Population-level effects of a community-based program on intimate partner violence: A stepped-wedge trial in South African informal settlements

Intimate partner violence (IPV) remains a widespread challenge in informal settlements, where poverty and unemployment are prevalent. The evidence for strategies to reduce IPV at the population level in such settings is limited. A stepped-wedge cluster randomised trial was conducted in 18 informal settlements in KwaZulu-Natal, South Africa, to evaluate the Asibonisane Community Responses (CR) program. The program included a ten-session Stepping Stones curriculum and community-wide HIV and IPV education. Four survey rounds were implemented with population-based samples of men aged 18–35 and women aged 18–24. The analytic sample comprised 549 women and 438 men in primary partnerships interviewed at least twice. At baseline, 22.8% of women reported physical IPV, 11.4% sexual IPV, and 21.3% emotional IPV; among men, 15.9% reported physical perpetration, 3.8% sexual, and 9.2% emotional. Intention-to-treat analysis showed significant reductions among women in emotional (aOR = 0.42, p <.001), physical (aOR = 0.70, p <.05), and sexual IPV (aOR = 0.27, p <.001), with similar reductions in the number and frequency of violent acts. Men reported decreases in emotional and physical IPV perpetration, though not sexual IPV. The findings demonstrate that multi-session community programming can reduce IPV in high-prevalence contexts, and that detailed tracking of multiple IPV forms helps capture meaningful progress toward population-level violence reduction.