Current Projects
| A national study of injury-related mortality, with a focus on homicide in South Africa | ||||||
|
Principle Investigator: Prof. Naeemah Abrahams (Naeemah.abrahams@mrc.ac.za) Synopsis: The GHRU conducted the 3rd national femicide study as the murder of women and girls, in acts of femicide, remains the most extreme form of gender-based violence (GBV). With South Africa being known for having one of the highest rates of femicide in the world, hardly a day passes without another case highlighted in the media. The GHRU has been studying femicide in South Africa for more than 20 years, with previous research showing that in 1999 four women, and in 2009 three women were killed every day by their husband or boyfriend (intimate partner). The 3rd national femicide study (using 2017 data) found a consistent decline in all forms of femicide seen across the 18 years. |
||||||
| A national study of female and child homicides during the COVID-19 pandemic in South Africa | ||||||
|
Principle Investigator: Prof. Naeemah Abrahams (Naeemah.abrahams@mrc.ac.za) Synopsis: We are currently undertaking the 4th national femicide study: We have employed the same methods used in the previous national female homicide studies (1999 and 2009 and 2017) to collect data for the 2020 COVID-19 year. It is crucial that research is done to begin to understand the extent and depth of the impact that the COVID-19 restrictions have had on GBV in South Africa. |
||||||
| Adaptation and impact evaluation of combined sexual violence and mental health interventions for female and lesbian, bisexual or queer women (LBQ) students in South African higher education institutions | ||||||
|
PI Contacts:
Synopsis: This ongoing project research aims to contribute to evidence-based, combined interventions in South African higher education campuses that reduce mental ill-health and the experience of SV among (i) first-year female students who partner with men, and (ii) lesbian, bisexual or queer women (LBQ). The research involves adaptation, preliminary testing, and evaluation of Ntombi Vimbela! and an evidence-based mental health intervention . Ntombi Vimbela! (NV!) is a manualised intervention that combines elements of sexuality education, gender transformation, and risk reduction strategies and has shown promise in reducing sexual assault incidence among South African first- year female students. |
||||||
| Adaptation of a combined intervention: Stepping Stones and Self Help+ for use with male students to prevent violence against women in South African higher education institutions | ||||||
|
PI: Prof. Yandisa Sikweyiya (E-mail: yandisa.sikweyiya@mrc.ac.za) Synopsis: This research project aims to contribute to evidence-based, combined interventions in South African higher education campuses that reduce mental ill-health and perpetration of sexual violence among male students who partner with women. The project will be conducted with enrolled male students at a South African university. |
||||||
| Advancing Disability Inclusive Research in Africa Network (ADIRA) | ||||||
| Advancing Disability Inclusive Research in Africa Network (ADIRA) aims to increase innovative and high quality research in Africa, led by African researchers, to improve the lives of people with disabilities in Africa. | ||||||
| ALIGHT Botswana | ||||||
| ALIGHT Botswana: Increasing participation of women and girls with disabilities in gender-based violence prevention programs in Botswana | ||||||
| Breaking the Silence | ||||||
|
Providing access to Comprehensive Sexuality Education and Sexual and Reproductive Health and Rights to Young People with Disabilities in Southern and Eastern Africa. The Breaking the Silence (BtS) project has set out to generate more knowledge and data on the sexual and reproductive health and rights of persons with disabilities. It is based at the Gender and Health Research Unit (GHRU) of the SAMRC. This site provides links to key publications from the GHRU and BtS team, information on the BTS flagship project on Comprehensive Sexuality Education (BtS-CSE) and initiatives supported by the BtS team. |
||||||
| Developing Research Capacity to Support Community-Based Interventions to Better Engage Men in the HIV Continuum of Care | ||||||
|
Principle Investigator: Associate Professor. Yandisa Sikweyiya (E-mail: yandisa.sikweyiya@mrc.ac.za) Synopsis: The overall objective of this project is to increase the pool of under-represented South African scientists conducting rigorous, interdisciplinary health social science research focused on better engaging men in the HIV continuum of prevention, treatment and care. Research regarding men, masculinities and HIV is a critical element of improving the country’s response to HIV, as men have consistently poorer rates of engagement with HIV services and worse antiretroviral treatment outcomes. The project is designed to provide intensive support and mentoring to two early-career researchers from under-represented groups who will also serve as Co-Investigators on the application. To facilitate independence, these Co-Investigators will be responsible for leading, designing and implementing two mixed methods comparative case studies in Cape Town and Johannesburg exploring the factors affecting the delivery, uptake and impact of services for HIV-positive men in South Africa. |
||||||
| DREAMS Evaluation in South Africa | ||||||
|
Investigator: Dr . Andy Gibbs (Email Andrew.Gibbs@mrc.ac.za) Synopsis: This is a large repeat cross-sectional evaluation of the DREAMS (Determined, Resilient, Empowered, AIDS-Free, Mentored and Safe) initiative, led by EpiCentre, and supported by SAMRC. The overall objective is to evaluate whether the DREAMS initiative can reduce HIV-incidence by 40% over a two-year period, amongst young women and girls (12-24) in four health districts in KwaZulu-Natal, and Gauteng, South Africa. The unit is providing support around measuring intimate partner violence, and analysis of this, as part of a series of secondary objectives of the study. The first cross-sectional survey was completed in September 2018, and a second cross-sectional survey will begin in 2019. |
||||||
| Exploring constructions, performances, and reconfigurations of masculinities during and after the Marikana mineworkers’ strike of 2012 | ||||||
