Intervention with Microfinance for AIDS and Gender Equity (IMAGE): Women\u2019s Engagement with the Scaled-up IMAGE Programme and Experience of Intimate Partner Violence in Rural South Africa

L Knight,M Molebatsi,S Lees,H Stöckl,M Ranganathan,T Polzer-Ngwato,T Abramsky,L Muvhango,C Watts

doi:10.1007/s11121-019-01070-w

L Knight, M Molebatsi + Show 7 more

Open Access

https://doi.org/10.1007/s11121-019-01070-w

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Abstract

The Intervention with Microfinance for AIDS and Gender Equity (IMAGE) programme has been scaled up to three provinces in South Africa. This paper explores associations between women’s engagement in the intervention, intimate partner violence (IPV) and factors associated with IPV and partner abuse. We enrolled women receiving group-based microfinance loans plus gender training into the scaled-up IMAGE cohort study (n = 860). We present cross-sectional analysis on participants’ characteristics and intervention engagement and use multivariate logistic regression to explore associations. 17% of women reported lifetime (95% CI 15 to 20%) and 7% past year (95% CI 5 to 9%) IPV, 9% past-year economic (95% CI 7 to 11%) and 11% past-year emotional (95% CI 9 to 14%) abuse. Women under 35 years had higher levels of IPV and emotional abuse. 53% of women attended all the trainings, 83% continuously borrowed and 98% agreed the training had a major impact on their life. Attendance was associated with improved partner relationships (χ2p < 0.001), but not lower IPV risk. Odds of past-year IPV decreased the more types of support (e.g. advice) women received from group members (aOR 0.27, p < 0.001 among those reporting all support versus none or some). A similar pattern was seen for economic, but not emotional, abuse. The scaled-up IMAGE intervention is widely acceptable and may support improvements in partner relationships, but younger women need to be targeted. Group support appears to be a potentially important component of the intervention.

Highlights

Intimate partner violence (IPV) and human immunodeficiency virus (HIV) are major public health challenges in South Africa; evidence on large-scale interventions that have successfully addressed both is sparseElectronic supplementary material The online version of this article contains supplementary material, which is available to authorized users.(IMAGE), Johannesburg, South Africa (Wagman et al 2015)
We aim to describe cohort characteristics and women’s engagement with the intervention and explore individual and intervention engagement factors associated with intimate partner violence (IPV) and abuse among rural South African women
IMAGE combines a poverty-focused microfinance initiative implemented by the Small Enterprise Foundation (SEF), with a ten-session participatory curriculum of gender and HIV training known as Sisters for Life (SfL)

Summary

Introduction

Intimate partner violence (IPV) and human immunodeficiency virus (HIV) are major public health challenges in South Africa; evidence on large-scale interventions that have successfully addressed both is sparse. According to the 2016 South Africa DHS Survey, 21% of ever-partnered women aged 18 and older reported lifetime physical IPV, whilst 8% reported past-year physical IPV; in addition, women reported 6% and 2% lifetime and past-year sexual IPV, respectively. HIV prevalence among South African women aged 15–49 years is estimated at approximately 24% (UNAIDS 2016). In high HIV prevalence settings such as South Africa, HIV infection is highly associated with physical and emotional violence and male controlling behaviour (Durevall and Lindskog 2015). In addition to the economic benefits of microfinance, there is some mixed evidence to suggest that it may be effective as a means for economically empowering women

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