Why interventions to prevent intimate partner violence and HIV have failed young women in southern Africa

Abstract

Introduction Adolescent girls and young women aged 15 to 24 years have some of the highest HIV incidence rates globally, with girls two to four times more likely to be living with HIV than their male peers. High levels of intimate partner violence ( IPV ) experienced by this age group is a significant risk factor for HIV acquisition. While behavioural interventions to prevent IPV and HIV in southern Africa have seen some success in reducing self‐reported experiences of IPV , these interventions have largely failed to achieve similar outcomes for young women. Discussion We identify three main reasons for the failure of IPV / HIV interventions for many young women in southern Africa. First, interventions are usually developed without the meaningful involvement of both young women and young men. Youth input into research design is largely focused on user testing or consultation of targeted groups, involving relatively low levels of participation. Second, interventions are focused on addressing individual risk factors rather than broader social and structural contexts of being a young woman. “Risk factor” interventions, rather than supporting women's agency, can pose a major barrier for supporting changes in behaviour among young women because they often fail to dislodge well‐entrenched gender and age‐related inequalities. Third, current intervention models have not adequately accounted for changes in gender norms and relationships across southern Africa. Individuals are getting married later in life (or not at all), new technologies are transforming romantic interactions and opening new opportunities for violence, and discussions about women's rights are both challenging gender inequalities and reinforcing them. Conclusions In order to move beyond the status quo of current approaches, and to support real innovation, IPV / HIV prevention interventions need to be co‐developed with youth as part of a meaningful participatory process of research, intervention design, youth involvement in development and implementation. This process of co‐development needs to be radical and break with the current focus on adapting existing interventions to meet the needs of young people, which are not well understood and often do not directly reflect their priorities. Broader social contexts and compound lenses are needed to avoid narrow approaches and to accommodate evolving norms.

Reproductive aspirations, contraception use and dual protection among adolescent girls and young women: the effect of motherhood and HIV status

“…Improving adolescent maternal outcomes and fostering child development also relies on preventing rapid repeat pregnancies. Moreover, given high rates of intimate partner violence and power-inequitable relationships reported by adolescent girls and young women, additional analyses integrating these complex considerations are needed [35]. Further research is needed on the experiences of AMLHIV across HIV, SRH and contraception and maternal and child health services, to better integrate and adapt them to the unique needs of this age group.…”

Instagram as a tool for study engagement and community building among adolescents: A social media pilot study

“…This strategy reflects the assertion made by some in the field of adolescent health, including the National Academies of Science (2019), that youth "have the capacity to make meaningful contributions to the design and execution of research." 24 In fact, a 2019 study of HIV and intimate partner violence prevention in southern Africa argues that to move beyond the status quo and "support real innovation," interventions need to be co-developed and implemented with youth, 25 so that they consider and reflect young people's priorities.…”

Thetha Nami: Participatory development of a peer-navigator intervention to deliver biosocial HIV prevention for adolescents and young men and women in rural South Africa

“…The Thetha Nami emergent intervention is thus theoretically aligned with the protection-risk framework [32,33] advocated to improve adolescent well-being. Whilst the Thetha Nami components are similar to combination prevention interventions such as DREAMS [7] by using community-based participatory research they are informed by a social justice framework and are explicitly led by the young people for whom the intervention is meant [21]. The emphasis on youth leadership and equity as the key ingredient to both intervention design and delivery, places Thetha Nami closer to the successful combination interventions that emerged from sex worker mobilization and collectivization a decade earlier [30] .…”

“…Community-based participatory research (CPPR) that places community members at the centre of the research process, provides a fora to listen and respond to the community, and the infrastructure to support community leadership and advocacy development, has been effective in generating relevant knowledge whilst supporting social change [20]. Such methods have been less frequently or consistently applied with young people, due to their limited social and political capital [21,22]. We hypothesise that placing young people at the centre of the intervention development process, listening and responding to their concerns through careful and well supported CBPR, will provide a mechanism to co-create and contextually adapt effective biosocial interventions to tackle the HIV epidemic in sub-saharan Africa.…”