Boundary work: understanding enactments of ‘community’ in an area-based,empowerment initiative

Engaging the community in initiatives to improve health and inequalities is a prominent feature of contemporary public health approaches. Yet, how ‘community’ might be differently interpreted and experienced through mechanisms of engagement is little understood, with potential implications for how the pathways of effect of such initiatives, and their impacts on health inequalities, might be evaluated. This study sought to explore how community was enacted through the delivery of an area-based, empowerment initiative underway in disadvantaged areas of England. An ethnographic approach was used to identify enactments of community arising around the core activities and decision-making processes of the resident-led initiative in two sites. Enactments comprised ‘boundary work’: the ongoing assertion and negotiation of boundaries around who or what was, and was not, eligible to contribute to decision-making, and / or benefit from the initiative. Boundary work arose around practices of connecting with and consulting residents, protecting locally defined interests and autonomy, negotiating different sets of interests, and navigating representation. The multiple, shifting enactments of community and its boundaries highlight implications for understanding processes of inclusion and exclusion inherent to community engagement, and for interpreting pathways between collective empowerment and improved health. The study also raises questions for evaluating similar complex, community initiatives, where community cannot be taken as a fixed analytical unit, but something continually in process through the interplay between the initiative and the wider context. This must inform interpretations of how, and for whom, community engagement might – or might not – improve health.     

‘Where sex ends and emotions begin’: love and HIV risk among female sex workers and their intimate,non-commercial partners along the Mexico-US border

This study explores the affective dimensions of female sex workers' relationships with their intimate, non-commercial partners and assesses how emotions shape each partner's sexual and drug-related risk within their relationship. We draw on qualitative data from a study of HIV, sexually transmitted infections and high-risk behaviours among female sex workers and their non-commercial partners in Tijuana and Ciudad Juárez, Mexico, to illustrate that these couples share relationships based on love, trust, respect and emotional and material support. These relationships range in emotional intensity, which shapes partners' decisions not to use condoms with each other. Drugs were important in most couples' relationships. Among injectors, syringe sharing was common and represented both a sign of care and a pragmatic reaction to conditions of material scarcity. Our findings suggest that couple-based HIV interventions to address dual sexual and drug-related risks should be tailored to the emotional dynamics of sex workers' intimate relationships.     

‘Yarn about it’: Aboriginal Australian women’s perceptions of the impact of routine enquiry for intimate partner violence

Aboriginal women globally are disproportionately affected by intimate partner violence (IPV) and face additional barriers to help-seeking. It is crucial that interventions for IPV are made safe for Indigenous women, given inflated rates of statutory intervention and widespread institutional racism. As part of a larger study of antenatal IPV screening, we interviewed 12 Aboriginal Australian women about the perceived impact of an antenatal IPV routine enquiry intervention. Seven women reported positive impact, and five women reported the absence of positive impact. Qualitative comparative analysis was used to map pathways to perceived impact. Cultural safety – the practice of countering tendencies in health care that undermine safety – was a key condition for positive impact. Others included: (i) continuity of care; (ii) asking about abuse without judgement and with care; and (iii) support and validation. Absence of these factors also typified pathways for nil positive impact. Naming the abuse, a sense of connection, unburdening, taking steps to safety and enabling informed care were all reported benefits. Two women reported explicitly negative impacts: one noted a sense of intrusion, and the other, disengagement from the health service. Interventions for IPV have the potential to benefit Indigenous women where cultural safety is prioritised.     

‘Sex’ – it’s not only women’s work: a case for refocusing on the functional role that sex plays in work for both women and men

Mention of the term sex work often invokes images of marginalized women at risk for HIV infection. Such images, however, are counterintuitive to the functional role intended by the movement that spawned use of the terms ‘sex work’ and ‘sex worker.’ This article looks at the sexual practices of men in urban China to argue for a return to a functional definition of ‘sex work’, which was originally meant to legitimize the role sex plays in work. The progenitors of this movement intended to use ‘sex work’ as a means to legitimize sex as an income-generating activity for women involved in prostitution. I show that sex can also serve a functional role in the work-related duties of men seeking economic and political success in contemporary urban China. Men in China utilize sex as one way for demonstrating the loyalty necessary to access state-owned and controlled resources in a market economy governed under a Leninist system. Overall, the article demonstrates that reclaiming perception of sex work as a functional rather than behavioral category can expand its use for preventing HIV among the broad subset of people who engage in sex as part of their work.     

