Using Cultural Ceremonies to Reduce Intimate Partner Violence and HIV Transmission

Last registered on October 25, 2023

Pre-Trial

Trial Information

General Information

Title
Using Cultural Ceremonies to Reduce Intimate Partner Violence and HIV Transmission
RCT ID
AEARCTR-0000211
Initial registration date
January 13, 2014

Initial registration date is when the trial was registered.

It corresponds to when the registration was submitted to the Registry to be reviewed for publication.

First published
January 13, 2014, 12:29 PM EST

First published corresponds to when the trial was first made public on the Registry after being reviewed.

Last updated
October 25, 2023, 4:00 PM EDT

Last updated is the most recent time when changes to the trial's registration were published.

Locations

Primary Investigator

Affiliation
J-PAL

Other Primary Investigator(s)

PI Affiliation
Addis Ababa University, School of Public Health
PI Affiliation
IFPRI

Additional Trial Information

Status
Completed
Start date
2014-07-28
End date
2017-10-31
Secondary IDs
Prior work
This trial does not extend or rely on any prior RCTs.
Abstract
Violence against women (VAW), the most extreme manifestation of the unequal power balance between women and men, is a major global public health concern. One of the most common forms of VAW is that perpetrated by a husband or other intimate partner. In Ethiopia, 70.9% of women reported having experienced physical and/or sexual intimate partner violence (IPV) in their lifetime, demonstrating the pervasiveness of the problem. A growing body of evidence has also linked IPV and HIV risk.

This study aims to evaluate, using a randomized controlled trial, the impact of a community-based intervention focused on Intimate Partner Violence and HIV delivered in the context of the Ethiopian coffee ceremony, a culturally established forum for community discussion and conflict resolution.
External Link(s)

Registration Citation

Citation
Deyesa, Negussie, Jessica Leight and Vandana Sharma. 2023. "Using Cultural Ceremonies to Reduce Intimate Partner Violence and HIV Transmission ." AEA RCT Registry. October 25. https://doi.org/10.1257/rct.211-5.0
Former Citation
Deyesa, Negussie, Jessica Leight and Vandana Sharma. 2023. "Using Cultural Ceremonies to Reduce Intimate Partner Violence and HIV Transmission ." AEA RCT Registry. October 25. https://www.socialscienceregistry.org/trials/211/history/198069
Experimental Details

Interventions

Intervention(s)
The Ethiopian traditional coffee ceremony will be used as an entry point for a community based intervention to provide information, change behaviour around IPV and improve gender equity and intra-couple relations. The coffee ceremony is a culturally established forum for community discussion and conflict resolution and an integral part of Ethiopian life. The intervention will involve regular coffee ceremonies, during which approximately 20 members of the community will participate in education and discussions centred on gender issues, sexuality, communication and conflict resolution, HIV/AIDS and its link with violence, as well as HIV/AIDS prevention. Each coffee ceremony will be moderated by a female or male facilitator trained in participatory learning, moderation, HIV/AIDS prevention, counselling, and gender issues. The intervention will involve 14 two‐hour session per group of participants.
Intervention (Hidden)
Intervention Start Date
2014-12-01
Intervention End Date
2015-04-01

Primary Outcomes

Primary Outcomes (end points)
Prevalence of physical and/or sexual IPV in the previous 12 months, male perpetration of violence, HIV knowledge, attitudes and behaviors
Primary Outcomes (explanation)

Secondary Outcomes

Secondary Outcomes (end points)
Secondary Outcomes (explanation)

Experimental Design

Experimental Design
The study is a cluster randomized controlled trial, with randomization at the village level. Villages will be randomly assigned to one of 4 study arms (3 intervention and one control arm): 1) Women only participate in the intervention, 2) Men only participate, 3) Both men and women (couples) participate, 4) Women and men receive the control intervention comprising a short informational session on violence reduction.
Experimental Design Details
Randomization Method
Randomization will be done in office by a computer
Randomization Unit
Randomization will be at the village level
Was the treatment clustered?
Yes

Experiment Characteristics

Sample size: planned number of clusters
64 villages in four districts (Meska, Mareko, Sedo and Silte) in Ethiopia
Sample size: planned number of observations
3392 women and 3392 men at baseline. At endline, an additional survey was administered to the spouses of the baseline survey, doubling the sample of both men and women.
Sample size (or number of clusters) by treatment arms
16 villages in each treatment arm
Minimum detectable effect size for main outcomes (accounting for sample design and clustering)
IRB

Institutional Review Boards (IRBs)

IRB Name
MIT, Committee On the Use of Human Subjects as Experimental Objects
IRB Approval Date
2012-12-20
IRB Approval Number
1211005333
IRB Name
Addis Ababa University College of Health Science Institutional Review Board
IRB Approval Date
2013-01-23
IRB Approval Number
044/12/SPH
Analysis Plan

