Identifying individual, partner, household, and neighborhood predictors of intimate partner violence among poor Ecuadorian and Colombian refugee women: A multi-level analysis

Intimate partner violence (IPV) effects a third of South American women and results in significant health and social consequences. Previous research on IPV has relied heavily on cross-sectional data and focused almost exclusively on the characteristics of the woman, ignoring important contextual factors. South America has experienced mass migration due to the recently-ended internal conflict in Colombia, and current instability in Venezuela. The region has simultaneously undergone rapid shifts regarding women’s rights. Using multilevel logistic regression on a longitudinal sample of 1312 poor Ecuadorian and Colombian women living in northern Ecuador, I explored predictors of recent emotional and physical and/or sexual IPV through two related theoretical lenses—social disorganization theory (aim 1) and feminist theory (aim 2). In the sample, 29.4% and 15.6% of women reported recent emotional and physical and/or sexual IPV, respectively. In the Aim 1 analysis, neighborhood social disorganization was marginally, positively associated with emotional IPV (AOR: 1.17, 95% CI: 0.99, 1.38) and trended in the same direction for physical and/or sexual IPV (AOR: 1.20, 95% CI: 0.96, 1.51). Mediation analysis suggest that higher social disorganization is associated with lower neighborhood-level civic engagement (AOR: 0.94, 95% CI: 0.91, 0.98) and higher neighborhood-level civic engagement is associated with lower odds of emotional IPV (AOR: 0.35, 95% CI: 0.13, 0.93). In the Aim 2 analysis, females' increasing participation in household decision-making between time 1 and time 2, at both the household and neighborhood-level, was negatively associated with emotional and physical and/or sexual IPV at time 2, respectively. Having lower education than their partner was a risk factor for IPV (emotional: AOR: 1.71, 95% CI: 1.22, 2.42; physical and/or sexual IPV: AOR: 1.57, 95% CI: 1.08, 2.28). Indicators of economic empowerment were not associated with IPV outcomes in the expected direction. Results support investing in strategies to increase women’s participation and achievement in higher education, and shifting gender norms to create more equitable households and neighborhoods. As South America, and other parts of the world, experience unprecedented mass migration, this research also underscores the importance of integrating IPV prevention and response programs into services in conflict-affected areas and host communities.Doctor of Philosoph

Intimate partner violence against women on the Colombia Ecuador border: a mixed-methods analysis of the liminal migrant experience.

BACKGROUND: Intimate partner violence (IPV) has serious long-term health and psychological consequences and is highly prevalent in Latin America and among displaced populations. Liminality - the ambiguous in-between state of individuals completing a migratory journey - represents a state of legal, economic, and physical insecurity. Through the framework of liminality, this analysis seeks to understand the unique challenges faced by displaced Colombian women in Ecuador including their experience of IPV. METHODS: We performed a secondary analysis of 15 in-depth interviews and 319 longitudinal surveys, conducted on the border of Ecuador and Colombia, following a sequential explanatory mixed-methods design. We analysed interviews thematically and mapped the main themes onto complementary quantitative variables. We conducted logistic regression with identified risk and protective factors (measured at time 1) and recent IPV (measured at time 2), controlling for demographic characteristics and IPV at time 1. RESULTS: Our mixed-methods analysis revealed four main mechanisms by which displacement influenced the social and economic realities of Colombian women years after crossing the border, compounding their risk of IPV and limiting their ability to escape it. Lack of legal residence and documentation, violence experienced along life course and migratory continuums which increased their risk for later revictimisation, social isolation including loss of support networks and restricted mobility and lastly, financial stress. CONCLUSIONS: This research highlights the critical importance of supporting the economic and social integration of migrants and refugees in host communities, as well as the need to carefully consider migration-related vulnerabilities in IPV prevention and response interventions. As the regional refugee crisis grows, policy makers must consider how the long-term marginalisation of refugee women contributes to their victimisation. This research also supports the idea of incorporating gender synchronised, transformative IPV prevention and response programmes into migration-related and poverty alleviation international development efforts

A Mixed-Methods Systematic Review: Infidelity, Romantic Jealousy and Intimate Partner Violence against Women.