‘As prostitutes,we control our bodies’: perceptions of health and body in the lives of establishment-based female sex workers in Tijuana,Mexico

Many studies of female sex work focus on HIV and other sexually transmitted infections because sex workers are considered bridges between high-risk and low-risk populations. The voices of female sex workers as they pertain to health issues are often lacking in the literature. This paper offers a feminist constructivist grounded theory study with establishment-based female sex workers in Tijuana, Mexico. Analyses of interviews with 20 women reveal that they are aware of the impact of their work on their bodies, but conceptualise their health holistically and not just in terms of HIV. They emphasise that working in the sex industry has implications for sexual health, non-sexual physical health and mental health. The paper concludes that in order for public health interventions to have more sustainable impact on the lives of female sex workers, they should take into account the voices of the women, including how they define their health. The findings suggest that public health professionals need to be more aware that female sex workers have agency and a desire to control their health and their bodies.     

‘In different situations,in different ways’: male sex work in St. Petersburg,Russia

We conducted a qualitative study of male sex work in St. Petersburg Russia with a focus on social vulnerabilities, HIV-risk perception and HIV-related behaviours. In-depth interviews were conducted with individuals knowledgeable about male sex work through their profession and with male sex workers themselves. Male sex work involves a variety of exchanges, including expensive vacations, negotiated monetary amounts or simply access to food. Methods of finding clients included the Internet, social venues (e.g. gay clubs and bars) and public places (e.g. parks). Use of the Internet greatly facilitated male sex work in a variety of ways. It was used by both individuals and agencies to find clients, and appeared to be increasing. Men often reported not being professionally connected to other male sex workers and limited disclosure about their work. Many were aware of the work-related risks to personal safety, including violence and robbery by clients. Perceived risk for HIV was mostly abstract and several exceptions to condom use with clients were noted. Alcohol use was reported as moderate but alcohol was consumed frequently in association with work. These data suggest that the most salient risks for male sex workers include professional isolation, threats to personal safety, limited perceived HIV risk and sub-optimal levels of condom use.     

‘Struggling to be the alpha’: sources of tension and intimate partner violence in same-sex relationships between men

In countries such as the USA, gay and bisexual men experience high rates of intimate partner violence. However, little is known about the factors that contribute to this form of violence. In this study, we examine gay and bisexual men’s perceptions of sources of tension in same-sex male relationships and how these may contribute to intimate partner violence. We conducted seven focus-group discussions with 64 gay and bisexual men in Atlanta, GA. Focus groups examined men’s reactions to the short-form revised Conflicts Tactics Scale to determine if each item was considered to be intimate partner violence if it were to occur among gay and bisexual men. Analysts completed a thematic analysis, using elements of grounded theory. The sources of tension that men identified included: gender role conflict, dyadic inequalities (e.g. differences in income, age, education), differences in ‘outness’ about sexual identity, substance use, jealousy and external homophobic violence. Results suggest that intimate partner violence interventions for gay and bisexual men should address behavioural factors, while also focusing on structural interventions. Interventions that aim to reduce homophobic stigma and redefine male gender roles may help to address some of the tension that contributes to intimate partner violence in same-sex male relationships.     

Migrants in Transit: The Importance of Monitoring HIV Risk Among Migrant Flows at the Mexico–US Border

