Background: Intimate partner violence (IPV) is associated with increased risk for HIV and reduced engagement along the HIV care continuum. Collective efficacy (CE), defined as mutual trust among community members and willingness to intervene on the behalf of the common good, has been found to be associated with reduced neighborhood violence. Limited research has explored whether CE is associated with reduced incidence of IPV. This is of particular interest among adolescent girls and young women (AGYW) in sub-Saharan Africa, where the burden of HIV is greatest and IPV is common.
Methods: We conducted longitudinal analysis among 2,533 AGYW (ages 13-20) enrolled in the HPTN 068 cohort in the Agincourt Health and Demographic Surveillance System. We included participants from the 28 villages where community surveys and annual census data were collected during the 068 study. HPTN 068 participants completed up to five annual survey visits (2011-2016). Household-level data were collected from the parent/guardian of each participant at all visits. CE was measured at the village-level in 28 communities in Agincourt via two population-based cross-sectional surveys among 18-35 year old residents in 2012 and 2014. The CE score represents a summary village score created by combining validated measures of community social cohesion and social control. We used Agincourt census data to adjust for village-level covariates. Multivariable Poisson generalized estimating equation regression models assessed the relative risk (RR) between village mean CE scores and subsequent physical IPV 12-month incidence, adjusting for age at baseline, HIV status, education, baseline reports of physical IPV, household assets, and community characteristics.
Results: Thirty-eight percent of the cohort (N=950) reported at least one episode of physical IPV after baseline. For every standard deviation increase in village-level CE, there was a 6% reduction in physical IPV incidence in the past 12 months (RR: 0.94; 95% CI: 0.90, 0.98; p< 0.01) among AGYW after adjusting for covariates.
Conclusions: Increased community-level CE was associated with reduced physical IPV incidence among AGYW in South Africa. These results support interventions that foster the development of CE at the community level to prevent IPV among AGYW and potentially improve HIV outcomes among this priority population.