PRB

(September 2007) Cheza Chezeka is unfaithful to his partner, engages in unsafe sex, and acquires a sexually transmitted infection. Fikirini, on the other hand, learns how to communicate and resist sexual temptation and peer pressure. Tino Mashakani abuses his girlfriend and brags about his violent behavior to his friends until one of them steps forward with advice on how to stop the violence.

Each of these dramatic characters was developed by the Tuelimishane project in Dar es Salaam, Tanzania. Tuelimishane used community-based theater and peer education to heighten awareness of HIV and gender-based violence and change behaviors.¹

Attitudes condoning gender-based violence are widespread in Dar es Salaam. According to one survey, nearly 48 percent of men ages 16 to 24 thought that a wife should tolerate being beaten to keep the family together. Women also condoned the use of violence in certain situations, with one in three agreeing that violence is justified if a woman disobeys her partner.²

The Link Between Risky HIV Behavior and Violence

Approximately 41 percent of women in Dar es Salaam have ever experienced physical or sexual violence, or both, according to a World Health Organization study.³ There is a clear association between men’s HIV risk behaviors and their reported use of violence. Men who reported more than one sexual partner were three to five times more likely to report violence in their relationships than men who reported one sexual partner.

The goals of the Tanzanian community theater and peer education project, begun in 2004, were to reduce HIV risk behaviors among young men and to reduce the rate of partner violence, “in order to create an environment that will enable women to negotiate safe sexual behaviors.” To meet these objectives, drama groups held 21 performances of three different plays, and reached nearly 7,000 community members. The skits were held at places young men frequented, such as market places, bus depots, soccer matches, and bars. The themes of the plays included sexual communication, infidelity, and conflict resolution. To reinforce the messages of each performance, members of the drama group distributed easy-to-read print material and conducted peer-support groups that gave men a safe environment to discuss these behaviors.

Preliminary results for this project show that in the intervention group approximately 12 percent more men reported using a condom in their last sexual encounter. There were no significant differences, however, in their sexual activity, number of sexual partners, or consumption of alcohol prior to sex. Violent behavior within their relationships was also reported at the same rate.

Fewer Say Violence Against Women is Justified

The researchers, Jessie Mbwambo, a psychiatrist at Muhimbili National Hospital in Tanzania; Suzanne Maman, an assistant professor of health education and health behavior at the University of North Carolina at Chapel Hill and adjunct assistant professor at Johns Hopkins Bloomberg School of Public Health; and Frowin Nyoni, a theater professor at the University of Dar es Salaam, did find evidence that male attitudes related to gender-based violence improved. The study points out that “men in the intervention community were significantly less likely to report that violence against women is justified under various scenarios, including if she did not complete her household work, if she disobeyed her partner, if he suspects she is unfaithful, if he learns she is unfaithful, and if she asks him to use a condom.”

The study also offers insights into the process of using community theater to discuss gender-based violence and HIV. The researchers suggest some best practices to successfully engage community members.

• Local youth input is critical to effectively design the intervention messages and to tailor solutions for combating HIV in individual communities.
• It is important to use local forms of expression, such as dance and music to encourage participation.
• The use of community role models, such as musicians, basketball players, and students, in the drama appeared to engage the audience.

Continuing Challenges

The peer-support component of the study proved more challenging. The researchers found that many of the men could not commit to the 12-month intervention. The urban community of Dar es Salaam was highly mobile, and because of job opportunities and family responsibilities, men often dropped out of the peer support groups. Researchers were only able to follow up with 63 percent of men who participated in the intervention community. To increase participation, the authors suggest:

• Target men at social venues instead of their place of residence.
• Be aware that sustained contact with participants in an urban setting is challenging.
• Articulate the incentives for participation throughout the year-long process.

Sara Maki is an intern at the Population Reference Bureau.

References

1. Jessie Mbwambo, Suzanne Maman, and Frowin Nyoni, “HIV and Violence Prevention Final Report,” Horizons Report (Washington, DC: Population Council, forthcoming). The project was partially funded by The Interagency Gender Working Group (IGWG), a network of nongovernmental organizations funded by USAID to promote sustainable development and improve reproductive health and HIV/AIDS outcomes worldwide.
2. Mbwambo, Maman, and Nyoni, “HIV and Violence Prevention Final Report.”
3. World Health Organization (WHO), WHO Multi-Country Study on Women’s Health and Domestic Violence Against Women (Geneva: WHO, 2005): 29.