|
Principle Investigator: Associate Professor. Yandisa Sikweyiya (E-mail: yandisa.sikweyiya@mrc.ac.za) Synopsis: Collective violence in the form of mass protest is an increasingly common occurrence during mass protests in post-apartheid South Africa. In recent times, one of the most extreme cases of such violence is that which broke out in 2012 during a mass protest among mineworkers in Marikana, North-West province. This was arguably the longest strike action in the mining sector since the advent democracy in 1994, lasting over 18 weeks. Men are often at the forefront of violent mass protests, and as they become increasingly common in South Africa, the applicability of the dominant theory (i.e. hegemonic masculinity) on men's use of violence comes into question. The aim of the study is to explore the socio-cultural issues that informed the constructions of masculinities during the Marikana mineworkers’ strike of 2012. Furthermore, the study will explore the versions of masculinities that were performed during the strike. Publications
|
||||||
| Exploring the link and impact of COVID-19 and lockdown to gender-based violence, mental health and livelihoods amongst selected populations in Gauteng and Eastern Cape provinces in South Africa | ||||||
|
Principle Investigator: Dr Pinky Mahlangu Synopsis: This ongoing research aims to generate knowledge about the impact and links of COVID-19 and lockdown to experiences of violence against women and children in the homes in South Africa. The findings of the study will address the question about the impact of pandemics on GBV experiences, in particular, whether violence against women and children is intensified during lockdown, how and why? Furthermore, the study will extend knowledge on how being on the frontline during pandemics like COVID-19 impacts on the lives of frontline health care workers. Publications:
|
||||||
| Exploring women’s experiences of severe intimate partner violence, circumstances surrounding the seeking of protection orders, and its perceived impact on them and their children’s wellbeing | ||||||
|
Principle Investigator: Dr. Leane Ramsoomar-Hariparsaad Co-I’s: Prof Rachel K Jewkes Prof Naeemah Abrahams Dr Nwabisa Shai Dr Samantha Willan Synopsis: South Africa has extremely high levels of Gender-Based Violence (GBV) and population prevalence rates of rape and intimate partner femicide (IPF) among the highest in the world. Research on IPF (defined as the murder of a woman by a current or ex-husband or boyfriend, rejected would-be lover, or same-sex partner) conducted over the last two decades by the SAMRC’s Gender & Health Research Unit showed that South Africa has an Intimate Femicide (IF) rate six times higher than the global rate, and 48% of all women killed are murdered by intimate partners. We are uncertain, from interviews with Investigating Officers, how many women who are killed had POs, and whether they were adhered to by the women themselves, as many return to, or keep contact with violent partners for multiple reasons, including related to children. It seems likely that many had POs as they often had histories of severe IPV prior to the IPF. We aim to understand the circumstances that lead to women seeking Protection Orders (POs) for intimate partner violence (IPV), their experiences in so doing, and more about the perceived impact of IPV and seeking a PO on their livelihoods, housing, mental health and children in the immediate aftermath of seeking the PO. This qualitative study will collect data from women through individual in-depth interviews (IDIs) at two time points and a narrative group interview. The study will provide insights into women’s experiences of seeking a PO, the context of their application and the aftermath for their lives, and provide much needed evidence to inform a new strategy on IPF prevention. |
||||||
| Formative research and development of a sexual violence prevention intervention for South African higher education institution | ||||||
|
Investigators: Dr. Mercilene Machisa (E-mail: Mercilene.Machisa@mrc.ac.za) Synopsis: Comprehensive literature reviews conducted by the HEAIDS Task Team that is developing the national policy framework to prevent and respond to sexual assault and gender-based violence (SGBV) in the higher education sector found that there is a lack of rigorously tested and evaluated campus-based interventions in South Africa. In particular, evidence-informed, campus-based interventions that combine sexuality, gender transformation and self-defense components currently do not exist in South Africa. Therefore, research is needed to understand the prevalence and context in which SGBV occurs on South African Higher Education Institutions (HEIs) and to inform the development of primary prevention interventions which address its underlying drivers among young women. To fill this critical gap in knowledge and practice, we are conducting formative research and intervention development in South African TVET colleges and universities. The project is expected to contribute to the national policy framework through providing evidence to inform SGBV programming. Moreover, the study will produce a rigorously tested intervention that can be brought to scale for the higher education sector. For more information contact Publications
Reports |
||||||
| Knowledge Attitudes Practices and HIV Prevalence Study Among Farm Workers in Limpopo province, South Africa: An Evaluation Study | ||||||
|
Principle Investigator: Associate Professor. Yandisa Sikweyiya (E-mail: yandisa.sikweyiya@mrc.ac.za) Synopsis: This study aims to evaluate knowledge, attitudes and practices on HIV and TB among farm workers in Limpopo, following the introduction of the PHAMSA interventions around HIV at the workplace. The objectives of this study are to 1) To determine the HIV and TB knowledge, attitudes, behaviour and practices in people working in the farms at Mopani and Vhembe districts, Limpopo, 2) To measure the changes in knowledge, attitudes and practices towards HIV and TB by comparing current results with the baseline study, 3) To determine access and challenges on access to health services amongst farmworkers, 4) to establish the current prevalence of HIV in the farming community, 4) To explore gender dimensions and challenges related to gender based violence amongst farm workers, including Men who have Sex with Men (MSM) and Lesbian, Gay, Bisexual and Transgender (LGBT) communities. Publications