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Post-Trial

Post Trial Information

Study Withdrawal

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Intervention

Is the intervention completed?
Yes
Intervention Completion Date
October 31, 2015, 12:00 +00:00
Data Collection Complete
Yes
Data Collection Completion Date
October 31, 2017, 12:00 +00:00
Final Sample Size: Number of Clusters (Unit of Randomization)
64 kebeles
Was attrition correlated with treatment status?
Final Sample Size: Total Number of Observations
Final Sample Size (or Number of Clusters) by Treatment Arms
Data Publication

Data Publication

Is public data available?
Yes
Public Data URL

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Program Files

Program Files
No
Reports, Papers & Other Materials

Relevant Paper(s)

Abstract
Background
Intimate partner violence (IPV) is associated with increased HIV risk and other adverse health and psychosocial outcomes. We assessed the impact of Unite for a Better Life (UBL), a gender-transformative, participatory intervention delivered to men, women, and couples in Ethiopia in the context of the coffee ceremony, a traditional community-based discussion forum.

Methods and findings
Villages (n = 64) in 4 Ethiopian districts were randomly allocated to control, men’s UBL, women’s UBL, or couples’ UBL, and approximately 106 households per village were randomly selected for inclusion in the trial. The intervention included 14 sessions delivered twice weekly by trained facilitators; control arm households were offered a short IPV educational session. Primary outcomes were women’s experience of past-year physical or sexual IPV 24 months postintervention. Secondary outcomes included male perpetration of past-year physical or sexual IPV, comprehensive HIV knowledge, and condom use at last intercourse. Additional prespecified outcomes included experience and perpetration of past-year physical and/or sexual IPV and emotional IPV, HIV/AIDs knowledge and behaviors, decision-making, and gender norms. An intention-to-treat (ITT) analysis was conducted, evaluating 6,770 households surveyed at baseline in 2014–2015 (1,680 households, 16 clusters in control; 1,692 households, 16 clusters in couples’ UBL; 1,707 households, 16 clusters in women’s UBL; 1,691 households, 16 clusters in men’s UBL). Follow-up data were available from 88% of baseline respondents and 87% of baseline spouses surveyed in 2017–2018. Results from both unadjusted and adjusted specifications are reported, the latter adjusting for age, education level, marriage length, polygamy, socioeconomic status, and months between intervention and endline. For primary outcomes, there was no effect of any UBL intervention compared to control on women’s past-year experience of physical (couples’ UBL arm adjusted odds ratio [AOR] = 1.00, 95% confidence interval [CI]: 0.77–1.30, p = 0.973; women’s UBL arm AOR = 1.11, 95% CI 0.87–1.42, p = 0.414; men’s UBL arm AOR = 1.02, 95% CI: 0.81–1.28, p = 0.865) or sexual IPV (couples’ UBL arm AOR = 0.86, 95% CI: 0.62–1.20, p = 0.378; women’s UBL arm AOR = 1.15, 95% CI: 0.89–1.50; p = 0.291; men’s UBL arm AOR = 0.80, 95% CI: 0.63–1.01, p = 0.062). For the secondary outcomes, only the men’s UBL intervention significantly reduced male perpetration of past-year sexual IPV (AOR: 0.73; 95% CI: 0.56–0.94, p = 0.014), and no intervention reduced perpetration of past-year physical IPV. Among women, the couples’ UBL intervention significantly improved comprehensive HIV knowledge, and both couples’ and women’s UBL significantly increased reported condom use at last intercourse. Among additional outcomes of interest, the men’s UBL intervention was associated with a significant reduction in women’s experience of past-year physical and/or sexual IPV (AOR = 0.81, 95% CI: 0.66–0.99, p = 0.036) and men’s perpetration of physical and/or sexual IPV (AOR = 0.78; 95% CI: 0.62–0.98, p = 0.037). UBL delivered to men and couples was associated with a significant reduction in HIV risk behaviors and more equitable intrahousehold decision-making and household task-sharing. The primary limitation is reliance on self-reported data.

Conclusions
A gender-transformative intervention delivered to men was effective in reducing self-reported perpetration of sexual IPV but did not reduce IPV when delivered to couples or women. We found evidence of decreased sexual IPV with men’s UBL across men’s and women’s reports and of increased HIV knowledge and condom use at last intercourse among women. The men’s UBL intervention could help accelerate progress towards gender equality and combating HIV/AIDS.

Trial registration
The trial was prospectively registered at clinicaltrials.gov (NCT02311699) and in the American Economic Association registry (AEARCTR-0000211).
Citation
Sharma V, Leight J, Verani F, Tewolde S, Deyessa N (2020) Effectiveness of a culturally appropriate intervention to prevent intimate partner violence and HIV transmission among men, women, and couples in rural Ethiopia: Findings from a cluster-randomized controlled trial. PLoS Med 17(8): e1003274. https://doi.org/10.1371/journal.pmed.1003274

Reports & Other Materials