Prevalence and drivers of violence in informal settlements in eThekwini, South Africa Andrew Gibbs, Laura Washington, Nolwazi Ntini, Thobani Khumalo, Samantha Willan, Yandisa Sikweyiya, Nwabisa Jama Shai, Esnat Chirwa, Rachel Jewkes

Urban informal settlements 61.7% of urban dwellers across the African continent, live in informal settlements. Set to increase from 400 million to 1.2 billion by 2050 (UN Habitat, 2015) In South Africa, HIV-prevalence in urban informal settlements twice that of formal settlements (Rehle et al, 2007) Kibera informal settlement in Kenya, 84.5% of women living there had experienced IPV, compared to 39% in the general population (Swart, 2011)

Gender inequalities and livelihood insecurity drive intimate partner violence: Women Clear evidence that: Their experience of poverty and gender inequalities drives their experience of IPV (Krishnan et al., 2008; Kim & Watts, 2005); Transforming gender norm/empowerment and strengthening livelihoods reduces IPV (Pronyk et al., 2006; Gibbs et al., 2012; Ellsberg et al., 2015)

Gender inequalities and livelihood insecurity drive intimate partner violence: Men Strong qualitative theoretical argument that men’s economic marginalization leads to increase in IPV perpetration (Bourgois, 1995; Silberschmidt, 2001; Gibbs et al., 2014) Quantitative data rather more mixed: Jewkes et al., 2011, cross sectional study of rape perpetration in South Africa – in descriptive analysis those earning >R500 in past month more likely to rape, but also those hungry due to lack of money more likely to. In regression, higher maternal education was associated with rape – suggested being better off linked to rape Jewkes et al., 2016 SEM model of data, showed men with higher SES had less gender equitable behaviours increased rape perpetration, while men with lower SES had this pathway mediated by childhood trauma From reviews know that strengthening men’s livelihoods – without transforming gender norms/relationships - can increase HIV-risk behaviours (Gibbs et al., unpublished) unsure impact on IPV perpetration Major issue as large number of interventions working to increase young people’s access to work

Stepping Stones and Creating Futures Cluster RCT with n=1320 participants (660 women; 660 men), in 34 clusters in urban informal settlements in Durban, South Africa Stepping Stones and Creating Futures, participatory, group-based intervention to reduce IPV through strengthening livelihoods and transforming gender norms: Pilot of intervention (n=232) showed strengthening livelihoods for women and men, more equitable gender attitudes, reduction in men’s controlling behaviours and reduction in women’s experience of sexual IPV (Jewkes et al., 2014) Baseline findings from 28/34 clusters (final data collection ongoing)

Socio-demographics & IPV Men (n=554) Mean/%(95%CI) Age 23.63(23.35-23.91) Education: Primary 11.73(9.35-14.63) Secondary (not complete) 57.04(52.92-61.06) Secondary (complete) 31.23(27.59-35.11) Earnings past month R404(321-487) Sexual/physical IPV past 12m 58.41(54.19-62.51) Sexual IPV past 12m 29.84(26.13-33.83) Physical IPV past 12m 51.17(46.95-55.38) Women (n=561) Mean/%(95%CI) Age 23.88(23.59-24.17) Education: Primary 8.02(6.04-10.57) Secondary (not complete) 58.47(54.36-62.46) Secondary (complete) 33.51(29.80-37.44) Earnings past month R176(139-231) Sexual/physical IPV past 12m 65.24(61.19-69.09) Sexual IPV past 12m 30.48(26.77-34.46) Physical IPV past 12m 59.36(55.22-63.37)

Socio-demographic, livelihoods and IPV Men - IPV   Women - IPV No Yes p value %/mean (95%CI) Age (mean) 23.65(23.20-24.10) 23.59(23.23-23.95) 0.8346 23.74(23.22-24.25) 23.95(23.60-24.30) 0.4929 Education: Primary 11.74(8.17-16.59) 11.76(8.69-15.73) 5.64(3.14-9.93) 9.29(6.72-12.70) Secondary 52.17(45.78-58.50) 60.34(54.94-65.56) 50.26(43.25-57.25) 62.84(57.74-67.67) Matric 36.09(30.21-42.41) 27.86(23.31-32.91) 0.106 44.10(37.28-51.15) 27.87(23.54-32.66) <0.0001 Livelihoods Earnings past 4 weeks (mean) 340(199-482) 450(350-550) 0.2012 198(125-272) 164(121-207) 0.3964 Earnt any money in past month (>=R1) 53.71(47.24-60.06) 68.73(63.37-73.63) 33.33(27.04-40.28) 30.87(26.33-35.82) 0.551 Food insecurity: None 20.52(15.79-26.23) 16.41(12.80-20.79) 27.18(21.38-33.87) 13.93(10.74-17.88) Moderate 57.64(51.20-63.83) 56.35(50.90-61.65) 49.74(42.78-56.71) 52.19(47.08-57.24) High 21.83(16.93-27.69) 27.24(22.63-32.41) 0.239 23.08(17.73-29.46) 33.88(29.21-38.89) Stole in past 4 weeks as hungry: Yes 24.89(19.71-30.91) 46.13(40.73-51.63) 22.05(16.75-28.45) 28.14(23.79-32.94) 0.117 Borrowed past 4 weeks: >Weekly 30.13(24.56-36.36) 41.80(36.52-47.27) 0.005 26.67(20.99-33.23) 35.25(30.53-40.27) 0.038 Worked in past 12m:Most/each month 15.72(11.50-21.12) 28.17(23.58-33.26) 0.001 20.00(14.97-26.21) 13.66(10.51-17.57) 0.05 Stress work (>=more) 12.16(11.74-12.58) 12.05(11.73-12.38) 0.6807 12.03(11.61-12.46) 11.92(11.62-12.22) 0.6744 Feelings shame work (>=more) 10.82(10.48-11.16) 10.93(10.66-11.21) 0.6158 10.59(10.23-10.96) 11.04(10.78-11.29) 0.0498 Livelihood efforts (>=more) 16.28(15.61-16.95) 17.21(16.67-17.75) 0.0323 15.65(14.95-16.34) 15.70(15.18-16.21) 0.9092

