A cluster randomised controlled trial to determine the effect of community mobilisation and advocacy on men's use of violence in periurban South Africa: study protocol.

OBJECTIVE: This paper describes the design and methods of a cluster randomised controlled trial (C-RCT) to determine the effectiveness of a community mobilisation intervention that is designed to reduce the perpetration of violence against women (VAW). METHODS AND ANALYSIS: A C-RCT of nine intervention and nine control clusters is being carried out in a periurban, semiformal settlement near Johannesburg, South Africa, between 2016 and 2018. A community mobilisation and advocacy intervention, called Sonke CHANGE is being implemented over 18 months. It comprises local advocacy and group activities to engage community members to challenge harmful gender norms and reduce VAW. The intervention is hypothesised to improve equitable masculinities, reduce alcohol use and ultimately, to reduce VAW. Intervention effectiveness will be determined through an audio computer-assisted self-interview questionnaire with behavioural measures among 2600 men aged between 18 and 40 years at baseline, 12 months and 24 months. The primary trial outcome is men's use of physical and/or sexual VAW. Secondary outcomes include harmful alcohol use, gender attitudes, controlling behaviours, transactional sex and social cohesion. The main analysis will be intention-to-treat based on the randomisation of clusters. A qualitative process evaluation is being conducted alongside the C-RCT. Implementers and men participating in the intervention will be interviewed longitudinally over the period of intervention implementation and observations of the workshops and other intervention activities are being carried out. ETHICS AND DISSEMINATION: Ethical approval was obtained from the University of the Witwatersrand Human Research Ethics Committee and procedures comply with ethical recommendations of the United Nations Multi-Country Study on Men and Violence. Dissemination of research findings will take place with local stakeholders and through peer-reviewed publications, with data available on request or after 5 years of trial completion. TRIAL REGISTRATION NUMBER: NCT02823288; Pre-result.

'If I buy the Kellogg's then he should [buy] the milk': young women's perspectives on relationship dynamics, gender power and HIV risk in Johannesburg, South Africa.

Ideals of masculinity and femininity may limit South African women's decision making power in relationships and increase their risk of HIV infection. We conducted 30 in-depth interviews with 18-24-year-old women in inner-city Johannesburg with the aim of understanding young women's expectations of intimate relationships with men, their perceptions of gender and power and how this influences HIV risk. We found that the majority of young women reported expectations of power in relationships that conform to a model of femininity marked by financial independence, freedom to make decisions, including over sexuality, and equality (resistant femininity). The majority of young women, however, were in relationships marked by intimate partner violence, infidelity or lack of condom use. In spite of this, more young women who subscribed to a resistant model of femininity were in less risky relationships than young women who subscribed to acquiescent models, in which power was vested in their male partners. Further, young women who subscribed to resistant femininity had more education than women who subscribed to an acquiescent model. The disconnect between expectations of relationships and young women's lived realities emphasises the need for structural changes that afford women greater economic and thus decision making power.

Barriers to women's participation in inter-conceptional care: a cross-sectional analysis.

BACKGROUND: We describe participation rates in a special interconceptional care program that addressed all commonly known barriers to care, and identify predictors of the observed levels of participation in this preventive care service. METHODS: A secondary analysis of data from women in the intervention arm of an interconceptional care clinical trial in Philadelphia (n = 442). Gelberg-Andersen Behavioral Model for Vulnerable Populations to Health Services (herein called Andersen model) was used as a theoretical base. We used a multinomial logit model to analyze the factors influencing women's level of participation in this enhanced interconceptional care program. RESULTS: Although common barriers were addressed, there was variable participation in the interconceptional interventions. The Andersen model did not explain the variation in interconceptional care participation (Wald ch sq = 49, p = 0.45). Enabling factors (p = 0.058), older maternal age (p = 0.03) and smoking (p = < 0.0001) were independently associated with participation. CONCLUSIONS: Actively removing common barriers to care does not guarantee the long-term and consistent participation of vulnerable women in preventive care. There are unknown factors beyond known barriers that affect participation in interconceptional care. New paradigms are needed to identify the additional factors that serve as barriers to participation in preventive care for vulnerable women.