|
||||||
|
Masibambane - Ladies Chat (PrEP Project)
|
||||||
|
Developing a gender-enhanced PrEP information-motivation workshop for young South African women The Masibambane - Ladies Chat PrEP project aims to develop and pilot an intervention workshop to increase PrEP uptake among young women who are at risk of HIV infection using a peer-driven recruitment and gender-enhanced approaches. Read more about the Masibambane - Ladies Chat (PrEP Project) study |
||||||
| Nqoba Sibindi! Women’s experiences of shame, self-blame and self-stigma post rape | ||||||
|
Principle Investigator: Dr Samantha Willan Synopsis: To explore women’s experiences and conceptualization of shame, self-blame and self-stigma post rape, and understand the impact of these on their mental health and well-being and their risk of contracting HIV post-rape to understand the implications for improving post-rape care services and interventions and to inform measurement. In 2022 sixteen female rape survivors, between 18-40 years, from the original RICE cohort participated in our study, they were each involved in 2-3 interviews, which were a combination of in-depth interviews and Life History interviews. Results are currently being written up. |
| Point of care STI testing and expedited partner treatment (EPT): CAPRISA |
|
Investigator: Dr. Andy Gibbs (Email Andrew.Gibbs@mrc.ac.za) Synopsis: The objective of this study is to assess whether point of care testing for STIs can improve treatment outcomes, and included expedited partner therapy. The study was an open cohort pilot study and followed women up over 12 weeks. Overall, rates of STI clearance were very high, and feasibility and acceptability of point of care STI testing and treatment was high. The majority of women who tested positive for an STI, were provided with treatment for their partner, and a small number of women refused expedited treatment. There was a trend whereby those who were provided with treatment for their partner had a higher rate of STI clearance, compared to those who refused expedited treatment (p<0.1). No social harms were reported, and women were happy about the expedited partner therapy. Citation: Garrett , N. J., Osman, F., Maharaj, B., Naicker, N., Gibbs, A., Norman, E., ... & Karim, S. S. A. (2018). Beyond syndromic management: Opportunities for diagnosis-based treatment of sexually transmitted infections in low-and middle-income countries. PloS one, 13(4), e0196209. |
| Post GBV Quality Assurance Tool |
|
Field Testing a Quality Assurance Tool for Assessing the Quality of Post Gender-Based Violence Care Services in Clinical Settings in South Africa Investigators: Kristin Dunkle, Jill Hanass-Hancock, Samantha Willan and Naeemah Abrahams High quality post gender-based violence (GBV) care is a priority for the South African government, including the Department of Health, Department of Social Development, the South African Police Service, and the National Prosecuting Authority. Quality assurance (QA) is an important component of realizing this priority. An existing QA tool for GBV care was developed in Mozambique by Jhpiego in collaboration with US Centers for Disease Control and Prevention (CDC), WHO, and PEPFAR partners to provide facility-based information on the availability, accessibility, and quality of GBV services. This tool is now being adapted for use in South Africa through (1) updating the tool to address current best practices and South Africa’s unique social, demographic, logistical, and legal contexts, and (2) ensuring that the tool adequately addresses the needs of Key Populations with increased vulnerability to GBV, including LGBTQI (lesbian, gay, bisexual, transgender, queer, and intersex) people, sex workers, and people with disabilities. The project is achieving this through four steps:
Expected benefits: The study will produce a version of the GBV QA tool optimized for use in South Africa. This will provide the South African Department of Health, Department of Social Development, aligned non-governmental organizations (NGOs), CDC/PEPFAR, and other interested sponsors and stakeholders with a resource for external quality assurance (EQA) in delivery of post-GBV care, as well as a tool that service providers themselves can use for internal QA and improvement of service delivery. Additionally, this project will produce updated post-violence care service referral directories for two focus districts, as well as a protocol for keeping the directory up to date. |
| Rape Impact Cohort Evaluation (RICE) Study |
|
Principle Investigator: Prof. Naeemah Abrahams (Naeemah.abrahams@mrc.ac.za) Synopsis: South Africa is a country known for high levels of HIV infection and sexual violence. The Rape Impact Cohort Evaluation (RICE) study overall aim was to describe the incidence and attributable burden of physical and mental health problems (including HIV acquisition) in adult women over a three-year post-rape period, through comparison with a cohort of women who have not been raped. The study was based in Durban KZN and we started enrolment in 2015 and the last follow-up interview was in March 2020. Using a longitudinal study design, we enrolled 852 women who reported a rape to services and 853 women who have not experienced a rape from health services. Women were then followed-up for a period of between 12- 36 months (depending on the enrolment date). Outcome measures included exposure to risk factors, mental health status, cardio-metabolic risks, biomarkers for HIV, STIs, pregnancy and stress. The primary analysis was to compare HIV incidence in the two groups This study provided ground-breaking empirical evidence on the role of rape in HIV acquisition and showed that women who were raped were 60% more likely to seroconvert over the follow-up period compared to women who were not raped. A key finding from the study is that the risk for HIV was not in the immediate period but in the long-term with the incidence rate differences most notable from 6 months post rape. This finding underscores the importance of regarding medium to long term mental health care as an essential part of post-rape care. We continue to analyse this rich data set over the next few years focusing on the multiple psychosocial and health outcomes. Additionally, we have now begun qualitative research to assist us in interpreting these results. Publications
