptability of violence
against women; acceptability of a woman refusing sex; community response to women
experiencing violence (among women reporting past year physical and/or sexual IPV); and past
year concurrent sexual partners (among partnered men). Data analysis will be appropriate to
the cluster-randomized study design. The target sample size per arm at each round of data
collection is 800.
Complementary qualitative and quantitative data will also be collected (from community
volunteers and resource people as well as from community members) to document processes of
change and potential pathways of impact.
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