Cited by 509Intimate Partner and Family ViolenceHIV/AIDS Research and InterventionsHIV, Drug Use, Sexual Risk

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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

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Abramsky, Tanya, Devries, Karen, Kiss, Ligia, Nakuti, Janet, Kyegombe, Nambusi, Starmann, Elizabeth, Cundill, Bonnie, Francisco, Leilani, Kaye, Dan, Musuya, Tina, Michau, Lori, Watts, Charlotte·2014·BMC Medicine

DOI 10.1186/s12916-014-0122-5PMC PMC4243194

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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 (n = 1,583) and four years post intervention implementation (n = 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.

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Figure 1 Four phases of SASA!CC BY · PubMed Central

Figure 2 SASA logic model.CC BY · PubMed Central

Figure 3 Trial profile.CC BY · PubMed Central

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Authors: Abramsky, T., Devries, K., Kiss, L., Nakuti, J., Kyegombe, N., Starmann, E., Cundill, B., Francisco, L., Kaye, D., Musuya, T., Michau, L., & Watts, C.
Affiliations: London School of Hygiene & Tropical Medicine (GB)
Raising Voices (UG)
Johns Hopkins University (US)
Makerere University (UG)
Center for Domestic Violence Prevention (UG)
Corresponding author: Abramsky, Tanya
ORCID: Abramsky, Tanya
Devries, Karen
Nakuti, Janet
Kyegombe, Nambusi
Starmann, Elizabeth
Cundill, Bonnie
Francisco, Leilani
Kaye, Dan
Michau, Lori
Watts, Charlotte
Venue: BMC Medicine
Publisher: Springer Science and Business Media LLC
Published: 2014-07-31
Volume: 12
Issue: 1
Pages: 122-122
ISSN: 1741-7015 (ISSN-L)
DOI: 10.1186/s12916-014-0122-5
PMC: PMC4243194
OpenAlex: W2132488181
Cited by: 507
References: 27
Citations by year: 2026: 39 · 2025: 39 · 2024: 32 · 2023: 41 · 2022: 46 · 2021: 49 · 2020: 48 · 2019: 54 · 2018: 44 · 2017: 30 · 2016: 42 · 2015: 25 · 2014: 17
FWCI: 48.37
Type: journal article
Language: en
Open access: gold
doi.org
Licence: cc-by
creativecommons.org/licenses/by/4.0 (unspecified)
Locations: BMC Medicine (publishedVersion, cc-by)
Europe PMC (PubMed Central) (publishedVersion, cc-by)
PubMed Central (publishedVersion, cc-by)
PubMed (publishedVersion)
LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
Greater South Information System
Funders: Irish Aid
London School of Hygiene and Tropical Medicine
Jerry M. Lewis, M.D. Mental Health Research Foundation
Australian Agency for International Development
South African Medical Research Council
Serbian Academy of Sciences and Arts
Medical Research Council
Topics: Social Sciences › Health › Intimate Partner and Family Violence
Health Sciences › Medicine › Infectious Diseases › HIV/AIDS Research and Interventions
Health Sciences › Medicine › Epidemiology › HIV, Drug Use, Sexual Risk
Keywords: community mobilization, intimate partner violence, violence against women, HIV risk behavior, sexual concurrency, sexual refusal, Kampala, Uganda, sub-Saharan Africa, community-level interventions, HIV prevention, gender norms, sexual and gender-based violence, sexual and reproductive health
MeSH terms: Adolescent, Adult, Community Health Services, Cross-Sectional Studies, Female, Humans, Male, Middle Aged, Risk Factors, Spouse Abuse, Uganda, HIV Infections, Cluster Analysis, Treatment Outcome, Community Networks

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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

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