Inter-ministerial National Structural Interventions Trial
In Botswana around 23.4% of adults aged 15-49 are living with HIV, the second highest HIV prevalence among adults worldwide after Swaziland. Despite current prevention efforts, the annual incidence of HIV among the adult population aged 15-49 years remains at around 1.5%: some 15,000 new infections every year. Young women in Botswana have much higher HIV rates than any other group. Those who suffer intimate partner violence, have high or lower incomes than their partners, have less education, and who are very poor have five times the HIV risk of young women who have none of these four factors.
Although structural factors are recognised as increasing the risk of HIV, there are few controlled trials of structural interventions that measure the impact on HIV infection. The Inter-ministerial National Structural Intervention Trial (INSTRUCT) is an HIV prevention initiative in Botswana that tests the impact of a combined package of structural and behavioural interventions focused on young women and the choice disabled. The nationwide study, led by CIET and Botswana’s National AIDS Coordinating Agency (NACA), is a cluster randomised controlled trial (trial registered as ISRCTN54878784) measuring the impact of interventions on HIV infection among young women. The INSTRUCT interventions are based on CIET’s recent Choice Disability trial in Botswana, Namibia and Swaziland, with the addition of a re-gearing of government structural support programmes towards those most vulnerable for HIV.
Fieldwork in the pilot district
In mid 2014, trained young women fieldworkers visited all households (as far as possible) to identify young women aged 15-29 years, to collect information about their experience of the structural support programs, and to share user-friendly information about the programs with them. They gathered data using handheld android tablets, using open-source software to collect and relay data directly to a central server. The survey confirmed that awareness of the government programs was patchy, few young women had applied, and very few had been able to benefit from the programs.
Work in the pilot district includes training teachers and community facilitators to use the audio-drama Beyond Victims and Villains (BVV) to stimulate discussion about gender violence and HIV risk and seek for local solutions. As well as school students, BVV groups include all segments of the community: young women and young men, older women and older men. The INSTRUCT team is working with government programs to look for ways to make programs more accessible to young women. Community workshops for young women aim to increase self-esteem and improve communication skills, as well as providing an opportunity to meet local program officers and receive help to apply for relevant support programs.
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