Article Text

Download PDFPDF
Community collective efficacy is associated with reduced physical intimate partner violence (IPV) incidence in the rural province of Mpumalanga, South Africa: findings from HPTN 068
  1. Anna M Leddy1,
  2. Sheri A Lippman1,2,
  3. Torsten B Neilands1,
  4. Rhian Twine2,
  5. Jennifer Ahern3,
  6. Francesc Xavier Gómez-Olivé2,
  7. Stephanie M DeLong4,
  8. Catherine MacPhail2,5,6,
  9. Kathleen Kahn2,7,
  10. Audrey E Pettifor2,4
  1. 1 Department of Medicine, Division of Prevention Science, Center for AIDS Prevention Studies, University of California, San Francisco, California, USA
  2. 2 MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
  3. 3 Division of Epidemiology and Biostatistics, School of Public Health, University of California Berkeley, Berkeley, California, USA
  4. 4 Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
  5. 5 School of Health and Society, University of Wollongong, Wollongong, New South Wales, Australia
  6. 6 Wits Reproductive Health and HIV Research Institute, University of the Witwatersrand, Johannesburg, South Africa
  7. 7 Division of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå Centre for Global Health Research, Umeå University, Umeå, Sweden
  1. Correspondence to Dr Anna M Leddy, Department of Medicine, Division of Prevention Science, Center for AIDS Prevention Studies, University of California, San Francisco, San Francisco CA 94158, USA; anna.leddy{at}


Background Intimate partner violence (IPV) is a human rights violation and is associated with a variety of adverse physical and mental health outcomes. Collective efficacy, defined as mutual trust among community members and willingness to intervene on the behalf of the common good, has been associated with reduced neighbourhood violence. Limited research has explored whether community collective efficacy is associated with reduced incidence of IPV. This is of particular interest among adolescent girls and young women (AGYW) in sub-Saharan Africa, where the burden of HIV is greatest and IPV is common.

Methods We collected longitudinal data among 2533 AGYW (ages 13–20) enrolled in the HPTN 068 cohort in Mpumalanga province, South Africa between 2011 and 2016. We included participants from 26 villages where community surveys were collected during the HPTN 068 study. Collective efficacy was measured at the village level via two population-based cross-sectional surveys in 2012 and 2014. Multivariable Poisson generalised estimating equation regression models estimated the relative risk ratio (RR) between village collective efficacy scores and subsequent physical IPV 12 month incidence, adjusting for village-level clustering and covariates.

Results Thirty-eight per cent of the cohort (n=950) reported at least one episode of recent physical IPV during follow-up. For every SD higher level of collective efficacy, there was a 6% lower level of physical IPV incidence (adjusted RR: 0.94; 95% CI 0.89 to 0.98) among AGYW after adjusting for covariates.

Conclusions Community-level interventions that foster the development of collective efficacy may reduce IPV among AGYW.

  • intimate partner violence
  • collective efficacy
  • adolescent girls and young women
  • South Africa

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Contributors AEP and SAL: conceived of this study. AEP, KK, CM, FXG-O and RT: responsible for HPTN 068 design and implementation; SAL, AEP, CM, RT, FXG-O and KK: responsible for community mobilisation, study design and implementation; AML: responsible for data merging and management. AML: led the analysis with assistance from TBN, SAL, JA and SMD; wrote the paper with input from all the author. All authors contributed to the interpretation of the findings; read and approved the final manuscript.

  • Funding This research is supported by the United States National Institute of Mental Health (R01MH110186; Pettifor). Data collection for HPTN 068 was provided by the National Institute of Allergy and Infectious Diseases (NIAID), the National Institute of Mental Health (NIMH), and the National Institute on Drug Abuse (NIDA) of the National Institutes of Health (NIH; award numbers UM1AI068619 [HPTN Leadership and Operations Center], UM1AI068617 [HPTN Statistical and Data Management Center], and UM1AI068613 [HPTN Laboratory Center]. Community survey data was supported by NIMH (R01MH087118; Pettifor and R01MH103198; Lippman/Pettifor). The Agincourt HDSS and census data collection is supported by South African Medical Research Council and University of the Witwatersrand, as well as the Wellcome Trust, UK (grants 058893/Z/99/A; 069683/Z/02/Z; 085477/Z/08/Z; 085477/B/08/Z).

  • Disclaimer The funding institutions have not participated in the design or implementation of the study. The contents are solely the responsibility of the authors and do not necessarily represent the views of the NIH.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval University of North Carolina at Chapel Hill, the University of the Witwatersrand Human Research Ethics Committee, and University of California, San Francisco.

  • Provenance and peer review Not commissioned; externally peer reviewed.