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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
Open accessAbstract
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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“At the end of the intervention, there were reported lower rates of IPV among the intervention community.”
From A systematic review of intimate partner violence interventions focused on improving social support and/ mental health outcomes of survivors (2020) · cites this paper as [34]
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“9 (3 RCTs, 3 pre-post evaluations, 3 qualitative research) of the studies we reviewed consisted of interventions described as being community-based [34–42].”
From A systematic review of intimate partner violence interventions focused on improving social support and/ mental health outcomes of survivors (2020) · cites this paper as [34]
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“However, it must be noted that only few of the advocate-based studies and 1 of the community-focused interventions reported an impact on IPV, with good level of evidence [15, 20–23, 34], similar to what has been found in other reviews of advocate-based interventions on intimate partner violence [45].”
From A systematic review of intimate partner violence interventions focused on improving social support and/ mental health outcomes of survivors (2020) · cites this paper as [34]
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Metadata
- 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
- Venue
- BMC Medicine
- Published
- 2014-07-31
- Volume
- 12
- Issue
- 1
- Pages
- 122-122
- ISSN
- 1741-7015 (ISSN-L)
- 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
- 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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