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Open Access Research article

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

Tanya Abramsky1*, Karen Devries1, Ligia Kiss1, Janet Nakuti2, Nambusi Kyegombe1, Elizabeth Starmann1, Bonnie Cundill1, Leilani Francisco3, Dan Kaye4, Tina Musuya5, Lori Michau2 and Charlotte Watts1

Author Affiliations

1 Gender Violence and Health Centre, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK

2 Raising Voices, 16 Tufnell Drive, Kamwokya, Kampala, Uganda

3 Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore 21205, MD, USA

4 Department of Obstetrics and Gynaecology, School of Medicine, Makerere University, Kampala, Uganda

5 Centre for Domestic Violence Prevention, 16 Tufnell Drive, Kamwokya, Kampala, Uganda

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BMC Medicine 2014, 12:122  doi:10.1186/s12916-014-0122-5

Published: 31 July 2014

Abstract

Background

Intimate partner violence (IPV) and HIV are important and interconnected public health concerns. While it is recognized that they share common social drivers, there is limited evidence surrounding the potential of community interventions to reduce violence and HIV risk at the community level. The SASA! study assessed the community-level impact of SASA!, a community mobilization intervention to prevent violence and reduce HIV-risk behaviors.

Methods

From 2007 to 2012 a pair-matched cluster randomized controlled trial (CRT) was conducted in eight communities (four intervention and four control) in Kampala, Uganda. Cross-sectional surveys of a random sample of community members, 18- to 49-years old, were undertaken at baseline (nā€‰=ā€‰1,583) and four years post intervention implementation (nā€‰=ā€‰2,532). Six violence and HIV-related primary outcomes were defined a priori. An adjusted cluster-level intention-to-treat analysis compared outcomes in intervention and control communities at follow-up.

Results

The intervention was associated with significantly lower social acceptance of IPV among women (adjusted risk ratio 0.54, 95% confidence interval (CI) 0.38 to 0.79) and lower acceptance among men (0.13, 95% CI 0.01 to 1.15); significantly greater acceptance that a woman can refuse sex among women (1.28, 95% CI 1.07 to 1.52) and men (1.31, 95% CI 1.00 to 1.70); 52% lower past year experience of physical IPV among women (0.48, 95% CI 0.16 to 1.39); and lower levels of past year experience of sexual IPV (0.76, 95% CI 0.33 to 1.72). Women experiencing violence in intervention communities were more likely to receive supportive community responses. Reported past year sexual concurrency by men was significantly lower in intervention compared to control communities (0.57, 95% CI 0.36 to 0.91).

Conclusions

This is the first CRT in sub-Saharan Africa to assess the community impact of a mobilization program on the social acceptability of IPV, the past year prevalence of IPV and levels of sexual concurrency. SASA! achieved important community impacts, and is now being delivered in control communities and replicated in 15 countries.

Trial registration

ClinicalTrials.gov #NCT00790959 webcite,

Study protocol available at http://www.trialsjournal.com/content/13/1/96 webcite

Keywords:
Violence prevention; Impact evaluation; Community mobilization; Intimate partner violence; Uganda; HIV; Gender based violence; East Africa