Althea conducts research at the junction of sociology and public health with particular emphasis on studying how gender oppression, along with other axes of social inequality, affect social, economic and health outcomes for women and girls. She has played a key role in designing, coordinating, and evaluating programmes in the areas of sexual and reproductive health and rights, gender-based violence, masculinities, women’s empowerment and youth development.
EMERGE blog 6. Promoting gender equality in HIV and GBV intervention research: how best to address challenges in shifting social norms
Over the past two decades, gender inequality has been identified as a key determinant for women’s and girls’ vulnerability to HIV and gender-based violence (GBV). In Sub-Saharan Africa, the evidence shows that women’s HIV and GBV risk is heightened and sustained because of a host of individual, social, and structural factors, which include shared community norms which reinforce restrictive gender roles and male dominance in relationships. Inequitable gender norms limit women’s ability to protect themselves from HIV and GBV while simultaneously putting social pressure on men to conform to harmful masculine ideals that equate manhood with dominance over women.
Over the past decade, there has been an uptake of HIV and GBV prevention strategies that seek to shift gender norms, with a sustained focus on gender inequality. Several interventions have incorporated community mobilisation as an approach to change inequitable gender norms, to reduce women’s and girls’ risk of exposure to intimate partner violence, and to improve HIV outcomes. Evaluations of these interventions suggest positive effects on individual and interpersonal attitudes and behaviour change. Yet, few interventions have shown a sustained impact in shifting social norms and broader structures (political economic and cultural systems) that interact with and influence gendered beliefs and practices and can increase women’s and girls’ HIV and GBV vulnerability.
‘One Man Can’ Community Mobilization Intervention
To assess whether community mobilisation targeting young men could transform harmful gender norms and decrease women’s HIV vulnerability, Sonke Gender Justice’s One Man Can (OMC) model was adapted and implemented as part of a multi level HIV intervention in Bushbuckridge, a rural area of Mpumalanga, South Africa. The OMC intervention was undertaken in partnership with the University of California San Francisco, the University of North Carolina, and Wits University Rural Public Health and Health Transitions Research Unit (Agincourt). Together, they implemented one of the first randomised controlled trials (RCT) to test a theory-based model of community mobilization to change gender norms and prevent HIV. The aim was to increase awareness about the relationship between gender inequities and HIV and encourage community action to address harmful gender norms and HIV risk. Local men and women were trained to serve as ‘community mobilisers’ to conduct a variety of outreach activities including workshops on gender socialisation, gender power dynamics, and HIV prevention, as well as to serve as positive role models in attitude and behaviour change. Additionally, community action teams (CATs), comprised of volunteer community members, were formed to disseminate knowledge about gender and HIV throughout their communities and raise awareness about the causes and consequences of harmful gender norms and HIV risks.
Analysis of qualitative data from the study revealed substantial attitudinal and moderate behavioural changes around GBV and HIV risk amongst OMC community mobilisers, as well as amongst CAT members and community members exposed to the intervention. These findings are also supported by quantitative survey data from the study showing that community mobilisation was associated with a greater reduction in experiences of IPV among young women as well as higher HIV testing uptake among men and women when comparing intervention and control communities. At the interpersonal level, data suggest the OMC intervention improved partner communication and the division of labour between men and women in the home. Also, community mobilisers and CAT members served as role models in advocating for gender equality, presenting alternative masculine ideals, and consistently putting into practice the gender equitable values and beliefs they upheld.
While data demonstrated that intervention implementers and community members underwent some shifts towards more equitable gender attitudes and practices, quantitative and qualitative analyses have not revealed evidence that shifts in gender norms have occurred at the broader community level. One explanation is that it may take longer than a two-year intervention for norms to shift and diffuse into the greater community. Additionally, the RCT research design for this intervention required several changes to Sonke’s original OMC community mobilisation model (exclusion of large-scale media campaigns and advocacy strategies) to avoid potential exposure to intervention activities in the control communities. The exclusion of these advocacy efforts might well have reduced some of the power to shift community-level gender norms, particularly since broader evidence suggests the need for multi-level approaches that also address social institutions and broader systems.
