摘要：Objectives. We sought to obtain evidence about the scope of women’s empowerment and the mechanisms underlying the significant reduction in intimate partner violence documented by the Intervention With Microfinance for AIDS and Gender Equity (IMAGE) cluster-randomized trial in rural South Africa. Methods. The IMAGE intervention combined a microfinance program with participatory training on understanding HIV infection, gender norms, domestic violence, and sexuality. Outcome measures included past year’s experience of intimate partner violence and 9 indicators of women’s empowerment. Qualitative data about changes occurring within intimate relationships, loan groups, and the community were also collected. Results. After 2 years, the risk of past-year physical or sexual violence by an intimate partner was reduced by more than half (adjusted risk ratio=0.45; 95% confidence interval=0.23, 0.91). Improvements in all 9 indicators of empowerment were observed. Reductions in violence resulted from a range of responses enabling women to challenge the acceptability of violence, expect and receive better treatment from partners, leave abusive relationships, and raise public awareness about intimate partner violence. Conclusions. Our findings, both qualitative and quantitative, indicate that economic and social empowerment of women can contribute to reductions in intimate partner violence. The Millennium Development Goals highlight the need to address gender inequality as a critical foundation for human development. 1 Violence against women is an explicit manifestation of gender inequality and is increasingly being recognized as an important risk factor for a range of poor health and economic development outcomes. A substantial body of international research has documented the magnitude and forms of such violence across a range of settings, in low-, middle-, and high-income countries. 2 , 3 Intimate partner violence (IPV)—violence perpetrated by a spouse or intimate partner—is the most common form of gender-based violence, and in addition to causing direct injury or loss of life, it increases vulnerability to a range of negative health outcomes, including HIV/AIDS. 4 – 6 To date, IPV interventions have ranged from those targeting affected individuals (such as health sector interventions, shelters for battered women, or treatment programs for abusers) to those reaching the broader community (such as school-based programs and public awareness campaigns challenging the acceptability of such violence). 7 – 9 However, as recent reviews have noted, 10 , 11 few approaches to preventing or responding to gender-based violence have been rigorously evaluated, even in high-income countries. Although IPV occurs across all socioeconomic groups, studies suggest that women who live in poverty are more likely to experience such violence. The fundamental link between violence and the continued subordinate status of women in society is also well recognized. 12 Although it has been suggested that women who are more economically and socially empowered may be protected from IPV, interventions that aim to empower women and focus on addressing poverty or gender inequalities have not yet been designed and tested. 9 – 13 Our Intervention With Microfinance for AIDS and Gender Equity (IMAGE) study used a cluster-randomized trial design to test the hypothesis that combining a microfinance-based poverty alleviation program with participatory training on HIV risk and prevention, gender norms, domestic violence, and sexuality can improve economic well-being, empower women, and lead to reductions in IPV.