Research Briefs |
| Sexual and Reproductive Health and Rights and Young Women in all their Diversities under the COVID-19 Epidemic in South Africa (COVID and SRHR project) |
| Sexual and Reproductive Health and Rights and Young Women in all their Diversities under the COVID-19 Epidemic in South Africa (COVID and SRHR project) - Young women in KwaZulu-Natal are extremely vulnerable to adverse sexual and reproductive health and rights (SRHR) outcomes and need to access SRHR services and commodities. Young women with disabilities are even more vulnerable to adverse SRHR outcomes than their peers and lack access to SRHR services and commodities. The recent worldwide coronavirus pandemic and accompanying countrywide lockdown are likely to affect the lives of young women with disabilities. Their access to SRHR is likely to be further reduced due to additional barriers to accessing SRHR services and commodities, and they may face increased risks of abuse/violence. |
| STREAM CAPRISA - viral load testing: point of care |
|
Investigator: Dr . Andy Gibbs (Email Andrew.Gibbs@mrc.ac.za) Synopsis: The study is assess whether point of care viral load testing can improve adherence and retention in care through a small pilot randomized control trial. As part of this work there is ongoing qualitative research to understand this process, and the experience of care from patients and staff. |
| The impact of Covid-19 lockdown on the help-seeking behaviour of survivors of violence and on service provision responding to violence against women in South Africa, a collaboration with LHSTM |
|
Principle Investigator: Dr Nwabisa Shai Synopsis: The impact of Covid-19 lockdown on the help-seeking behaviour of survivors of violence and on service provision responding to violence against women in South Africa: A qualitative study to explore to understand the extent to which women survivors of violence were able to seek help during the national COVID-19 lockdown stages from 26 March 2020 to 31 July 2021, and how the provision of health and psychosocial services for Violence Against Women (VAW) were impacted. The study will recruit women who experienced violence and may or may not have sought help, and service providers and key informants working in non-governmental organisations or government departments offering Violence Against Women (VAW) health and/or psychosocial services. The study findings are envisaged to inform policy and practice related to VAW services in the province and widely. |
Completed Projects
| A cRCT to assess the impact of the Rural Response System (RRS) to Reduce Violence against Women in Ghana |
|
Principle Investigator: Associate Professor. Yandisa Sikweyiya (E-mail: yandisa.sikweyiya@mrc.ac.za) Synopsis: Publications:
|
| A narrative approach to understanding child homicide from the perspective of incarcerated South African parents convicted of killing their children |
|
Investigator: Miss. Bianca Dekel (Email: Bianca.dekel@mrc.ac.za) New synopsis: The dissertation is divided into two phases. Phase one includes a scoping review, which describes research on the homicide of infants (aged 0-1 year), pertaining to victim and perpetrator characteristics. A search of 18 databases, yielded 53 included articles, of which, 39 were cases studies, two qualitative, and 12 quantitative. The review’s main finding is the shortage of good quality data as most included studies were case studies. Therefore, we hope that this review encourages the development of a larger scholarship of robust research focused on the homicide of infants. Phase two presents the findings of a life history study, couched within a biopsychosocial epistemology, undertaken to uncover the life stories of parents who are incarcerated for killing either a biological child, a stepchild, or a child in their care. The qualitative study draws on 49 in-depth interviews with 22 participants. Through a grounded theory analysis of the life stories presented, it becomes evident how traumatic parent-child experiences in the form of absent parents, neglect, and abuse, had a profound impact on these participants. Their narratives suggest that, in the absence of reparative environments, their histories of childhood abuse and abandonment, were potentially risk factors for negative consequences in the parenting role, as they likely reenacted these cycles of unhealthy behavior with partners and children. Their narratives also shed light on their widespread exposure to interpersonal and structural violence during adolescence and adulthood, the possible untreated trauma symptoms, and the resorting to maladaptive coping strategies such as drugs and/or alcohol, in the absence of support in the aftermath of experiencing such trauma. This possibly resulted in these parents lacking resources to mitigate the sequelae of multiple, adverse experiences. Consequently, it becomes evident that a multitude of factors seemed to influence their pathway to violence/crime, showing that a single factor seemingly does not result in the perpetration of abuse. Instead, the possibility that a father or mother will become violent, is a function of many factors. Publications
|
| An ethnographic study of ethical issues in conducting gender-based violence research in community based studies in South Africa |
|
The aim of this research is to contribute to understanding about how people from the community perceive discussing violence in a research context and what are their concerns related to this. Through comparing these to those underlying in the World Health Organization guidelines, we will deepen our understanding of the extent to which the safeguards seem to be relevant in addressing community concerns and risks of participation in research and the extent to which those provided in the community study (below) did protect participants with respect to issues of anonymity, confidentiality, safety, informed consent. In the year 2010 a Non-Governmental Organization called GenderLinks, located in Johannesburg, will be undertaking a community-based survey of gender-based violence together with other collaborators including the South African Medical Research Council’s Gender and Health Unit. This survey will collect data in 65 enumeration areas in the Gauteng province which have been randomly sampled. The ethnographic study will study ethical issues related to and arising from this survey. For the ethnographic study, the co-investigator (Yandisa Sikweyiya) plans to select two (2) enumeration areas and study these in some depth. This study will follow an anthropological type of field work. Email yandisa.sikweyiya@mrc.ac.za Publications
