The challenge
Intimate partner violence and HIV are interconnected public health concerns, but there was limited evidence on whether community interventions could reduce violence at the community level.
The case
SASA!, designed by Raising Voices and implemented in Kampala by the Centre for Domestic Violence Prevention (CEDOVIP), is a community mobilisation intervention that promotes critical discussion of power and power inequalities, involving community activists, local government and cultural leaders, police officers and health care providers. Its name means 'now' in Kiswahili and stands for its phases: Start, Awareness, Support, Action. From 2007 to 2012, Tanya Abramsky and colleagues ran a pair-matched cluster randomized trial in eight communities, four intervention and four control, surveying random samples of 18- to 49-year-olds at baseline (n = 1,583) and four years post intervention implementation (n = 2,532). The intervention was associated with significantly lower social acceptance of intimate partner violence among women (adjusted risk ratio 0.54), significantly greater acceptance that a woman can refuse sex, and 52% lower past-year experience of physical intimate partner violence among women (adjusted risk ratio 0.48, 95% CI 0.16 to 1.39), and women experiencing violence in intervention communities were more likely to receive supportive community responses. A secondary analysis found significant reductions in the continuation of prior abuse, including continued physical violence (adjusted risk ratio 0.42).
Why it worked
The authors say SASA! achieved important community impacts and was being replicated in more than 15 countries; with only eight communities, the confidence interval on the reduction in physical violence was wide and included no effect.
Sources
- Abramsky, T., Devries, K., Kiss, L., Nakuti, J., Kyegombe, N., Starmann, E., Cundill, B., Francisco, L., Kaye, D., Musuya, T., Michau, L., & Watts, C. (2014). Findings from the SASA! Study: a cluster randomized controlled trial to assess the impact of a community mobilization intervention to prevent violence against women and reduce HIV risk in Kampala, Uganda. BMC Medicine, 12, 122.
- Abramsky, T., Devries, K. M., Michau, L., Nakuti, J., Musuya, T., Kyegombe, N., & Watts, C. (2016). The impact of SASA!, a community mobilisation intervention, on women's experiences of intimate partner violence: secondary findings from a cluster randomised trial in Kampala, Uganda. Journal of Epidemiology and Community Health, 70(8), 818–825.
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