We conducted a probability-based survey of migrant flows traveling across the Mexico–US border, and we estimated HIV infection rates, risk behaviors, and contextual factors for migrants representing 5 distinct migration phases. Our results suggest that the influence of migration is not uniform across genders or risk factors. By considering the predeparture, transit, and interception phases of the migration process, our findings complement previous studies on HIV among Mexican migrants conducted at the destination and return phases. Monitoring HIV risk among this vulnerable transnational population is critical for better understanding patterns of risk at different points of the migration process and for informing the development of protection policies and programs.Previous research indicates that Mexican labor migrants in the United States are at increased risk for HIV infection1–3 and may be a bridge population for increasing rates of HIV/AIDS in rural Mexico.4–6 The behavioral ecological model posits that health behaviors are influenced by a hierarchy of factors, including individual characteristics, features of the proximal context, and broader structural factors.7 The proximal context involves the physical and social conditions in which individuals live, work, learn, and play. The broader environment comprises political, social, and economic structures and cultural factors. Bidirectional influences exist across factors at the individual, contextual, and structural level, with interventions at the structural level having the most far-reaching public health impact.7 Mexican migrants tend to be male and young, have low levels of educational attainment, and report limited HIV prevention knowledge and condom use.8,9 Increased risk for HIV in migrants may result from the interplay between these individual characteristics and the broader contextual and structural factors in migration between Mexico and the United States.10Migration is a complex and multistage process involving 5 phases: predeparture, transit, destination, interception, and return.11 Different constellations of contextual and structural factors may influence risk behaviors for HIV infection among migrants at each of these stages. Research on HIV risk among migrants must cover the different phases involved in the migration process and identify risks as well as prevention and treatment opportunities associated with each of them.12 Much of our knowledge regarding HIV prevalence and behavioral risk factors among Mexican migrants has emanated from surveys conducted among receiving communities in the United States 1^,2^,13–15 and sending communities in Mexico.16^,17 These studies have covered the destination and return phases of migration.Mexican migrants in the United States (i.e., the destination) are exposed to contexts that may heighten their HIV risk. HIV prevalence rates are higher in the United States than in Mexico,18 increasing the probability of coming into contact with the virus. Furthermore, many migrants live in environments characterized by unbalanced gender composition (i.e., male overrepresentation) and limited family- and community-based social behavioral controls.19 They experience loneliness, geographic isolation, social exclusion,20 fear,21 poor living and working conditions, and limited access to health care, including access to HIV testing and other prevention services.2^,16^,19^,21–24 All these factors coalesce to increase the probability of risk behaviors for HIV, such as alcohol and drug use, sex with sex workers, and unprotected sex practices.9,10 Surveys in Mexican sending communities have documented higher rates of behavioral risk factors, such as a higher number of sexual partners and illicit drug use, but also increased rates of condom use, knowledge of HIV transmission, and HIV testing among return migrants, compared to nonmigrants in the same communities.16,25Little research has examined HIV risk among Mexican migrants during the predeparture, transit, and interception phases of the migration process. The same factors that may push migrants away from their sending communities, such as poverty,26 violence,27 and gender power unbalances,28,29 are also structural factors that may increase their HIV risk even before they leave these communities.30 The transit phase is defined as the period when migrants are between their place of origin and their destination.11 For most Mexican migrants, the northern border of Mexico is an intermediate point in their trajectory between the 2 countries. Northbound unauthorized and deported migrants may spend time in this transit location making arrangements to enter or reenter the United States. This region has been described as at heightened risk for infectious diseases such as HIV to occur and is characterized by “an economically disadvantaged population” and “a nexus for drug use, prostitution, and mobility.”^31(p428)Research with injecting drug users and sex workers in Mexican border cities has provided critical evidence of migration as a structural risk factor for HIV infection and substance use as well as the prevention needs of these high-risk groups.14,32 These studies have offered some insights into the potential risks among migrants in this intermediate migration context. Finally, migrants apprehended while trying to enter or after reaching the destination communities (i.e., interception phase) are at a particularly critical stage. Detention in immigration centers or prisons can have detrimental effects on migrants’ health.11 Interception may also be a marker of higher social vulnerability, as migrants who have less economic and social resources are more likely to experience this migration phase. A recent survey found higher rates of HIV infection and behavioral risk factors among deported Mexican migrants in Tijuana, Mexico, than among the US and Mexico populations.33 In general, knowledge concerning HIV risk among migrants at the 5 migration phases is fragmented, and the heterogeneity of sampling and data collection methodologies that previous studies have used creates challenges for comparing data on the different phases.There are an estimated 12 million Mexican migrants in the United States.34 Although not all migrants go through all 5 migration phases (some may never be intercepted, some may settle permanently in the region of destination and never return), many Mexican migrants go through 2 or more of these phases in their lifetime. Data on Mexican migration patterns indicate that circular migration (i.e., traveling back and forth between Mexico and the United States) is relatively common among Mexican migrants.34,35 About 29% of Mexican migrants are estimated to engage in circular migration,36 and 50% of undocumented migrants leave the United States within the first year of immigration.37 Proximity, social and political conditions, transportation costs, and cultural identity make Mexicans more likely to return to their home country than are migrants from other countries. Although the strengthening and stricter enforcement of border policies has lowered this trend in recent years, the incentives to emigrate out of Mexico have also increased.38 These circular migration patterns between Mexico and the United States result in sizable migrant flows traveling across the Mexican border.It is estimated that each year more than 600 000 Mexican migrants arrive in the United States, approximately 400 000 Mexican migrants return from the United States, and approximately 400 000 Mexican migrants are deported to Mexico.39,40 The same individual may arrive, return, or be deported more than once. In 2012, the net rate of Mexicans departing Mexico (mostly to the United States) and entering Mexico (most of whom are return migrants) was 41.9 and 14.3 per 1000, respectively.41 An estimated 300 000 Mexican migrants were admitted to a detention facility and repatriated by US immigration authorities,42 and an additional 266 000 unauthorized Mexican migrants were apprehended at the Mexican border.40 The volume and mix of migrants traveling across the Mexico–US border makes this region an important setting for binational monitoring of the mobile populations’ health. Such monitoring can further our understanding of HIV infection levels and of behavioral and environmental factors that contribute to HIV infection among Mexican migrants representing different phases and contexts of the migration process. Ongoing surveillance of this region can also reveal changes in HIV infection and behavioral risk factors among migrants on the move and inform the need for interventions to reduce HIV risk among Mexican migrants in sending, receiving, and intermediate communities.We estimated and compared the levels of HIV infection, risk behaviors, and contextual factors associated with different migration phases, using data from a survey of migrant flows who traveled across the Mexico–US border region and represented the different phases and geographic contexts of migration between Mexico and the United States.     