|
| An investigation of the relationships between poor mental health, child abuse, women's experiences and male perpetration of intimate partner violence in Gauteng province of South Africa |
|
Investigator: Dr. Mercilene Machisa Synopsis: Intimate partner violence (IPV), childhood abuse, violent traumatic exposures, mental ill health and alcohol abuse are significant public health problems globally. The relationships between child abuse, mental ill health and IPV perpetration or victimisation are complex but research among representative samples of men and women in the South African general has been limited. Depression, post-traumatic stress disorder (PTSD), and alcohol abuse are among mental health consequences of child abuse, violent traumatic exposures and IPV experiences among women. Nonetheless, some women exposed to IPV and adversity are psychologically resilient and function well despite these exposures. There is evidence from some studies showing mental health risk factors for women’s experiences of IPV. Systematic reviews of literature have shown connections between women’s reports of male partners’ alcohol abuse and their experience of IPV but there has been little work done to synthesize literature based on men’s reports of alcohol abuse and their perpetration of IPV. Moreover, data exploring the influences men’s mental health on IPV perpetration in the general population is scanty. This study was conducted to appraise existing global literature and to investigate through analysis of secondary data the relationship between child abuse, mental ill-health, women’s experiences and men’s perpetration of IPV in Gauteng province of South Africa. Publications
For more information contact Dr Mercilene Machisa (mercilene.machisa@mrc.ac.za) |
| A RCT evaluation of a brief woman-focused behaviour change intervention that aims to increase knowledge and skills to reduce substance abuse, sexual risk and victimization in VCT settings |
| The aim of the study is to use a RCT to test the effectiveness of combining voluntary counselling and testing (VCT) with a woman-focused intervention in helping women reduce their substance abuse, sexual risk, and victimization compared to two control groups ( a VCT only group and an equal-attention (nutrition) group) at 3-, 6-, 9-, and 12-month follow-ups. The study is being led by Research Triangle Institute (RTI) (Wendee Wechsberg) and the Alcohol and Drug Research Unit of the MRC (Charles Parry). The Unit is collaborating. It is funded from the NIAAA in the USA via a R01 mechanism. |
| Child sexual assault: Exploring the needs of the girl child and their care giver in the period after rape |
|
The objective of the study is to develop an understanding of children’s psychosocial needs post rape and to determine the extent to which the existing services meet the needs of both the child and their primary caregiver. The study is designed as a longitudinal follow-up study using qualitative semi-structured interviews with both sexually abused children and their adult care givers. Screening tools will also be used with the children to assess psychological symptomatology. A purposive sample of 36 CSA survivors (child and care giver) will be recruited and followed-up from point of contact for a 6 month follow-up period.. Another focus of the study is to explore issues of disclosure among children. The data is currently being analysed. Email: nabraham@mrc.ac.za
|
| Constructions of Femininity in the Context of Sexual Relationships among Women living in the rural Eastern Cape Province, South Africa |
|
Investigator: Dr. Nwabisa Shai (Email: Nwabisa.Shai@mrc.ac.za) Synopsis: While there exist multiple models of femininity, the ideal femininity is accessible through marriage and occupies the top of a cultural hierarchy among women within a patriarchal gender order. In the absence of marriage, unmarried women carve their own versions of femininity with some versions adapting attributes of the ideal model of femininity while others accentuate women’s vulnerability to HIV infection and gender based violence (GBV). Configurations of femininity entail fluidity which facilitates women's oscillation between femininities depending on their marital status, harmony in intimate relationships, socioeconomic conditions and aspirations. The ideal femininity itself is unattainable to married and unmarried women alike. Constructions of femininity intersect with women’s health risks, male gender power and gender violence, and highlight women’s resilience, risk-taking and agency in the context of adversity for love and/or survival. |
| Cochrane review: Psychosocial group interventions to improve psychological well-being in adults living with HIV |
|
Investigator: Ms. Ingrid Van Der Heijden (Email: Ingrid.VanDerHeijden@mrc.ac.za) Synopsis: Being diagnosed with human immunodeficiency virus (HIV), and labelled with a chronic, life-threatening, and often stigmatizing disease, can impact on a person’s well-being. Psychosocial group interventions aim to improve life-functioning and coping as individuals adjust to the diagnosis. The aim of the systematic review was to examine the effectiveness of psychosocial group interventions for improving the psychological well-being of adults living with HIV/AIDS. The authors conclude that group-based psychosocial interventions may have a small effect on measures of depression and coping, but the clinical importance of this is unclear. The systematic review highlighted the absence of psychosocial interventions targeting heterosexual HIV positive populations living in high HIV prevalence and resource-poor settings. Citation: van der Heijden , I., Abrahams, N., Sinclair, D. (2016). Psychosocial group interventions to improve psychological well-being in adults living with HIV. Cochrane Database of Systematic Reviews 2017, Issue 3. Art. No.: CD010806. |
