How Cutting-Edge Trials Are Combatting Intimate Partner Violence in Sub-Saharan Africa
In the shadows of homes across Sub-Saharan Africa (SSA), a silent crisis persists: intimate partner violence (IPV). Defined as physical, sexual, or psychological harm by a current or former partner, IPV affects 33% of women in SSA during their lifetimes—exceeding the global average of 27% 1 5 . The consequences are devastating: traumatic injuries, unintended pregnancies, depression, and even death. Despite decades of awareness, traditional interventions often fall short. Now, researchers are turning to randomized controlled trials (RCTs)—the gold standard in medical science—to test innovative solutions. This article explores how these trials are uncovering pathways to safety and empowerment.
of women in SSA experience IPV
higher risk of physical violence with controlling behaviors
increase in IPV odds with partner alcohol abuse
IPV manifests through physical assault, sexual coercion, emotional abuse, and controlling behaviors (e.g., restricting movement or finances). In SSA, patriarchal norms and economic inequality amplify risks 1 6 . Recent discoveries reveal:
Alcohol use, economic stress, and gender inequality create a "perfect storm" for IPV in couples living with HIV. The Mlambe trial (2024) tested a multifaceted intervention to disrupt this cycle in Malawi, where 38% of women experience partner violence 8 .
The RCT enrolled 250 couples with at least one HIV-positive partner and heavy alcohol use. Participants were randomized into two groups:
Standard HIV care and pamphlets on alcohol harms.
Assessments were conducted at baseline, 11, 15, and 20 months, measuring:
Conflict Tactics Scale-2
AUDIT test
Dyadic adjustment scale
At 20 months, the Mlambe group showed dramatic improvements:
| Outcome | Intervention Group | Control Group | p-value |
|---|---|---|---|
| Physical IPV incidence | 18% | 31% | <0.001 |
| HIV viral suppression | 68% | 42% | <0.01 |
| Heavy alcohol use | 22% | 44% | <0.001 |
| Joint savings rate | 89% | 35% | <0.001 |
Mlambe proved that bundling economic empowerment with relationship strengthening and alcohol reduction creates synergistic effects. Savings accounts reduced financial coercion, while counseling shifted power dynamics. The trial also demonstrated that IPV interventions can improve broader health outcomes, like HIV control 8 .
Conducting RCTs on IPV in SSA faces unique hurdles:
Ensuring participant safety is critical. Trials use code words during follow-ups and partner separate interviews to prevent retaliation.
IPV is underreported due to stigma. Tools like audio computer-assisted surveys (ACASI) enhance disclosure 6 .
Interventions must respect local contexts. In Tanzania, trials incorporated community elders as mediators 7 .
Combining RCTs with qualitative research to understand "why" interventions work.
Programs like Stepping Stones in South Africa involve men as allies 5 .
Essential research tools and reagents for IPV RCTs:
| Tool/Reagent | Function | Example in Use |
|---|---|---|
| CTS-2 Scale | Measures IPV types and frequency | Captured physical/sexual violence in Mlambe 6 |
| Dried Blood Spots | Collects HIV viral load samples in low-resource settings | Used in Mlambe to track ART adherence 8 |
| AUDIT Questionnaire | Screens for hazardous alcohol use | Identified heavy drinkers for Mlambe enrollment 8 |
| DHS Domestic Violence Module | Standardized IPV assessment across countries | Enabled cross-country prevalence studies 1 6 |
| Actiwatch Devices | Objectively measures sleep disruption linked to IPV trauma | Pilot-tested in Ethiopian RCTs 9 |
RCTs have illuminated effective strategies:
The USPSTF recommends routine IPV screening in clinics to identify at-risk women 3 .
As Mlambe shows, bundling IPV interventions with HIV programs maximizes impact 8 .
"Controlling behaviors are the canary in the coal mine for physical violence. RCTs prove we can intervene at this stage to prevent escalation."
The road ahead requires scaling successful RCT models, engaging men, and advocating for policies that address poverty and gender inequality—IPV's deepest roots.