‘It’s more funner than doing work’: children’s perspectives on using tablet computers in the early years of school

There is a clamour of voices around the contemporary issue of tablet computers in early years education. A growing body of research presents the potential of tablet computers to transform education, provide unprecedented learning opportunities and positive outcomes for young children and offer rich opportunities for independent learning and collaborative interaction. However, this is tempered with disquiet from a number of sources which posit that digital devices are diminishing children’s play and are an affront to childhood. Many of these polemic debates come from adult perspectives yet children are the key users in the dizzying advancement of technology and their views are a crucial element in understanding the conceptualisation of tablet devices as pedagogical tools. This paper takes a children’s rights approach in acknowledging that children have the right to have their voices heard and their experiences understood. Therefore, this paper seeks to add further insights to the debates on digital technology in early years education by presenting the views of one of the central players within this debate – young children.     

How important are venue-based HIV risks among male clients of female sex workers? A mixed methods analysis of the risk environment in nightlife venues in Tijuana, Mexico

In 2008, 400 males ≥18 years old who paid or traded for sex with a female sex worker (FSW) in Tijuana, Mexico, in the past 4 months completed surveys and HIV/STI testing; 30 also completed qualitative interviews. To analyze environmental sources of HIV vulnerability among male clients of FSWs in Tijuana, we used mixed methods to investigate correlates of clients who met FSWs in nightlife venues and clients' perspectives on venue-based HIV risk. Logistic regression identified micro-level correlates of meeting FSWs in nightlife venues, which were triangulated with clients' narratives regarding macro-level influences. In a multivariate model, offering increased pay for unprotected sex and binge drinking were micro-level factors that were independently associated with meeting FSWs in nightlife venues versus other places. In qualitative interviews, clients characterized nightlife venues as high risk due to the following macro-level features: social norms dictating heavy alcohol consumption; economic exploitation by establishment owners; and poor enforcement of sex work regulations in nightlife venues. Structural interventions in nightlife venues are needed to address venue-based risks.     

‘Women at risk’: the health and social vulnerabilities of the regular female partners of men who inject drugs in Delhi,India

Needle and syringe sharing is common among people who inject drugs and so is unprotected sex, which consequently puts their sex partners at risk of sexually transmitted infections (STIs) including HIV and other blood-borne infections, like hepatitis. We undertook a nested study with the regular female partners of men who inject drugs participating in a longitudinal HIV incidence study in Delhi, India. In-depth interviews were conducted with female partners of 32 men. The interviews aimed to gather focused and contextual knowledge of determinants of safe sex and reproductive health needs of these women. Information obtained through interviews was triangulated and linked to the baseline behavioural data of their partner (index men who injected drugs). The study findings illustrate that women in monogamous relationships have a low perception of STI- and HIV-related risk. Additionally, lack of awareness about hepatitis B and C is a cause of concern. Findings also suggest impact of male drug use on the fertility of the female partner. It is critical to empower regular female partners to build their self-risk assessment skills and self-efficacy to negotiate condom use. Future work must explore the role of drug abuse among men who inject drugs in predicting fertility and reproductive morbidity among their female partners.     