Socio-demographic, livelihoods and IPV Men - IPV   Women - IPV No Yes p value %/mean (95%CI) Age (mean) 23.65(23.20-24.10) 23.59(23.23-23.95) 0.8346 23.74(23.22-24.25) 23.95(23.60-24.30) 0.4929 Education: Primary 11.74(8.17-16.59) 11.76(8.69-15.73) 5.64(3.14-9.93) 9.29(6.72-12.70) Secondary 52.17(45.78-58.50) 60.34(54.94-65.56) 50.26(43.25-57.25) 62.84(57.74-67.67) Matric 36.09(30.21-42.41) 27.86(23.31-32.91) 0.106 44.10(37.28-51.15) 27.87(23.54-32.66) <0.0001 Livelihoods Earnings past 4 weeks (mean) 340(199-482) 450(350-550) 0.2012 198(125-272) 164(121-207) 0.3964 Earnt any money in past month (>=R1) 53.71(47.24-60.06) 68.73(63.37-73.63) 33.33(27.04-40.28) 30.87(26.33-35.82) 0.551 Food insecurity: None 20.52(15.79-26.23) 16.41(12.80-20.79) 27.18(21.38-33.87) 13.93(10.74-17.88) Moderate 57.64(51.20-63.83) 56.35(50.90-61.65) 49.74(42.78-56.71) 52.19(47.08-57.24) High 21.83(16.93-27.69) 27.24(22.63-32.41) 0.239 23.08(17.73-29.46) 33.88(29.21-38.89) Stole in past 4 weeks as hungry: Yes 24.89(19.71-30.91) 46.13(40.73-51.63) 22.05(16.75-28.45) 28.14(23.79-32.94) 0.117 Borrowed past 4 weeks: >Weekly 30.13(24.56-36.36) 41.80(36.52-47.27) 0.005 26.67(20.99-33.23) 35.25(30.53-40.27) 0.038 Worked in past 12m:Most/each month 15.72(11.50-21.12) 28.17(23.58-33.26) 0.001 20.00(14.97-26.21) 13.66(10.51-17.57) 0.05 Stress work (>=more) 12.16(11.74-12.58) 12.05(11.73-12.38) 0.6807 12.03(11.61-12.46) 11.92(11.62-12.22) 0.6744 Feelings shame work (>=more) 10.82(10.48-11.16) 10.93(10.66-11.21) 0.6158 10.59(10.23-10.96) 11.04(10.78-11.29) 0.0498 Livelihood efforts (>=more) 16.28(15.61-16.95) 17.21(16.67-17.75) 0.0323 15.65(14.95-16.34) 15.70(15.18-16.21) 0.9092

Gender relationships Men - IPV Women - IPV No Yes p value   Men - IPV Women - IPV No Yes p value Gender attitudes/relationships %/mean (95%CI) Gender attitudes (>=less equitable) 26.72(25.42-28.03) 29.07(28.03-30.10) <0.05 22.79(21.44-24.14) 26.22(25.25-27.18) <0.0001 Controlling behaviours (>=more) 10.04(9.54-10.54) 11.55(11.14-11.96) 8.19(7.62-8.76) 11.33(10.90-11.77) Alcohol use (>=more) 5.58(4.70-6.47) 9.92(8.93-10.90) 2.51(1.90-3.12) 5.39(4.64-6.14) Drug use past 12m: Yes 41.41(35.14-47.97) 60.25(54.76-65.49) 20.51(15.42-26.76) 36.89(32.06-41.99) Hope (>=more) 13.89(13.34-14.43) 12.26(11.77-12.76) 14.04(13.44-14.64) 13.43(12.98-13.89) 0.1149 Childhood trauma (>=more) 5.52(4.81-6.23) 8.82(8.09-9.55) 4.97(4.25-5.69) 7.35(6.74-7.96) Views life (>=more positive) 9.97(9.48-10.45) 10.49(10.11-10.88) 0.0922 9.88(9.38-10.38) 9.90(9.53-10.26) 0.9442 Life success (>=more successful) 2.04(1.88-2.21) 2.38(2.22-2.54) 0.0045 2.44(2.23-2.66) 2.53(2.36-2.69) 0.534

