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Online Program

322059
Can a large-scale, multilevel economic and food security structural intervention have an impact on gender dynamics in rural central Malawi?


Tuesday, November 3, 2015 : 2:43 p.m. - 2:56 p.m.

Lindsay Emer, PhD(c), Joseph J. Zilber School of Public Health, University of Wisconsin-Milwaukee, Milwaukee, WI
Alice Fang Yan, MD, PhD, Joseph J. Zilber School of Public Health, University of Wisconsin-Milwaukee, Milwaukee, WI
Patricia E. Stevens, RN, PhD, FAAN, College of Nursing, University of Wisconsin-Milwaukee, Milwaukee, WI
Katarina Grande, MPH, Joseph J. Zilber School of Public Health, University of Wisconsin-Milwaukee, Milwaukee, WI
Loren W. Galvao, MD, MPH, Center for Global Health Equity, College of Nursing, University of Wisconsin-Milwaukee, Milwaukee, WI
Emmanuel Ngui, DrPH, MSc, Joseph J. Zilber School of Public Health,, University of Wisconsin-Milwaukee, Milwaukee, WI
Thokozani Mwenyekonde, CARE, CARE International in Malawi, Lilongwe, Malawi
Lucy Mkandawire-Valhmu, PhD, RN, College of Nursing, University of Wisconsin-Milwaukee, Milwaukee, WI
Thula Saka, Diploma Rural Development, CARE International in Malawi, CARE, Lilongwe, Malawi
Chrispine Manda, CARE International in Malawi, Malawi
Gerald Kosamu, CARE International-Malawi, Malawi
Melissa Lemke, M.A., Center for Urban Population Health, University of Wisconsin School of Medicine and Public Health, Milwaukee, WI
Chrissie Depete, Diploma Rural Development, CARE International in Malawi, CARE, Lilongwe, Malawi
Lance S. Weinhardt, PhD, Joseph J. Zilber School of Public Health, University of Wisconsin-Milwaukee, Milwaukee, WI
Audio (mp3) recording Recorded Presentation (mp4)
Malawi bears one of the heaviest HIV burdens worldwide (10.2% adult prevalence). Women are disproportionately affected compared to men (13% versus 8% prevalence). In addition to increased physiological vulnerability, cultural norms reinforcing gender inequalities put women at increased risk for HIV infection. In a non-equivalent control group effectiveness study (SAGE4Health), we examined how a large-scale, multilevel economic and food security structural intervention may affect gender dynamics that increase HIV risk in women.

Participants (N=274 for intervention, N=120 for control) were asked questions related to gender dynamics with their current husband/partners in the past 12 months in five subscales (power sharing, psychological abuse, physical abuse, sexual abuse and economic abuse). We assessed intervention effects on perceived gender dynamics among women at baseline, 18-month and 36-month follow-up. Generalized estimating equation with repeated measures linear regression analysis was used to compare change in gender dynamics over time between the two groups.

There were significant intervention effects on power sharing and psychological abuse. Relative to baseline, women in the intervention group reported decreased male control in decision-making (p=.039) and decreased psychological abuse (p=.017) at 18-months when compared to women in the control group. Both of these effects were not sustained at 36- months. No significant intervention effects were found for the other subscales.

This combined structural intervention appears to have temporarily improved gender dynamics relating to male control in decision-making and psychological abuse for women in rural Malawi.  This improvement may have decreased their vulnerability to HIV during the intervention.

Learning Areas:

Conduct evaluation related to programs, research, and other areas of practice
Protection of the public in relation to communicable diseases including prevention or control
Public health or related research

Learning Objectives:
Evaluate the effects of a large-scale, multilevel economic and food security structural intervention on gender dynamics in rural Malawi

Keyword(s): Women and HIV/AIDS, International Health

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am the Research Assistant to the Principle Investigator of multiple federally funded grants focusing on HIV/AIDS prevention. My research interests include using structural interventions to reduce the spread of HIV in Sub-Saharan Africa.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

Back to: 4332.0: Women’s health