Nambusi Kyegombe
Abstract
Findings from the SASA! Study on the Impact of a Community Mobilisation Intervention Designed to Prevent Violence Against Women and Reduce HIV-Related Risk in Kampala, Uganda
Intimate partner violence (IPV) violates women’s human rights, and is a serious public health concern associated with increased HIV risk. The SASA! study assessed the community-level impact of SASA!, a community mobilisation intervention designed to prevent IPV and reduce HIV-related risk behaviours.
From 2007-2012 a pair-matched cluster randomised controlled trial (CRT) was conducted in eight communities (4 intervention, 4 control) in Kampala, Uganda. Cross-sectional surveys of a random sample of community members, aged 18-49, were undertaken at baseline (n=1583) and 4 years post intervention implementation (n=2532). Six violence and HIV-related primary outcomes were defined a priori. An adjusted cluster-level intention-to-treat analysis compared outcomes in intervention and control communities at follow-up. Under a nested qualitative study, 40 in-depth interviews with community members (20 women, 20 men) were conducted at follow-up, audio recorded, transcribed verbatim, and analysed using thematic analysis.
The intervention was associated with significantly lower social acceptance of IPV among women (adjusted risk ratio 0.54, 95%CI 0.38-0.79), and lower acceptance among men (0.13, 0.01-1.15); significantly greater acceptance that a woman can refuse sex among women (1.28, 1.07-1.52) and men (1.31, 1.00-1.70); 52% lower past year experience of physical IPV among women (0.48, 0.161.39); and lower levels of past year experience of sexual IPV (0.76, 0.33-1.72). Women experiencing violence in intervention communities were more likely to receive supportive community responses. Reported past year sexual concurrency by men was significantly lower in intervention compared to control communities (0.57, 0.36-0.91). Qualitative data show that SASA! influenced the dynamics of individual relationships and broader community norms enabling some couples to reduce their experience of violence.
SASA! achieved important community impacts, on the social acceptability of IPV, the past year prevalence of IPV, and levels of sexual concurrency and is now being delivered in control communities.