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.

The Disability Data Initiative is a global disability rights monitoring initiative that includes a hub for Sub-Saharan Africa. The initiative screens and analyses regularly national censuses and surveys to monitor disability rights.

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.

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:

1. Mahlangu P, Sikweyiya Y, Gibbs A, Shai N, Machisa M. "I Carry the Trauma and Can Vividly Remember": Mental Health Impacts of the COVID-19 Pandemic on Frontline Health Care Workers in South Africa. International Journal of Environmental Research and Public Health. 2023 Jan 29;20(3):2365.
   DOI: 10.3390/ijerph20032365
2. Mahlangu P, Gibbs A, Shai N, Machisa M, Nunze N, Sikweyiya Y. Impact of COVID-19 lockdown and link to women and children’s experiences of violence in the home in South Africa. BMC Public Health. 2022 May 21;22(1):1029.
   DOI: 10.1186/s12889-022-13422-3

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.

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

1. Mlangeni N, Malotle M, Made F, Ramodike J, Sikweyiya Y, Du Preez C, Thompson NS, Sebe N, Zungu M. Factors Associated with TB Screening Among Farmworkers in Limpopo, South Africa. Global Health Action. 2023 Dec 31;16(1):2162227. Epub 2023 Jan 20.
   DOI: 10.1080/16549716.2022.2162227

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.

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.