Current Projects

Current 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: The overall goal of this project is to reduce the prevalence of violence against women (VAW) (over 24 months) and promote and protect the rights of women and girls.  Using a cluster randomized controlled trial (cRCT) design, the specific objectives of the impact assessment will be: 1) To assess the impact of the Rural Response System model/COMBAT in reducing VAW, 2) To determine whether RRS model/COMBAT  interventions are effective in enabling women in to reduce their exposure to intimate partner violence (IPV) and men to reduce their perpetration of IPV, 3) To assess if the RRS model changes discriminatory social norms and gender roles which consider VAW acceptable, 4) To assess the extent to which RRS has changed individual attitudes about gender inequality, 5) To assess state institutional response to reported cases of VAW, 6) To assess whether the RRS model facilitated a shift in power relations between men and women in the household/community to become more equitable.

    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
    An investigation of the relationship between mental ill health, women’s experiences and men’s perpetration of intimate partner violence in Gauteng, South Africa

    Investigator: Ms. 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

    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.

    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.

    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.

      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.
      E-mail: rjewkes@mrc.ac.za

      Project Publications

      • Jewkes R, Nduna M, Levin J, Jama N, Dunkle K, Puren A, Duvvury N (2008) Impact of Stepping Stones on HIV, HSV-2 and sexual behaviour in rural South Africa: cluster randomised controlled trial British Medical Journal 337:a506
      • Jewkes R, Nduna M, Jama N (2002) Stepping Stones. A training manual for sexual and reproductive health, communication and relationship skills. Edition two. . Published by Medical Research Council, Pretoria.
      • Jewkes R, Wood K, Duvvury N. “I woke up after I joined Stepping Stones”: meanings of a HIV behavioural intervention in rural South African young people’s lives. Health Education Research (in press)
      • Jewkes R, Nduna M, Levin J, Jama N, Dunkle K, Khuzwayo N, Koss M, Puren A, Wood K, Duvvury N.  A cluster randomised controlled trial to determine the effectiveness of Stepping Stones in preventing HIV infections and promoting safer sexual behaviour amongst youth in the rural Eastern Cape, South Africa: trial design, methods and baseline findings. Tropical Medicine and International Health 2006; 11:3-16.
      • Jewkes R, Dunkle K. Nduna M, Shai N. Intimate partner violence, relationship gender power inequity, and incidence of HIV infection in young women in South Africa: a cohort study. The Lancet (in press)
      • Jewkes R, Dunkle K, Koss MP, Levin J, Nduna M, Jama N, Sikweyiya Y. Rape perpetration by young, rural South African men: prevalence, patterns and risk factors. Social Science and Medicine. 2006; 63: 2949-61
      • Dunkle K, Jewkes R Nduna M, Levin J, Jama N, Khuzwayo N, Koss MP, Duvvury N Perpetration of partner violence and HIV risk behaviour among young men in the rural Eastern Cape AIDS 2006; 20: 2017-14.
      • Jewkes R, Dunkle K, Nduna M, Levin J, Jama N, Khuzwayo N, Koss M, Puren A, Duvvury N. Factors associated with HIV sero-positivity in young, rural South African men, International Journal of Epidemiology 2006; 35: 1455-1460.
      • Jewkes R, Dunkle K, Nduna M, Levin J, Jama N, Khuzwayo N, Koss M, Puren A, Duvvury N, Factors associated with HIV sero-status in young rural South African women: connections between intimate partner violence and HIV International Journal of Epidemiology 2006; 35: 1461-8.
      • Dunkle KL, Jewkes RK, Nduna M, Jama N, Levin JB, Sikweyiya Y, Koss MP. Transactional sex and economic exchange with partners among young South African men in the rural Eastern Cape: prevalence, predictors and associations with gender-based violence. Social Science and Medicine 2007, 65(6),  1235-48.
      • Shai  N, Jewkes R, Nduna M, Levin J, Dunkle K. Factors associated with consistent and inconsistent condom use among rural young women in South Africa. AIDS Care. (in press)

      Policy brief

      • Jewkes R, Nduna M, Levin J, Jama N, Dunkle K, Wood K, Koss M, Puren A, Duvvury N.  Evaluation of Stepping Stones: A gender transformative HIV prevention intervention (March 2007)

