Effect of a structural intervention for the prevention of intimate-partner violence and HIV in rural South Africa: a cluster randomised trial
Effect of a structural intervention for the prevention of intimate-partner violence and HIV in rural South Africa: a cluster randomised trial
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DOI：
10.1016/s0140-6736(06)69744-4
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发表时间：
2006-12-02
期刊：
影响因子：
168.9
通讯作者：
Porter, John D. H.
中科院分区：
文献类型：
--
作者：
Pronyk, Paul M.;Hargreaves, James R.;Porter, John D. H.
在南部非洲大部分地区，艾滋病毒感染和亲密伴侣暴力有着共同的风险环境。干预与小额信贷的艾滋病和性别平等（IMAGE）研究的目的是评估一个结构性的干预措施，结合小额信贷方案与性别和艾滋病毒的培训课程。方法在南非林波波省农村村庄配对，并随机分配到接受干预研究开始（干预组，n=4）或3年后（对照组，n=4）。向参加干预小组的贫穷妇女提供了贷款。参与性学习和行动课程被纳入每两周举行一次的贷款会议。试验的两组被分为三组：直接参与计划或匹配的对照组（队列1），随机选择的14-35岁的家庭共同居民（队列2）和随机选择的社区成员（队列3）。主要结果是在过去12个月内由配偶或其他性亲密行为（队列1），在过去12个月内最后一次与非配偶伴侣发生无保护性交（队列2和队列3），和艾滋病毒发病率（队列3）的亲密伴侣暴力的经验，无论是身体上的还是性的。在符合方案的基础上进行分析。该试验在ClinicalTrials.gov注册，编号NCT 00242957。队列1的结果是，亲密伴侣暴力的经历减少了55%（调整后的风险比[aRR] 0.45，95%CI 0.23-0.91;调整后的风险差异-7.3%，-16.2至1.5）。干预并没有影响队列二中与非配偶伴侣发生无保护性交的比率（aRR 1.02，0.85-1.23），对与非配偶伴侣发生最后一次无保护性交的比率没有影响（0.89，0.66-1.19）或艾滋病毒发病率（1.06，0.66-1.69）。社会和经济发展干预措施有可能改变南部非洲艾滋病毒和亲密伴侣暴力的风险环境。
Background HIV infection and intimate-partner violence share a common risk environment in much of southern Africa. The aim of the Intervention with Microfinance for AIDS and Gender Equity (IMAGE) study was to assess a structural intervention that combined a microfinance programme with a gender and HIV training curriculum.Methods Villages in the rural Limpopo province of South Africa were pair-matched and randomly allocated to receive the intervention at study onset (intervention group, n=4) or 3 years later (comparison group, n=4). Loans were provided to poor women who enrolled in the intervention group. A participatory learning and action curriculum was integrated into loan meetings, which took place every 2 weeks. Both arms of the trial were divided into three groups: direct programme participants or matched controls (cohort one), randomly selected 14-35-year-old household co-residents (cohort two), and randomly selected community members (cohort three). Primary outcomes were experience of intimate-partner violence either physical or sexual-in the past 12 months by a spouse or other sexual intimate (cohort one), unprotected sexual intercourse at last occurrence with a non-spousal partner in the past 12 months (cohorts two and three), and HIV incidence (cohort three). Analyses were done on a per-protocol basis. This trial is registered with ClinicalTrials.gov, number NCT00242957.Findings in cohort one, experience of intimate-partner violence was reduced by 55% (adjusted risk ratio [aRR] 0.45, 95% CI 0.23-0.91; adjusted risk difference -7.3%,-16.2 to 1.5). The intervention did not affect the rate of unprotected sexual intercourse with a non-spousal partner in cohort two (aRR 1.02, 0.85-1.23), and there was no effect on the rate of unprotected sexual intercourse at last occurrence with a non-spousal partner (0.89, 0.66-1.19) or HIV incidence (1.06, 0.66-1.69) in cohort three.Interpretation A combined microfinance and training intervention can lead to reductions in levels of intimate-partner violence in programme participants. Social and economic development interventions have the potential to alter risk environments for HIV and intimate-partner violence in southern Africa.