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Process elements contributing to community mobilization for HIV risk reduction and gender equality in rural South Africa.

ABSTRACT: Community mobilization has been recognized as a critical enabler for HIV prevention and is employed for challenging gender inequalities. We worked together with community partners to implement the 'One Man Can' intervention in rural Mpumalanga, South Africa to promote gender equality and HIV risk reduction. During the intervention, we conducted longitudinal qualitative interviews and focus group discussions with community mobilizers (n = 26), volunteer community action team members (n = 22) and community members (n = 52) to explore their experience of being part of the intervention and their experiences of change associated with the intervention. The objective of the study was to examine processes of change in community mobilization for gender equity and HIV prevention. Our analysis showed that over time, participants referred to three key elements of their engagement with the intervention: developing respect for others; inter-personal communication; and empathy. These elements were viewed as assisting them in adopting a 'better life' and associated with behaviour change in the intervention's main focus areas of promoting gender equality and HIV risk reduction behaviours. We discuss how these concepts relate to the essential domains contained within our theoretical framework of community mobilization-specifically critical consciousness, shared concerns and social cohesion -, as demonstrated in this community. We interpret the focus on these key elements as significant indicators of communities engaging with the community mobilization process and initiating movement towards structural changes for HIV prevention.

SUBMITTER: MacPhail C

PROVIDER: S-EPMC6886772 | biostudies-literature | 2019

REPOSITORIES: biostudies-literature

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Process elements contributing to community mobilization for HIV risk reduction and gender equality in rural South Africa.

MacPhail Catherine C Khoza Nomhle N Treves-Kagan Sarah S Selin Amanda A Gómez-Olivé Xavier X Peacock Dean D Rebombo Dumisani D Twine Rhian R Maman Suzanne S Kahn Kathleen K DeLong Stephanie M SM Hill Lauren M LM Lippman Sheri A SA Pettifor Audrey A

PloS one 20191202 12

Community mobilization has been recognized as a critical enabler for HIV prevention and is employed for challenging gender inequalities. We worked together with community partners to implement the 'One Man Can' intervention in rural Mpumalanga, South Africa to promote gender equality and HIV risk reduction. During the intervention, we conducted longitudinal qualitative interviews and focus group discussions with community mobilizers (n = 26), volunteer community action team members (n = 22) and ...[more]

PMID: 31790483

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Project description:ObjectivesResearch on migration and HIV has largely focused on male migration, often failing to measure HIV risks associated with migration for women. We aimed to establish whether associations between migration and HIV infection differ for women and men, and identify possible mechanisms by which women's migration contributes to their high infection risk.DesignData on socio-demographic characteristics, patterns of migration, sexual behavior and HIV infection status were obtained for a population of 11,677 women aged 15-49 and men aged 15-54, resident members of households within a demographic surveillance area participating in HIV surveillance in 2003-04.MethodsLogistic regression was conducted to examine whether sex and migration were independently associated with HIV infection in three additive effects models, using measures of recent migration, household presence and migration frequency. Multiplicative effects models were fitted to explore whether the risk of HIV associated with migration differed for males and females. Further modeling and simulations explored whether composition or behavioral differences accounted for observed associations.ResultsRelative to non-migrant males, non-migrant females had higher odds of being HIV-positive (adjusted odds ratio [aOR] = 1.72; 95% confidence interval [1.49-1.99]), but odds were higher for female migrants (aOR = 2.55 [2.07-3.13]). Female migrants also had higher odds of infection relative to female non-migrants (aOR = 1.48 [1.23-1.77]). The association between number of sexual partners over the lifetime and HIV infection was modified by both sex and migrant status: For male non-migrants, each additional partner was associated with 3% higher odds of HIV infection (aOR = 1.03 [1.02-1.05]); for male migrants the association between number of partners and HIV infection was non-significant. Each additional partner increased odds of HIV infection by 22% for female non-migrants (aOR = 1.22 [1.12-1.32]) and 46% for female migrants (aOR = 1.46 [1.25-1.69]).ConclusionsHigher risk sexual behavior in the context of migration increased women's likelihood of HIV infection.