‘There was a struggle between my instinct and my head’: women’s perception and experience of masturbation in contemporary Vietnam

This paper investigates how masturbation, as one form of non-coital sexual practice, is interpreted and experienced by young married women in contemporary Vietnam. Data were collected through semi-structured interviews with 20 professional women aged 25–40 living in Hanoi. Thematic analysis suggests that by embracing the pursuit of pleasure and aspiring to achieve this goal, many women stake a claim for modernity by promoting the idea that they are no longer traditional in this particular domain of social life. However, wider social forces associated with traditional Vietnamese gender ideology and sexual values remain firmly rooted, impacting on their everyday lives as working wives and mothers, and stalling their pursuit of pleasure and thus ‘wellbeing’ in its fullest sense. Indeed, among participants in this study, sex was interpreted as being almost exclusively organised around penile-vaginal intercourse. Even when sex was conceptualised as involving more than penetration, penile-vaginal intercourse was still viewed as its most essential component, without which a sexual transaction could not be seen as complete. The normality of penetrative sex was sometimes coupled with the stigma and discrimination associated with other non-coital sexual practices, positioning women firmly within conventional discourses of naturalness and health in regard to sex.     

Changes in the prevalence of mood and anxiety disorders among male and female current smokers in the United States: 1990–2001

PurposeThe present study investigated whether the prevalence of mood and anxiety disorders has increased over time among current smokers and whether these trends differ by gender and in comparison with nonsmokers.MethodsData were drawn from the National Comorbidity Survey (1990) and the National Comorbidity Survey-Replication (2001), representative samples of the US adult population. Binomial regression analyses were used to determine differences between mood and anxiety disorders among current smokers in 1990 and 2001 and whether these differed by gender and in comparison with those who were former or never current smokers.ResultsAny anxiety disorder, panic attacks, panic disorder, social anxiety disorder and dysthymia were all significantly more common among current smokers in 2001 compared with 1990 and except for social anxiety disorder these increases were significantly greater than any trend found in non-smokers. Increases in panic attacks, social anxiety disorder, and dysthymia were more pronounced in female than in male smokers. Major depressive disorder and generalized anxiety disorder were not found to increase over time among smokers.ConclusionsThe prevalence of several anxiety disorders and dysthymia among current smokers appears to have increased from 1990 to 2001. Future studies are needed to determine whether these trends have continued. If so, interventions aimed at moving the prevalence lower may have limited success if treatment of mental health problems such as anxiety disorders and certain mood disorders are not considered in the development and dissemination of tobacco control programs.     

Prevalence of human papillomavirus in teenage heterosexual males following the implementation of female and male school-based vaccination in Australia: 2014–2017

BackgroundAustralia introduced a school-based human papillomavirus (HPV) vaccination program for females aged 12–13 years in 2007, with a three-year catch-up to age 26; and for boys aged 12–13 from 2013, with a two-year catch-up to age 15. This study aimed to compare the prevalence of penile HPV between teenage heterosexual males in cohorts eligible or non-eligible for the school-based male vaccination program.MethodsBetween 2014 and 2017, sexually active heterosexual males aged 17–19 were recruited from sexual health centres and community sources across Australia. Males provided a self-collected penile swab for 37 HPV genotypes using Roche Linear Array and completed a questionnaire. We calculated adjusted prevalence ratios (aPR) of HPV between males in two periods: 2014–2015 (preceding implementation of school-based male vaccination) and 2016–2017 (eligible for school-based male vaccination). Self-reported vaccine doses were confirmed with doses reported to the National HPV Vaccination Program Register.ResultsOverall, 152 males were recruited in 2014–2015 and 146 in 2016–2017. Numbers of female sex partners and condom use did not differ between the two periods. The prevalence of quadrivalent vaccine-preventable [4vHPV] genotypes (6/11/16/18) was low in both periods (2.6% [2014–15] versus 0.7% [2016–17]; p = 0.371; aPR 0.28 [95% CI: 0.03–2.62]). Compared with men in 2014–2015, men in 2016–2017 had a lower prevalence of any of the 37 HPV genotypes tested (21.7% versus 11.6%; aPR 0.62 [95% CI: 0.36–1.07]) and any of the 13 high-risk genotypes tested (15.8% versus 7.5%; aPR 0.59 [95% CI: 0.30–1.19]). Prevalence of low-risk HPV genotypes did not differ between the two periods. Of the males recruited in 2016–2017, 55% had received ≥1 vaccine dose.ConclusionThe prevalence of 4vHPV genotypes among teenage heterosexual males in both cohorts was low, presumably due to herd protection from the female-only vaccination program. Further studies are required to determine the impact of universal HPV vaccination on HPV prevalence in males.     

