Why interventions to prevent intimate partner violence and HIV have failed young women in southern Africa.

Jenevieve Mannell,Janet Seeley,Maryam Shahmanesh,Samantha Willan,Lorraine Sherr,Andrew Gibbs

doi:10.1002/jia2.25380

Abstract

IntroductionAdolescent girls and young women aged 15 to 24 years have some of the highest HIV incidence rates globally, with girls two to four times more likely to be living with HIV than their male peers. High levels of intimate partner violence (IPV) experienced by this age group is a significant risk factor for HIV acquisition. While behavioural interventions to prevent IPV and HIV in southern Africa have seen some success in reducing self‐reported experiences of IPV, these interventions have largely failed to achieve similar outcomes for young women.DiscussionWe identify three main reasons for the failure of IPV/HIV interventions for many young women in southern Africa. First, interventions are usually developed without the meaningful involvement of both young women and young men. Youth input into research design is largely focused on user testing or consultation of targeted groups, involving relatively low levels of participation. Second, interventions are focused on addressing individual risk factors rather than broader social and structural contexts of being a young woman. “Risk factor” interventions, rather than supporting women's agency, can pose a major barrier for supporting changes in behaviour among young women because they often fail to dislodge well‐entrenched gender and age‐related inequalities. Third, current intervention models have not adequately accounted for changes in gender norms and relationships across southern Africa. Individuals are getting married later in life (or not at all), new technologies are transforming romantic interactions and opening new opportunities for violence, and discussions about women's rights are both challenging gender inequalities and reinforcing them.ConclusionsIn order to move beyond the status quo of current approaches, and to support real innovation, IPV/HIV prevention interventions need to be co‐developed with youth as part of a meaningful participatory process of research, intervention design, youth involvement in development and implementation. This process of co‐development needs to be radical and break with the current focus on adapting existing interventions to meet the needs of young people, which are not well understood and often do not directly reflect their priorities. Broader social contexts and compound lenses are needed to avoid narrow approaches and to accommodate evolving norms.

Highlights

Adolescent girls and young women aged 15 to 24 years, those out of school, have some of the highest HIV incidence rates globally, with girls two to four times more likely to be living with HIV than their male peers [1]
Through our collective experience working on behavioural interventions to prevent intimate partner violence (IPV) and reduce HIV risk across subSaharan Africa, and engagement with the reviews described above, we have identified three main reasons for the failure of these interventions for many young women
Addressing the three challenges of IPV and HIV interventions we have highlighted in this commentary requires a bold new approach

Summary

| INTRODUCTION

Adolescent girls and young women aged 15 to 24 years, those out of school, have some of the highest HIV incidence rates globally, with girls two to four times more likely to be living with HIV than their male peers [1]. While a recent systematic review of HIV prevention interventions highlighted the lack of consistent positive findings by evaluations among young women [23] This is compounded, by the fact that there is little age-disaggregated information within evaluations; a systematic review of adolescent focused IPV and HIV prevention interventions found only six rigorous evaluations, of which only one showed reductions in physical IPV for young women in school, another showed an impact on young men’s perpetration of IPV, and the other four, did not disaggregate by age [24]. Reviewing oral antiretroviral pre-exposure prophylaxis (PrEP) for young women in sub-Saharan Africa, Celum and colleagues [25] point to the limited overall impact among women under the age of 21 linked primarily to poor engagement and adherence They argue the failure of PrEP interventions for young women is the result of the lack of consideration of local contextual factors, including social norms around sexuality and broader structural barriers making it difficult for young women to adhere to PrEP. We discuss some reasons behind the failure of behavioural IPV and HIV risk prevention interventions for young women with the purpose of identifying a potential way forward for future intervention development

| DISCUSSION

| CONCLUSIONS