| Curriculum development and training manuals for sexual assault care practitioners in South Africa |
|
The Unit received funding from DFID to develop a training curriculum for health professionals providing sexual assault care for the National Department of Health. The curriculum is a 10 day training course plus two days of practicum. The curriculum has been documented in a 250 page participants’ manual trainers and 200 page trainers’ manual both of which have been written in the past year. These documents are evidence-based, cover a comprehensive approach to rape care and use adult education methods which a great deal of reflection and skills building. A range of supportive materials have also been produced including an assessment booklet for the practicum for the trainer and for the trainee, a course certificate, a 16 page brochure for distribution to survivors of rape in health facilities, a revised draft of the J88 form and a 30 minute DVD with four clips demonstrating good practice talking to and supporting survivors and demonstrations of trauma-focused cognitive behavioural therapy. In 2008 the curriculum was piloted with the training of 144 health care providers from 8 provinces in 4 two week training courses. Evaluation of the training has three parts. First all trainees had to complete a MCQ before and after the course to test knowledge. Through this we established effectiveness in significantly increasing knowledge. Secondly, all were asked to complete a questionnaire that measured gender attitudes and attitudes and confidence at work. This was done before training, immediately afterwards and three months later. Finally qualitative interviews were conducted with providers trained in two facilities before and after training and also with a further group of 15 providers some months after training, the aim being to explore the extent and nature of health system barriers to service improvement after training. E-mail: rjewkes@mrc.ac.za Project publications
|
| Evaluation of Stepping Stones: a gender transformative HIV prevention intervention |
|
Stepping Stones is a gender transformative HIV prevention behaviour intervention (see training tools page). The Unit has been evaluating the intervention since 2002 among youth in the rural Eastern Cape. It is a cluster randomised controlled trial to determine its impact on HIV and HSV2 incidence, and sexual and violent behaviours. The research also included qualitative research. Data collection has been completed and the main findings have been presented for publication. Data analysis for a range of papers that will deepen our understanding of gender and sexual behaviour is ongoing. Partners in the research were Dr Jonathan Levin, MRC Uganda, Dr Adrian Puren of NICD, Dr Kristin Dunkle of Emory University, Dr Nata Duvvury of ICRW, Prof Mary Koss of University of Arizona and Dr Kate Wood of the Institute of Education. The Stepping Stones manual is currently being revised and shortened and the third edition will be published in July 2010. Further analyses of the dataset are being conducted within the Unit particularly focusing on child abuse, HSV2, transactional sex, concurrency, condom use, pregnancy, mental health and the qualitative dataset. Project Publications
Policy brief
Fact sheet
|
| Exploring an effective multisectoral and multilevel response to HIV and AIDS: implications for implementation of the National Strategic Plan on HIV and AIDS in South Africa. |
|
Investigator: Dr. Pinky Mahlangu (Email: pinky.mahlangu@mrc.ac.za) Synopsis: We know that effective responses to social issues with multiple drivers such as violence, HIV, climate change and other issues require a multisectoral approach. A multisector approach brings together various stakeholders including government, civil society and the private sector. Advocacy around adoption of the multisectoral approach for effective responses has been widely documented. However, there has been limited guidance regarding the ‘how’ of the multisectoral approach. Little is known about how to effectively implement a multisectoral approach. Drawing from the South African experience on the multisectoral response to HIV, a qualitative study which highlights the challenges and makes recommendations for effective implementation of the multisectoral approach was conducted. A framework which aims to inform development, implementation, and evaluation of multisector collaborations was proposes. This work contributes to literature on multisector collaboration, and makes recommendation to inform policy and practice on multisectoral action. Publications
|
| Exploring whether and how young women’s agency shifts, with a focus on reproductive decision making and intimate partner violence, following a gender consciousness raising and livelihoods strengthening intervention |
|
Investigator: Ms. Samantha Wilian Synopsis: The aim of the study is to determine whether the combined gender transformative (Stepping Stones) and livelihood strengthening (Creating Futures) interventions are effective in enabling women in informal settlements in eThekwini, South Africa to reduce their exposure to intimate partner violence (IPV) and increase their reproductive decision making, and the role of agency therein. The three key objectives are:
Publications
|
| Men and Gender Equality Policy Project |
|
This is a three year project led by Promundo in Brazil which aims to analyse public policies relating to gender equality and men/boys; to undertake qualitative research on men who adopt non-traditional care giving roles in order to map and understand what influences these; and to develop an international men and gender equality survey. The Gender & Health Research Unit is the South African partner for this initiative with Prof Robert Morrell of the University of KwaZulu Natal. The initiative spans across South Africa, Brazil, Mexico, Chile, UK and India. E-mail: rjewkes@mrc.ac.za Project publications
|
| Mothering in the context of intimate partner violence: A South African qualitative study |
|