‘Medicine doesn’t cure my worries’: Understanding the drivers of mental distress in older Nepalese women living in the UK

The mental health of migrant communities is an important public health concern. A growing body of literature suggests that social and cultural determinants of health significantly contribute to the mental health and wellbeing of older migrants in their host countries. Despite the increasing population of older Nepalese migrants in the UK, there is little research exploring the mental health needs of this community. This article explores older Nepalese women’s experiences of drivers of mental distress in London. Data was collected using in-depth interviews with 20 older Nepalese women living in the London Borough of Greenwich. Grounded thematic analysis of women’s narratives identified six overarching factors contributing to their emotional distress that pose potential risks to their mental health: absence of family, language barriers, housing problems, physical illness, lack of appropriate support, fears of death, and inadequate financial resources. In many cases, the impact of these factors was experienced in combination rather than isolation, often influenced by cultural dynamics. Findings highlight that re-settlement in the absence of family is at the heart of emotional challenges for older Nepalese women. The paper concludes with a series of recommendations for supporting processes of settlement to mitigate this risk among older Nepalese women in the UK.     

‘There is fear but there is no other work’: a preliminary qualitative exploration of the experience of sex workers in eastern Democratic Republic of Congo

Two decades of conflict and insecurity have had a devastating impact on many in the Democratic Republic of Congo (DRC), including marginalised groups such as sex workers. In the province of North Kivu, many residents face desperate conditions that render them vulnerable to exploitation and abuse. As a result, many turn to the sex trade in what can often be described as ‘survival sex’. This small-scale qualitative study explores the experience of urban sex workers in the eastern region of the DRC. Sex workers were recruited at their place of business and asked to participate in a semi-structured interview. Eight participants were recruited, including seven women and one man. Our analysis identified several themes: (1) economic hardship as a catalyst for joining the sex trade, (2) significant work-related violence and (3) a paucity of available resources or assistance. Responses to specific prompts indicated that sex workers do not trust law enforcement and there are significant barriers to both medical care and local resources. Further studies of this vulnerable population and its needs are encouraged in order to develop programmes that provide the means to manage the hazards of their work and obtain an alternative source of income.     

Unpacking the ‘structural’ in a structural approach for HIV prevention among female sex workers: A case study from China

Interventions for HIV prevention among female sex workers (FSWs) in China focus on HIV/sexually transmitted infection (STI) and individual behaviour change. An occupational health framework facilitates intervention across an array of health issues FSWs face including HIV/STI, violence, reproductive health, stigma and substance use. Through a case study of a community-based Jiaozhou (JZ) FSW programme, we developed a conceptual framework incorporating global discussions of structural approaches to HIV prevention with the specific social and structural contexts identified among FSWs in China. Based on ethnographic fieldwork between August 2010 and May 2013, we describe the evolution of this programme to its current occupational health focus and unpack the intervention strategies. We describe the critical features of the programme that have fostered success among FSWs including high-quality clinical services provided within a welcoming setting, responsive outreach work through staff and trained FSW peers, interpersonal and community-level engagement aimed at changing the local social and structural environments of sex work and tailored health education materials. This intervention differs from other projects in China by adopting a more holistic approach to FSW health that incorporates social issues. It also demonstrates the feasibility of structural interventions among FSWs even within an environment that has strong anti-prostitution policies.     

Women’s perceptions of effects of war on intimate partner violence and gender roles in two post-conflict West African Countries: consequences and unexpected opportunities

Background

The aim of this paper is to explore women’s perceptions of the causes of intimate partner violence (IPV) in West Africa, and the ways in which they understand these causes to interact with the experiences of war.

Methods

The study was conducted in two locations in Sierra Leone and two in Liberia, using focus group discussions (N groups =14) and individual interviews (N?=?20).

Results

Women perceive the causes of IPV to be linked with other difficulties faced by women in these settings, including their financial dependence on men, traditional gender expectations and social changes that took place during and after the wars in those countries. According to respondents, the wars increased the use of violence by some men, as violence became for them a normal way of responding to frustrations and challenges. However, the war also resulted in women becoming economically active, which was said by some to have decreased IPV, as the pressure on men to provide for their families reduced. Economic independence, together with services provided by NGOs, also gave women the option of leaving a violent relationship.

Conclusions

IPV was found to be a significant problem for women in Sierra Leone and Liberia.The interactions between war experiences and financial and cultural issues are multi-faceted and not uniformly positive or negative.