Project description:Social psychologists have not fully investigated the role of leadership in mobilizing widespread support for social change, particularly gender equality. The burden of achieving gender equality is typically placed on women (particularly female leaders) - the main targets of such inequality. Traditional approaches frame workplace gender equality as either a women's issue, which limits men's (non-target's) involvement in the movement, or a meritocratic non-issue that exists due to women's (target's) tendency to pursue less intensive careers. In contrast to such work focusing on women's experiences as targets of discrimination or men's role in preserving inequality, we propose a solidarity-based approach that positions men and women as agents of change. This approach relies on two processes: leadership processes - particularly leadership as a form of influence based on shared identities among leaders and followers (e.g., their gender group); and political solidarity as a way to mobilize the silent majority (men) to work as allies beside a minority (women) and embrace equality as a common cause for both groups. In two experiments (Ns = 338, 336) we studied how leader gender and message framing affect men's and women's support for equality by contrasting a solidarity-based framing of gender equality as a common cause for men and women, with a women's issue frame (Experiment 1) or a meritocratic frame (Experiment 2). The statement was attributed to a male or female leader (Experiments 1-2) or, additionally, to a government agency (Experiment 1). Women reported higher sense of common cause (Experiment 2) and collective action intentions than men (Experiments 1-2), and higher intentions under common cause compared to meritocracy frames (Experiment 2). Interestingly, male leaders invoked higher sense of common cause and collective action intentions for both men and women regardless of framing (Experiment 2). Irrespective of leader gender however, as predicted common cause framing boosted perceived leader prototypicality, legitimacy, and influence across the board (Experiments 1-2). Yet this was qualified by women (compared to men) rating leaders as more legitimate and influential under common cause compared to meritocracy framing (Experiment 2). Women's reactions to equality messages, and the intersection of leadership and solidarity toward equality are discussed.

Project description:IntroductionCommunity mobilization (CM) is increasingly recognized as critical to generating changes in social norms and behaviours needed to achieve reductions in HIV. We conducted a CM intervention to modify negative gender norms, particularly among men, in order to reduce associated HIV risk.MethodsTwenty two villages in the Agincourt Health and Socio-Demographic Surveillance Site in rural Mpumalanga, South Africa were randomized to either a theory-based, gender transformative, CM intervention or no intervention. Two cross-sectional, population-based surveys were conducted in 2012 (pre-intervention, n = 600 women; n = 581 men) and 2014 (post-intervention, n = 600 women; n = 575 men) among adults ages 18 to 35 years. We used an intent-to-treat (ITT) approach using survey regression cluster-adjusted standard errors to determine the intervention effect by trial arm on gender norms, measured using the Gender Equitable Mens Scale (GEMS), and secondary behavioural outcomes.ResultsAmong men, there was a significant 2.7 point increase (Beta Coefficient 95% CI: 0.62, 4.78, p = 0.01) in GEMS between those in intervention compared to control communities. We did not observe a significant difference in GEMS scores for women by trial arm. Among men and women in intervention communities, we did not observe significant differences in perpetration of intimate partner violence (IPV), condom use at last sex or hazardous drinking compared to control communities. The number of sex partners in the past 12 months (AOR 0.29, 95% CI 0.11 to 0.77) were significantly lower in women in intervention communities compared to control communities and IPV victimization was lower among women in intervention communities, but the reduction was not statistically significant (AOR 0.53, 95% CI 0.24 to 1.16).ConclusionCommunity mobilization can reduce negative gender norms among men and has the potential to create environments that are more supportive of preventing IPV and reducing HIV risk behaviour. Nevertheless, we did not observe that changes in attitudes towards gender norms resulted in desired changes in risk behaviours suggesting that more time may be necessary to change behaviour or that the intervention may need to address behaviours more directly.Clinical trials numberClinicalTrials.gov NCT02129530.

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Process elements contributing to community mobilization for HIV risk reduction and gender equality in rural South Africa.

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Process elements contributing to community mobilization for HIV risk reduction and gender equality in rural South Africa.

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