Investigators: Miss Bianca Dekel (Email: Bianca.dekel@mrc.ac.za) and Prof. Naeemah Abrahams (Naeemah.abrahams@mrc.ac.za) Synopsis: The aim of this study is to explore women’s experiences of mothering in the context of IPV. Data will be analyzed by means of grounded theory. This qualitative study will contribute to filling the knowledge gap regarding mothering in the context of IPV in South Africa. It is our hope that the forthcoming findings will stimulate the development of more closely targeted and sustainable interventions which are cognizant of the mothers’ story. Publications: Dekel, B., & Abrahams, N. (2021). ‘I will rather be killed by corona than by him…’: Experiences of abused women seeking shelter during South Africa’s COVID-19 lockdown. PLoS one, 16(10), e0259275. |
| National Study on Female and Child Homicide in South Africa – 2009 |
|
Principle Investigator: Prof. Naeemah Abrahams (Naeemah.abrahams@mrc.ac.za) Investigator: Miss. Bianca Dekel (Bianca.dekel@mrc.ac.za) Synopsis: Dedicated femicide studies must be done as current crime data does not allow for disaggregation and the identity of the perpetrators. The 1st National Femicide study established that South Africa has an intimate femicide rate that far exceeds documented rates for other countries i.e. in 1999 we found 4 women were killed per day by an intimate partner. We repeated the Femicide study to look at women killed in 2009. As before we used a national mortuary-based sample and followed up all the identified cases with police to gain further information about the circumstances of the murder and the identity of the perpetrator. We found an overall decline in the number of women killed but it remained more than 1000 women killed by an intimate which related to 3 women a day. Women were also killed by non-partners i.e. strangers/ acquaintances. We further found for 20% of the women killed, a perpetrator was never identified. We also included child homicides and for the 1st time established the scope of child homicides in South Africa. See all our reports attached. Publications
Research Brief
|
| Providing rape survivors with pre-exposure prophylaxis (PrEP) and psychological support to prevent long term HIV acquisition: a feasibility study |
|
Principle Investigator: Prof. Naeemah Abrahams (Naeemah.Abrahams@mrc.ac.za) Co-Principle Investigator: Prof Rachel Jewkes (Rachel.Jewkes@mrc.ac.za) Co-Investigators: Dr Esnat Chirwa (Esnat.Chirwa@mrc.ac.za), Ms Shibe Mhlongo (Shibe.Mhlongo@mrc.ac.za), Dr Beth Spooner (Elizabeth.Spooner@mrc.ac.za), Prof Bromwyn.Myers@mrc.ac.za), Prof Soraya Seedat (sseedat@sun.ac.za), Dr Claudia Garcia-Moreno (garciamorenoc@who.int), Dr Samantha Willan (Samantha.Willan@mrc.ac.za), Dr Jani Nöthling (Jani.Nothling@mrc.ac.za), Ms Gugu Gigaba (GigabaS@ukzn.ac.za). Synopsis: The aim of the study is to investigate the feasibility and acceptability of a combined pre-exposure prophylaxis (PrEP) and stepped mental health interventions called Self-Help Plus (SH+) followed, when needed, by Problem Management Plus (PM+) in reducing medium- to long-term HIV acquisition among rape and gender-based violence survivors. SH+/PM+ will be tested with 100 rape-exposed women and 50 women seeking shelter after intimate partner violence or other forms of gender-based violence, in and around the eThekwini region in KwaZulu Natal. PrEP will be offered to all HIV negative women enrolled in the study. The study will measure HIV prevalence, uptake of PrEP and change in mental health symptoms (depression and posttraumatic stress disorder) over six months. The findings of the study will be disseminated using research briefs, presentations and publications. To read more about the RICE2 project please visit our Doing What Matters in Times of Stress Webpage. |
| Rape Adjudication and Prosecution Study in South Africa (RAPSSA) |
|
The Rape Adjudication and Prosecution Study in South Africa (RAPSSA) is a national study of the prosecution and adjudication of rape matters (including attempted rape) as reported to the police (including sections 15/16 of the Sexual Offences Act i.e. “consensual” sexual penetration). With an overall aim to investigate and understand amenable factors in rape case attrition, the study investigated the epidemiology of rape cases reported to police in the year 2012 and the patterns of their attrition at provincial and national level. Read more. Publications
|
| Skhokho Supporting Success Project: A whole school and family intervention for the primary prevention of sexual and intimate partner violence |
| This project aims to develop and test a suite of interventions to strengthen the capacity of schools and school staff as well as home and adolescents’ caregivers to support teenagers to protect themselves against becoming a victim of, or perpetrating, gender-based violence such as intimate partner violence (“dating violence” or “dating abuse”) and rape. The suite of interventions includes a Grade 8 Life Orientation curriculum including learner workbook and educator training and workbook; positive discipline skills workshop for educators; school values workshop; and a workshop for parents of Grade 8 learners. This suite of interventions will be rigorously evaluated in a randomised controlled trial with 24 schools in three study arms (no intervention vs school intervention only vs school and parent intervention). Project outcomes will be assessed using qualitative in-depth interviews and quantitative surveys with Grade 8 learners, these learners’ parents, and educators and school staff at the 30 trial schools. During 2012/2013 project activities focus on formative research and intervention development; in 2014 the interventions will be implemented along with monitoring and evaluation research activities; and in 2015 follow up evaluations will be conducted. For more information about this project, please contact Prof. Rachel Jewkes (Rachel.jewkes@mrc.ac.za) |
| Sondela: A gender-based risk reduction coping skills intervention for HIV positive men and women living in South Africa |
|