Infidelity and romantic jealousy (RJ) are commonly cited relational level drivers of intimate partner violence (IPV) but remain undertheorized and underutilized in IPV research and prevention. This global systematic review aims to characterize the existing research on real or suspected infidelity and RJ in relation to IPV and inform future research and programming. We systematically searched 11 databases for peer-reviewed research, published between April 2009 and 2019, that provided data on the prevalence or a measure of association (quantitative), or pathway (qualitative), between real or suspected infidelity or RJ, and IPV. Fifty-one papers from 28 countries were included and the evidence showed a consistent association between real or suspected infidelity, RJ and IPV. Our findings identify three overarching mechanisms and six pathways between infidelity, RJ and IPV. These provide support for prominent theories in the field related to patriarchal culture, threatened masculinities and femininities and a lack of emotional regulation and conflict resolution skills, but not evolutionary theories. Our findings suggest that researchers should use standardized measurement tools that make the distinction between RJ and suspected, confirmed and accusations of infidelity. Policy and programming should aim to transform traditional gender roles, accounting for infidelity and RJ and improving couple's communication and trust

The role of gender and romantic jealousy in intimate partner violence against women, a mixed-methods study in Northern Ecuador.

Male romantic jealousy is a commonly cited driver of intimate partner violence against women. An in-depth, contextualised understanding of the pathways and mechanisms from jealousy to intimate partner violence is, however, needed to inform programmes and interventions. We triangulated data from 48 interviews, eight focus groups and 1216 survey findings from low-income married women and men in northern Ecuador. Male jealousy was associated with controlling behaviours (aOR: 14.47, 95% CI: 9.47, 22.12) and sexual intimate partner violence (aOR: 2.4, 95% CI: 1.12, 5.12). Controlling behaviours were associated with physical and sexual intimate partner violence (aOR: 2.16, 95% CI: 1.21, 3.84). Qualitatively we found that most respondents framed jealousy within a discourse of love, and three triggers of male jealousy leading to intimate partner violence were identified: (1) community gossip, which acted as a mechanism of community control over women's movements and sexuality; (2) women joining the labour force, which was quantitatively associated with intimate partner violence and partially mediated by jealousy; and (3) women's refusal to have sex, which could lead husbands to coerce sex through accusations of infidelity. Gender-transformative interventions at the individual, couple and community level providing models of alternative masculinities and femininities may offer promise in reducing intimate partner violence in Ecuador. Importantly, future economic empowerment interventions should address jealousy to mitigate potential intimate partner violence backlash

A situational analysis methodology to inform comprehensive HIV prevention and treatment programming, applied in rural South Africa

Successful HIV prevention programming requires engaging communities in the planning process and responding to the social environmental factors that shape health and behaviour in a specific local context. We conducted two community-based situational analyses to inform a large, comprehensive HIV prevention programme in two rural districts of North West Province South Africa in 2012. The methodology includes: initial partnership building, goal setting and background research; 1 week of field work; in-field and subsequent data analysis; and community dissemination and programmatic incorporation of results. We describe the methodology and a case study of the approach in rural South Africa; assess if the methodology generated data with sufficient saturation, breadth and utility for programming purposes; and evaluate if this process successfully engaged the community. Between the two sites, 87 men and 105 women consented to in-depth interviews; 17 focus groups were conducted; and 13 health facilities and 7 NGOs were assessed. The methodology succeeded in quickly collecting high-quality data relevant to tailoring a comprehensive HIV programme and created a strong foundation for community engagement and integration with local health services. This methodology can be an accessible tool in guiding community engagement and tailoring future combination HIV prevention and care programmes

Acceptability and Feasibility of HIV Self-Testing Among Transgender Women in San Francisco: A Mixed Methods Pilot Study.

An estimated one in four transgender women (trans women) in the U.S. are infected with HIV. Rates of HIV testing are not commensurate with their risk, necessitating alternative strategies for early detection and care. We explored the feasibility and acceptability of HIV self-testing (HIVST) with 50 HIV-negative adult trans women in San Francisco. Participants received three self-test kits to perform once a month. Acceptability and behavioral surveys were collected as were 11 in-depth interviews (IDIs). Among 50 participants, 44 reported utilizing HIVST at least once; 94 % reported the test easy to use; 93 % said results were easy to read; and 91 % would recommend it to others. Most participants (68 %) preferred HIVST to clinic-based testing, although price was a key barrier to uptake. IDIs revealed a tension between desires for privacy versus support found at testing sites. HIVST for trans women was acceptable and feasible and requires careful consideration of linkage to support services