Maman awarded NIMH grant to expand HIV and partner violence prevention efforts in Tanzania

Dr. Suzanne Maman

The five-year study, led by Suzanne Maman, PhD, associate professor of health behavior, will offer small loans and leadership training to young men in Dar es Salaam, the largest city in Tanzania. Maman said the effort could be an effective strategy to reduce HIV risks and partner violence among young men who socialize in camps, which are organized networks of primarily young men who meet daily throughout the city.

In earlier research, Maman and her team found that young, HIV-infected women had a tenfold greater risk of experiencing violence from an intimate partner than did young uninfected women. The team members quickly decided that they could address women’s risks most effectively by working with the men.

“Many of the men we talked with said they would like access to skills training and a regular source of income,” said Maman, who has been involved in research related to HIV and gender-based violence in Tanzania since 1999. “That sparked the idea to pilot a microfinance and health project.”

Formative research that led to the current award was conducted with funds from an NIMH intervention development grant and a small grant from the UNC Injury Prevention and Research Center. The pilot study was conducted with funds from a Gillings Innovation Lab grant.

Microfinance has proven effective in efforts to achieve health benefits in communities such as Dar es Salaam, although most microfinance initiatives have focused upon women. Maman will work with partners in the U.S. and Tanzania, including Muhimbili University of Allied Sciences in Dar es Salaam, to assess the efficacy of this combined approach in reducing HIV risk and partner violence.

Maman’s team of scientists trained in public health and medicine will begin this intervention trial in late 2012 with all men 15 and older from 54 camps throughout Dar es Salaam, an expected enrollment of about 2,800. Half of the camps in the trial will be randomized to receive a combined microfinance and leadership training intervention. The microfinance intervention will consist of training, including guidance in developing a business plan, as well as the distribution of small loans, expected to be repaid within six months, for creating and supporting small businesses such as sale of secondhand clothing, video rentals, bicycle repair and fish frying.

The intervention will be coupled with leadership training designed to develop skill and confidence in delivering HIV and partner violence prevention messages to peers through enhanced communication, negotiation and goal setting. To assess the efficacy of the intervention, all men in the camps will complete a behavioral survey and clinical assessment for sexually transmitted infections at baseline and post-intervention.

Of the 670 men interviewed in the camps during the formative research for this trial, 47 percent reported two or more sex partners in the past year, and 47 percent of those had one or more concurrent sexual partnerships. Of those, 21 percent reported at least one symptom of a sexually transmitted disease in the preceding four weeks, and 41 percent reported perpetrating physical or sexual violence against a female partner.

“Microfinance addresses the skills and resource issue, and the health promotion piece addresses the serious health risks that the men and women face related to HIV and other sexually transmitted infections,” Maman said.