      Fact sheet

      • Jewkes R, Jama N, Nduna M, Levin J, Dunkle K, Khuzwayo N, Duvvury N, Koss M. Stepping Stones Study: Fact sheet on young people’s health and sexual practices in villages and townships of the rural Eastern Cape. Medical Research Council, Pretoria. 2005.
      Exploring an effective multisectoral and multilevel approach to HIV and AIDS: implications for implementation of National Strategic Plan on HIV and AIDS in South Africa

      Investigator: Ms. Pinky Mahlangu (Email: pinky.mahlangu@mrc.ac.za)

      Synopsis: We know that effective responses to complex societal problems that have multiple determinants such as violence, HIV, climate change and other issues require a multisectoral approach that brings together various stakeholders including government, civil society and the private sector. Even more so, most public health issues are cross-cutting, and can never effectively addressed by the health sector working alone.  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 in practise. Little is known about how to effectively implement multisector approaches that can lead to positive outcomes associated with it. Drawing from the South African experience on the multisectoral response to HIV, this qualitative study explores the challenges in implementing a multisectoral approach and makes recommendations on how they can be addressed. The four objectives of the research are to (1) explore how AIDS Councils implement and coordinate the multisectoral approach to HIV and AIDS at national, provincial and local level, (2) explore how selected government departments integrate HIV in their work, collaborate and coordinate the government response to HIV at national, provincial and local level, (3) review existing frameworks informing multisector collaboration in practise (4) and to draw from key findings to develop a framework for multisector collaboration.  The four objectives of the study are answered using qualitative research techniques for data collection and analysis. These include identification and review of key policy documents, key informant interviews with officials from government departments, focus group discussions with members of AIDS Councils, participant observations during development of the national HIV and AIDS plan, during development of strategic plans of government departments, and during meetings of AIDS Councils. Together, this work aims to contribute to the literature on multisector collaboration, and to make policy recommendations to improve implementation of the multisectoral approach on the national response to HIV in South Africa.

       Publications

      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. 

      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:

      1. To develop an understanding of young women’s sense of agency in urban informal settlements in relation to IPV and reproductive decision making.
      2. As a combined gender transformative (Stepping Stones) and livelihood strengthening (Creating Futures) intervention takes place, to explore how this intervention impacts on young women’s sense of agency and perceived ability to resist IPV and their experiences of reproductive decision making.
      3. To develop an understanding of the contextual factors enabling or hindering the programme from building young women’s sense of agency; reducing experiences of IPV; and improving reproductive decision making
      Formative research and development of a Sexual Violence Prevention Intervention for South African higher education institutions

      Investigators:

      Ms. Mercilene Machisa (E-mail: Mercilene.Machisa@mrc.ac.za)
      Ms. Pinky Mahlangu (Email: pinky.mahlangu@mrc.ac.za)
      Associate Professor. Yandisa Sikweyiya (E-mail: yandisa.sikweyiya@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.

      Formative Research and Development of a Sexual Violence Prevention Intervention for South African Higher Education Institutions

      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.

      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.

      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: The 1st National Study on Female Homicide (see below Completed projects) established that South Africa has an intimate femicide rate that far exceeds documented rates for other countries. Overall homicide rates has been decreasing in South Africa since 1994 and similar trends has been reported for intimate femicide in developed countries. We are however not able to establish a pattern for intimate femicide in South Africa as current crime data does not allow for such disaggregation. The 1st study also alerted us to the problem of child murders (0-17 years) of which very little is known. This current study is designed as a mortuary based study to identify from a national sample all cases of female homicides and child homicides. We will follow up all of the identified cases with police to gain further information about the circumstances of the murder and the identity of the perpetrator. This project aims to establish the incidence of female and intimate homicide for 2009 and this will be compare to the 1999 study, allowing us to establish whether there are similar declining shifts in patterns of female murders as seen in overall murders in SA. Importantly, this project will allow us for the first time to establish how big the problem of child homicides is in South Africa and we would be able to describe the circumstances of these murders. E

      Publications
      (Abrahams, Mathews et al. 2012, Abrahams, Mathews et al. 2013, Mathews, Abrahams et al. 2013)

      Research Brief

      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.