Gender relationships Men - IPV Women - IPV No Yes p value   Men - IPV Women - IPV No Yes p value Gender attitudes/relationships %/mean (95%CI) Gender attitudes (>=less equitable) 26.72(25.42-28.03) 29.07(28.03-30.10) <0.05 22.79(21.44-24.14) 26.22(25.25-27.18) <0.0001 Controlling behaviours (>=more) 10.04(9.54-10.54) 11.55(11.14-11.96) 8.19(7.62-8.76) 11.33(10.90-11.77) Alcohol use (>=more) 5.58(4.70-6.47) 9.92(8.93-10.90) 2.51(1.90-3.12) 5.39(4.64-6.14) Drug use past 12m: Yes 41.41(35.14-47.97) 60.25(54.76-65.49) 20.51(15.42-26.76) 36.89(32.06-41.99) Hope (>=more) 13.89(13.34-14.43) 12.26(11.77-12.76) 14.04(13.44-14.64) 13.43(12.98-13.89) 0.1149 Childhood trauma (>=more) 5.52(4.81-6.23) 8.82(8.09-9.55) 4.97(4.25-5.69) 7.35(6.74-7.96) Views life (>=more positive) 9.97(9.48-10.45) 10.49(10.11-10.88) 0.0922 9.88(9.38-10.38) 9.90(9.53-10.26) 0.9442 Life success (>=more successful) 2.04(1.88-2.21) 2.38(2.22-2.54) 0.0045 2.44(2.23-2.66) 2.53(2.36-2.69) 0.534

Regression models Men aOR p-value Stealing because of hunger 1.83 0.004 Working in past 12m (every/most months) 1.92 0.008 Controlling behaviours (>=more) 1.09 0.003 Alcohol use (>=more) 1.06 <0.0001 Hope 0.93 0.002 Childhood traumas (>=more) Life success (>=more successful) 1.21 0.01 No. observations: 547, Wald chi=80.31, p<0.00001 Controlling for education and age Women aOR p-value Hunger: Low base Moderate 1.56 0.084 High 2.13 0.01 Controlling behaviours (>=more) 1.16 <0.0001 Alcohol use (>=more) 1.09 Hope 0.95 0.033 No. observations: 561, Wald chi75.28, p<0.00001 Controlling for education and age

Regression models Men aOR p-value Stealing because of hunger 1.83 0.004 Working in past 12m (every/most months) 1.92 0.008 Controlling behaviours (>=more) 1.09 0.003 Alcohol use (>=more) 1.06 <0.0001 Hope 0.93 0.002 Childhood traumas (>=more) Life success (>=more successful) 1.21 0.01 No. observations: 547, Wald chi=80.31, p<0.00001 Controlling for education and age Women aOR p-value Hunger: Low base Moderate 1.56 0.084 High 2.13 0.01 Controlling behaviours (>=more) 1.16 <0.0001 Alcohol use (>=more) 1.09 Hope 0.95 0.033 No. observations: 561, Wald chi75.28, p<0.00001 Controlling for education and age

SEM Men Depression Drug use Hope Alcohol use Sadness Substance use Any IPV in past 12m Childhood traumas Working in past 12m Stealing because of hunger Arguing in relationship Education Controlling behaviours Inequitable gender attitudes

SEM Women Arguing in relationship Drug use Childhood traumas Alcohol use Depression Education Any IPV in past 12m Controlling behaviours Inequitable gender attitudes Poor No food to eat in household Go to sleep hungry as no food Not eat for a whole day as no food Borrowing as no food

Discussion: Men For men see a clustering of factors linked to IPV: Being slightly better off (in context of poverty): working more in the past 12m, viewing self as successful as a man Gender inequitable practices Childhood traumas Reflects argument that men who are slightly better off, associated with greater sense of sexual entitlement and control of women Raises significant issues about just doing economic strengthening interventions with men, without focusing on gender transformative interventions at the same time

Discussion women For women constellation of factors shape their risk of IPV driven by poverty: Poverty drives poorer educational outcomes, poorer mental health outcomes Poverty drives gender inequalities, primarily in the form of controlling behaviours Reinforces need for comprehensive gender transformative and economic strengthening interventions

Acknowledgements: Project Empower staff – facilitators and administrative team HEARD – fieldworkers Participants