Investigator: Dr. Nwabisa Shai (Email: Nwabisa.Shai@mrc.ac.za) Synopsis: Gender exacerbates unequal health experiences and outcomes and influences the differential experiences of women as compared to men. Thus gender is integral to adjusting to living with HIV. The aim of the study was to develop a gender-based risk reduction and coping skills intervention for HIV positive men and women living in South Africa. The intervention responds to issues such as trauma, depression, HIV-related stigma, stress, HIV disclosure, relationship difficulties (including violence against women), health and ARV adherence using a gender lens. Sondela is a six session manual, of 3 hours each, delivered to gender specific groups (of men or women) for up to 25 participants, by 2 same gender facilitators, one of which could be an HIV positive peer. It makes use of participatory techniques, take home exercises, and group discussions, and reflections that enhance critical thinking. The intervention was piloted and evaluated in 2015 in Gauteng, KwaZulu Natal and Western Cape with black men and women living in low socio-economic communities. Men and women who had been recently clinically diagnosed as HIV positive were recruited and referred to the Sondela groups by HIV counsellors at community health centres. Forty men and women participated in the groups. Sondela promises to be valuable in supporting health system initiatives and psychosocial support to strengthen linkages to and retention in HIV care. There is a need for rigorous evaluation of Sondela to establish its effectiveness in a general population. Citation: Shai , N., Sikweyiya, Y., van der Heijden, I., Abrahams, N., Jewkes, R. (2017) "I was in the darkness but the group brought me light": Development, relevance and feasibility of the Sondela HIV adjustment and coping intervention. PLoS ONE 12(6): e0178135. |
| Study of rape perpetration and its intersections with HIV |
|
This study is being undertaken in collaboration with the School of Education Studies at the University of KwaZulu Natal (Robert Morrell) and Emory University (Kristin Dunkle). The aim of the study is to describe the epidemiology of rape perpetration; factors associated with raping; to describe the associations between rape and HIV sero-status and risk behaviours. In 2008 we implemented the data collection for the study, working in 222 census enumeration areas in three districts in the Eastern Cape and KwaZulu Natal (OR Tambo, Ugu and Ethekwini), where we sought to interview 4440 households. Informants were men aged 18-49. This survey includes a range of questions on aspects of men’s backgrounds, particularly their experiences in childhood, other violent and criminal practices and other aspects of men’s behaviour, such as caring and child rearing practices. Our questionnaire is being shared with collaborators in Brazil, Mexico, Chile and India who have funding for a multi-country study that will replicate large areas of our data collection which will enable us to have access to a multi-country data set for comparative analysis of data on men and masculinities. A new report from the MRC’s Gender and Health Research Unit tries to understand the prevalence of rape perpetration in a random sample community-based adult men as well as understanding factors associated with rape perpetration, and to describe intersections between rape, physical intimate partner violence and HIV. E-mail: rjewkes@mrc.ac.za Project publications
|
| Understanding men and women’s disability and gender-related needs in linking to HIV treatment and care in South Africa |
|
Dr Ingrid van der Heijden, Dr Kristin Dunkle, Dr Andrew Gibbs, Dr Yandisa Sikweyiya and Dr Jill Hanass-Hancock Synoposis: People with disabilities who are HIV positive may face added barriers to linkages to HIV treatment and care than people without disabilities, however they have often been unintentionally left behind in HIV policy-planning, programme development, service delivery and data collection. Thus research is needed to inform interventions to link HIV positive people to care and treatment to avoid further disabling conditions and exclusion. A formative qualitative study including 40 HIV positive men and women attending ART support groups in Gugulethu, Western Cape will be conducted to understand the unique experiences of persons with disabilities living with HIV from their own perspectives. The project seeks to understand how the barriers faced by people with disabilities living with HIV impede their ability to access HIV-related services, and how they are able to manage, treat and cope with their HIV positive status. The research questions will query the following: (1) How does HIV diagnosis (and stigma) affect men and women with disabilities, including their physical and mental health, participation, and intimate partner relationships. (2) What are the barriers and enablers to linkages to care for adults living with HIV and disability (i.e. How does disability impact on ART treatment and adherence?) (3) What is past year history viral suppression of HIV positive adults with disabilities? (4) How does type and severity of disability and gender (masculinity/femininity) impact on the above? |
| Women with physical disabilities' experiences of violence in the Western Cape, South Africa |
|
Investigator: Ms. Ingrid Van Der Heijden (Email: Ingrid.VanDerHeijden@mrc.ac.za) Synopsis: Disability and GBV are interrelated. Importantly, violence is a major cause of disability, and disability increases a women’s vulnerability to violence, depending on the type and severity of impairment. This qualitative study focused on a hugely neglected public health problem – violence against women with disabilities. Through conducting in-depth interviews with 30 physically disabled women and 19 disability and GBV service providers in the Western Cape, the research: (1) explored the nature and forms of violence experienced by disabled women during their lifetime, (2) identified the risk factors for experiencing violence (3) described the construction of sexuality for women with disabilities and how this promotes experiences of intimate partner violence, and (4) identified the barriers and facilitators to GBV support services and pathways to care for women with disabilities. The study makes contribution towards the development of disability-inclusive ethics guidelines on GBV research, especially in LMIC contexts, to prevent and respond to violence against women with disabilities in South Africa and other low- middle income settings Publications:
|