Challenges in shifting gender norms
Many HIV and GBV social and behavioural interventions have struggled to clearly illustrate shifts towards gender equitable norms and that any observed change in norms can be attributed to intervention activities. There are several challenges to demonstrating changes in gender norms and establishing causality, which include construct conflation, measurement, and funding limitations that effect intervention implementation and evaluation. Social norms are described as shared beliefs, within a defined reference group, of ideas and actions that are considered as typical or appropriate (and sometimes both), and that are reinforced and legitimated through social sanctions. When we conceptualize gender norms in social and behavioural research they are often conflated with gendered ideologies, attitudes, and practices, which are in fact distinct constructs that both influence and are products of gender norms. At the community level, when women report greater agency in negotiating safer sexual practices, can we extrapolate and say that there has been a shift in norms on women’s sexual autonomy? What other types of evidence would we need to support this finding?
One challenge is conceptualising norms and another is how best to measure social norms. In many gender transformative interventions the GEM scale has become the gold standard in assessing men’s and women’s perceptions of gender norms. The GEM scale, and to a lesser extent the Gender Norm Attitudes Scale, is frequently incorporated in RCT baseline and end-line surveys to quantitatively measure intervention impact on changes in gender equitable norms. With the exception of these scales, there are very few quantitative and qualitative methods to measure people’s perceptions of the shared ideas and actions that comprise norms, the social sanctions attached to these norms, and how norms might change as a result of social and behavioural interventions. Multi-method approaches have gained traction in both HIV and GBV intervention research. However, funding constraints often result in downscaling or cutting qualitative evaluation strategies, despite limitations of relying primarily on quantitative measures in tracking complex processes of social change.
Funding limitations also create other hurdles to GBV and HIV interventions that seek to change gender norms. For example, funding constraints often only allow for short intervention implementation timeframes (1-3 years), despite ambitious outcome measures that seek change at multiple levels. While previous interventions have shown marked attitude and behaviour change and the individual and interpersonal levels, it has been difficult to demonstrate strong evidence on shifts in deeply entrenched gender norms after such a short period of time, and funding for longitudinal follow up evaluation is rare. Given the current funding environment for HIV and GBV intervention research, it may be necessary to critically assess the feasibility of conceptual frameworks that include social norms change as a desired short-term outcome.
Conceptualization, measurement and funding are also important factors when considering how best to sustain even minimal shifts towards more equitable gender norms after an intervention has concluded. Some key questions to consider are:
1) What are practical sustainability objectives for HIV and GBV interventions and how do we build planning to sustain social norm change into interventions?
2) What are the appropriate methodological approaches and types of evidence needed to measure if shifts towards gender equitable norms are maintained over time and the dynamic processes that allow for long-term sustainability?
3) How can HIV and GBV researchers and program implementers work with donor communities to advocate for funding that will allow longitudinal evaluation of gender norms change?
Emerging HIV and GBV research aiming to shift gender norms
Building on the OMC community mobilisation trial and other conceptually rigorous research projects, a variety of innovative evaluations of interventions are underway, seeking to understand how GBV and HIV interventions can promote more equitable gender norms. One promising initiative, funded by the UK Department for International Development (DFID), is the What Works to Prevent Violence Against Women and Girls Programme. This initiative aims to explore the social and economic drivers of GBV and evaluate approaches to addressing these drivers in diverse contexts around the world. As part of the What Works programme, Sonke Gender Justice and the University of Wits School of Public Health are collaborating to implement the Sonke CHANGE Trial, a GBV prevention RCT targeting men in an urban informal settlement in South Africa. The Sonke CHANGE Trial further adapts Sonke’s OMC model by expanding the community mobilisation and advocacy components of the intervention and evaluating its impact on men’s use of violence against women and girls, shifts towards gender-equitable norms and individual and interpersonal behaviour change. As we embark on this new intervention, we reflect on the challenges of demonstrating shifts towards gender equitable norms and hope our findings, and those from other social and behavioural interventions, provide new insights on how best to overcome these obstacles.
To find out more about One Man Can, read the EMERGE case study and related story of change