Challenging Gender Roles among Serodiscordant Couples to Reduce Risks in South Africa
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Transcript of Challenging Gender Roles among Serodiscordant Couples to Reduce Risks in South Africa
Challenging Gender Roles among Serodiscordant Couples to
Reduce Risks in South Africa
W. Zule, A. Minnis, I. Doherty, B. Myers, J. Ndirangu, J., & W. Wechsberg
Funded by NIAAA grant number R01AA018076
Background
South Africa: Intersection of AOD, HIV and GBV
• Alcohol and other drug (AOD) use is high, and intersecting with men being abusive and gender-based violence.
• Women (especially young women) are at greatest risk of victimization
• SA also has a high prevalence of physical and sexual violence and victimization
• SA also has more people living with HIV, especially among women from heterosexual transmission
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Male Gender Roles in the TownshipsTraditional Power and Control
Couples’ Health CoOp (CHC)Study
Cape Town, SAFunded by NIAAA
Addressing AOD, sexual risk,
gender roles and HIV risk reduction
R01AA018076
Advantages of Bringing Couples Together
• Responsibility for HIV risk reduction is placed on both members of the couple
• Safe environment to disclose sensitive issues• Can address gender power imbalances re: sexual
coercion, condom negotiation, and needle sharing• Improve communication skills in vivo with a third
party • STI and HIV risk reduction can be combined with
reproductive healthEl-Bassel et al., JAIDS, 2010
Mapping Drinking Establishments
300 COUPLES WERE RECRUITEDPEER LED INTERVENTIONS INLOCAL COMMUNITY CENTERS
• Developed and Adapted Men Health CoOp intervention
• Tweaked the Women’s Health CoOp• Developed the Couples Health CoOp
intervention• Mapped 1296 bars using GIS and made into 30
communities that were randomized
Pretest to Pilot test to RCT
Experimental DesignGIS Mapped Shebeens and Surrounding Neighborhoods
HCT & WHC
Eligible Men Women Main Partners
MHC & WHC CHC
Randomization of neighborhoods
Eligible Men Women Main Partners Eligible Men Women Main
Partners
HCT WHC2-sessions
MHC2-sessions
WHC2-sessions
CHC2-sessions
6-monthfollowup
6-monthfollowup
6-monthfollowup
6-monthfollowup
6-monthfollowup
6-monthfollowup
HCT – HIV counseling and testingWHC -- Women’s Health CoOpMHC -- Men’s Health CoOpCHC – Couples’ Health CoOp
-- Included in current analysis
Goals of Study• Understand how AOD &
gender roles relate to risk behaviors and violence.
• How time in shebeens affects relationships.
• Enhance risk reduction skills & reduce risk behavior.
• Increase communication & problem solving skills.
• Learn how to enjoy & value each other more.
Example from Intervention about the intersection of
AOD, Sexual Risk and Violence
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The Couples Health CoOp Biological Results
Baseline Prevalence(300 couples)
Men n=300
Womenn=300
HIV confirmed 12% 25%
Pregnancy -- 8%
Alcohol 4% 1%
Mandrax 12% 3%
Cocaine 0% 0%
Methamphetamine 14% 3%
Opiates 1% 0%
Marijuana 32% 8%
R01AA018076
Serodiscordance of HIV among couples
Woman Neg / Man HIV+4%
Both NEGATIVE70%
Woman HIV+ / Man Neg
17%
Both HIV+9%
Bio behavioral outcomes • Favored the Couples Health CoOp
intervention• With reduced seroincidence and
AOD (will be reported Thursday)However, we went further into the entrenched cultural gender roles…
Outcome Measures• Relationship control evaluated as
“shared decision making” (8 items).• Relationship communication
regarding HIV prevention/risk (e.g. condom use and HIV risk behaviors) (11 items).
• (No) victimization (i.e. physical or sexual abuse) by partner
Relationship Control (women)
Comparison β 95% CI P-valueCouples vs. Women’s CoOp
-0.60 -1.29, 0.10 0.09
Gender Separate vs. Women’s CoOp
0.66 -0.05, 1.37 0.07
Couples vs. Gender Separate
-1.26 -1.94, -0.57 <0.001
Relationship Control (men)
Comparison β 95% CI P-valueCouples vs. WHC -0.30 -1.07, 0.46 0.43
Gender Separate vs. WHC
0.34 -0.44, 1.13 0.39
Couples vs. Gender Separate
-0.65 -1.39, 0.10 0.09
Relationship Communication (women)
Comparison Β 95% CI P-valueCouples vs. WHC -1.94 -2.86, -1.01 <0.001
Gender Separate vs. WHC
-0.67 1.61, 0.26 0.157
Couples vs. Gender Separate
-1.26 -2.17, -0.36 0.007
Relationship Communication (men)
Comparison Β 95% CI P-value
Couples vs. WHC 1.20 0.02, 2.38 0.045
Gender Separate vs. WHC 0.97 -0.24, 2.18 0.116
Couples vs. Gender Separate 0.23 -0.91, 1.37 0.69
(No) Victimization (women)• Women in the separate (MHC/WHC)
arm were more likely than women in the Couples arm to report no victimization.
• Odds ratio = 3.05; 95% C.I. = 1.55, 6.00
(No) Victimization (males)• There were no significant
differences in self-reports of victimization between any of the study arms by males
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Conclusions• Overall the results were mixed regarding the benefits of
working with partners separately versus working with them as a couple.
• Working with both partners in a couple with regard to gender roles appears to work better with the female partner in a gender specific group
• In one instance (Communication) men appeared more responsive
• Our next step will be to perform couple-level analyses to assess how benefits are distributed within and across couples
• Implement the WHC in health care settings with even stronger evidence