5 December 2006
A groundbreaking trial project which combines microfinance with gender and Aids education has contributed to a 55% drop in intimate partner violence - a key factor in HIV transmission - among a group of poor South African women.
The results of the trial were published online in British medical journal The Lancet on Friday to coincide with both World Aids Day and the 16 Days of Activism for No Violence Against Women and Children campaign.
The project - singled out at the opening plenary of the 2006 International Aids Conference in Toronto as an important intervention targeting women and girls - has already transformed the lives of thousands of women.
The Intervention with Microfinance for Aids and Gender Equity Study (Image) is a three-year study involving 850 women and 4 000 young people from the rural Sekhukuneland district of South Africa's Limpopo province.
South Africa is currently experiencing one of the highest rates of HIV infection - and one of the highest rape burdens - in the world. And the country's rural women are at especially high risk of HIV because their social and economic conditions place further constraints on their opportunities and life choices.
Addressing the 'triple threat'
Image offers rural women access to microfinance - so they can set up businesses and become economically self-sufficient - as well as gender and HIV education, to help them better negotiate sexual relationships and challenge negative attitudes within their community.
This is the first time that the links between poverty, violence and HIV - the so-called "triple threat" to development - have been explored in this way, and the trial is the first in Africa to have found a link between this approach and a reduction in levels of intimate partner violence.
The Image intervention - a joint initiative between Johannesburg's University of the Witswatersrand, the London School of Hygiene and Tropical Medicine, and a microfinance provider called the Small Enterprise Foundation - targets the poorest.
Nearly three-quarters of the women involved in the study note that, for their families, having enough food to eat is a daily concern.
After two years of involvement in the programme, their levels of economic well-being improved, with loans as small as R500 helping the women to set up as dressmakers, sell fruit and vegetables or open their own shops.
At the same time, there was clear evidence of changes in women's empowerment - greater self confidence, more influence over household decisions, and the challenging of traditional gender norms.
Among women participating in the intervention, their experience of physical and/or sexual violence over the past year was reduced by half, relative to a control group of women from villages that didn't receive the intervention.
Women supporting women
According to
Dr Julia Kim, a clinical research fellow at the London School of Hygiene and Tropical Medicine and a co-founder of the project, the conventional "ABC" HIV prevention message - abstain, be faithful, use a condom - is "just not having enough impact.
"In South Africa, as in many places around the world, poverty and gender inequalities are shaping the nature of sexual relationships," says Kim. "If you're in a violent relationship, asking your husband to use a condom could provoke suspicion and further violence, and there's little value in being faithful if your husband sees his own infidelity as part of 'being a man'.
"With women making up the majority of those infected with HIV in sub-Saharan Africa, and young women at three times the risk of young men, it was clear to us that more needed to be done."
The programme, Kim says, works on the principles of "women supporting women" and "strength in numbers". It also explores, and tries to question, "the deep cultural messages that surround sex and relationships in South Africa, and the way women and girls are expected to behave."
Funders of the Image trial include South Africa's Department of Health and Britain's Department for International Development.
In a statement issued on Friday, Hilary Benn, UK secretary of state for international development, commented: "Changing cultural behaviour, especially attitudes towards sex and relationships, and tackling the stigma that underlies Aids, is one of the greatest challenges we face in our response to the disease.
"That is why the innovation of the Image programme is an excellent example of a really practical way of dealing with a complex issue. The study helps give women more choices and power, and it is that which is helping change the lives of those most at risk."
SouthAfrica.info reporter
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