      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.
      Rape Impact Cohort Evaluation (RICE)

      Principle Investigator: Prof. Naeemah Abrahams (Naeemah.abrahams@mrc.ac.za)

      Synopsis: The RICE study is a longitudinal study following a cohort of 1008 rape survivors and 1008 women attending family planning services (control group). The overall aim of the study is to describe the attributable burden of ill-health up to 24 months after rape.  The study will also explore the disease mechanisms including psychological, physiological, social and genetic. The study will also identify risk factors (individual, relational, social and criminal) for health problems that may be HIV risk factors at different time points. A sub study among HIV+ women will explore the impact of rape on their ability to link and retain in care.  

      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.

      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.

      Telomere  length-related genetic variants as predictive biomarkers of major depressive disorder in a rape-exposed cohort of South African women

      Investigator: Ms. Alesha Sewnath (Email: Alesha.Sewnath@mrc.ac.za)

      Synopsis: Telomere shortening reflects cumulative damage over time and may therefore serve as a marker of cellular or biological ageing. Recent publications indicate an association between telomere length and psychopathology, including major depressive disorder (MDD). However, as these studies have been cross-sectional, it is difficult to delineate between cause and effect. Telomere length has been found to be influenced by genetic factors, with heritability estimates of > 70%. Impaired telomere biology, resulting in reduced telomere length, may thus be, at least partially, under genetic control. Numerous GWAS have revealed association between variants in a number of genes and telomere length, and of the genes associated with telomere length, telomerase reverse transcriptase (TERT), telomerase RNA component (TERC) and oligonucleotide/oligosaccharide-binding fold containing 1 (OBFC1), have been amongst the most often replicated in various populations. The present study will investigate the association between genetic variants in the 3 aforementioned genes and MDD in a cohort of rape-exposed women (363 who meet criteria for MDD 12 months post-rape exposure, and 266 rape-exposed controls), recruited from various centers in Kwa-Zulu Natal, in order to determine whether impaired telomere biology predicts increased risk for development of MDD. This will be the first study of its kind to be conducted in a South African population.

      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)

      New 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 included ethical recommendations for future disability-inclusive GBV studies, and recommendations to prevent and respond to violence against women with disabilities in South Africa and other low- middle income settings.

      Publications:

        Completed Projects

        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

        • Abrahams, N. and S. Mathews (2008). "Services for child sexual abuse lacking." S Afr Med J 98(7): 494.
        • Mathews, S., N. Abrahams and R. Jewkes (2013). "Exploring Mental Health Adjustment of Children Post Sexual Assault in South Africa." Journal of Child Sexual Abuse 22(6): 639-657
        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

        • Jina R, Jewkes R, Christofides N, Loots L (eds) Caring for survivors of sexual assault. A training programme for health care providers in South Africa. Participants’ manual. Department of Health, Pretoria. 2008.
        • Sexual assault and rape: a survivor’s guide. Booklet published by Department of Health, Pretoria. 2008
        • Jina R, Jewkes R, Christofides N, Loots L. 2014. A cross-sectional study on the effect of post-rape training on knowledge and confidence of health professionals in South Africa. Int J Gynaecol Obstet., 126(2):187-92.
        • Jina R, Jewkes R, Christofides N Knowledge and confidence of South African health care providers regarding post-rape care: a cross-sectional study. BMC Health Services Research 2013, 13:257 doi:10.1186/1472-6963-13-257
        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

        • Redpath J, Morrell R, Jewkes R, Peacock D (2009) Masculinities and public policy in South Africa: changing masculinities and working toward gender equality. Sonke Gender Justice, Cape Town.
        • Barker G, Greene M, Goldstein-Siegel E, Nascimento M, Segundo M, Ricardo C, Figueroa JG, Redpath J, Morrell R, Jewkes R, Peacock D, Aguayo F, Sadler M, Das A, Singh S, Pawar A, Pawlak P. What men have to do with it. Policy policies to promote gender equality. International Center for Research on Women. Washington. 2010
        • Morrell R, Jewkes R (2009) Men who care. A case study of masculinities and gender equity in South Africa. Technical Report. University of KwaZulu Natal. Durban.
        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

        • Jewkes R, Sikweyiya Y, Morrell R, Dunkle K (2009) Understanding men’s health and use of violence: interface of rape and HIV in South Africa. Technical Report. Medical Research Council, Pretoria.
        • Sikweyiya Y, Jewkes R, Morrell R. Talking about Rape: Men’s responses to questions about rape in a research environment in South Africa. Agenda 2007; 74: 48-57.

         

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