Stepping Stones and Creating Futures Intervention Trial
Phase: PHASE3
Conditions: IPV, Sexual Violence
Sponsor: University of KwaZulu

 
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Stepping Stones and Creating Futures Intervention Trial 
 
Version 8: September 2016 
 
MRC Reference: EC006-2/2015 
BREC (UKZN) Reference: BFC043/15 
 
Principal Investigator:  
 
Andrew Gibbs 
Gender and Health Research Unit, SA MRC 
4th Floor, 491 Peter Mokaba, Overport, Durban, South Africa 
Office: +27 31 203 4899 
 
Health Economics and HIV/AIDS Research Division (HEARD), University of KwaZulu-
Natal 
4th Floor J-Block, Westville Campus, University Road, Durban, South Africa  
Mobile : 079 342 1918 
 
Co-investigators: 
 
Laura Washington 
Project Empower, Durban, South Africa. Office : 031 3103564 
 
 Rachel Jewkes, Samantha Willan, Nwabisa Jama Shai, Yandisa Sikweyiya, Esnat Chirwa 
Gender and Health Research Unit, SA MRC, Office : 0 12 339-8526  
 
Costing sub-study :  
Anna Vassall, Giulia Ferrari, 
London School of Hygiene and Tropical Medicine. Office : +44(0) 207 927 2612 
 
Michael Strauss 
HEARD, University of KwaZulu-Natal 
 
 
Key words: Gender-based violence, economic empowerment, gender transformative, 
randomised controlled trial, primary prevention, livelihood strengthening, 
 

 
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Executive summary  
Over 30% of women globally have experienced physical and or sexual intimate partner 
violence (IPV) in their lifetime [1]. IPV is in the top 20 of the global burden of disease, with 
women who experience IPV having increased rates of depression, suicidality and harmful 
alcohol use [1]. Studies show that South Africa has particularly high rates of IPV [2]. 
Reducing the perpetration and experience of IPV is a major health priority.  
 
AIM: to determine whether the combined Stepping Stones and Creating Futures interventions 
are effective in enabling women in informal settlements to reduce their exposure to intimate 
partner violence (IPV) and men in informal settlements to reduce their perpetration of IPV, 
including controlling behaviours.   
 
METHODS: 
Design: A randomised controlled trial with two arms 
i) 
Stepping Stones and Creating Futures 
ii) 
Control arm (Cash incentive for study participation and delayed intervention) 
 
Interventions: There are two interventions which will be delivered sequentially:  
i)  Stepping Stones which consists of 10 sessions of about 3 hours duration. This is a 
participatory intervention which is delivered in the main to single sex groups of about 20 
people. It seeks to strengthen relationships and to transform views on gender and in the 
process impact on exposure to, or participation in, gender-based violence and HIV risk.  
These cover gender and peer influences our actions; sex and love; conception and 
contraception; STIs and HIV; safer sex and condoms; GBV; motivations for behaviour 
(including influences of alcohol and poverty); and communication skills. 
 
ii) Creating Futures is a facilitated group intervention covering eleven, three-hour sessions in 
single-sex groups of approximately twenty people. The key sessions cover: my life and the 
resources I have used in my life and livelihood, setting medium term livelihood goals and the 
need for assets for livelihoods and coping with crises; social resources for livelihoods (trust 
and community participation); education and learning including past experiences and how to 
build on these; getting and keeping jobs including work expectations and how ones on own 
behaviours may impede or increase our ability to get a job and to keep it, appropriate work 
opportunities and increase owns own ability to market ones skills and apply for work and 
overcome challenges in job seeking and maintaining a job; income generating activities and 
how to identify viable business opportunities, the  resources necessary to respond to such 
opportunities, basic business principles and business risks;  saving and coping with shocks 
including spending patterns and strategies for saving, and causes and consequences of getting 
into debt and ways of overcoming debt. 
 
Setting: Informal settlements in and around EThekwini Municipality (Durban) 
 
Sample size: 1320 adults (40 per cluster – 20 male and 20 female) will be recruited in 34 
clusters for the study. In each cluster will be based in an informal settlement.   
 
Integrated qualitative research study: A multi-method qualitative evaluation of the 
intervention will take place, comprising of 40 repeat in-depth interviews (20 women, 20 

 
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men), participant observation in two clusters with the same interviewees and for women 
(n=10), PhotoVoice workshops.   
 
Integrated costing and process evaluation: An integrated costing and process evaluation will 
be conducted to understand: i) the cost effectiveness of the intervention ii) challenges of 
delivery through a review of financial records (retrospective and prospective) and shadowing 
and observation of facilitators (between 4 and 8 clusters) over the course of the delivery of 
the intervention.  
 
Instrument: standard questionnaires will be used. Data collection will use cell phones and 
will be self-administered. Data will be collected from the participants at baseline, 12m and 
24m post intervention.  
 
Qualitative instruments will be standard semi-structured questionnaires implemented by 
trained field researchers. Data will be collected from the same participants at baseline through 
two interviews, 6m, 12m and 18m post intervention.  
 
Observation guides will shape data collection for participant observation. 
 
PhotoVoice research will be guided by a PhotoVoice tool – this tool sets out series of four 
workshops spread out over 18months for women to participate in. The PhotoVoice tool sets 
out the workshop schedule, including participants being trained on the use of cameras and the 
ethics of photography before being asked to take photos to illustrate particular themes. The 
PhotoVoice tool, also sets out subsequent discussion of the photos will be shaped by 
participants and recorded for analysis.  
 
 
Fieldworkers will be trained in ethnographic techniques and approaches to data collection, 
including taking notes to observe the delivery of the intervention and time-motion data tools.  
 
Costing instruments have been developed to extract financial information on the costs of 
developing and delivering the intervention. These include standard semi-structured 
interviews, excel spreadsheets (for extraction of financial records). 
 
Content: social and demographic characteristics and circumstances, personal gender attitudes 
and social norms, sexual behaviour (partner numbers, condom use at last sex, partner type at 
last sex (main or casual) transactional sex), mental health (depression, suicidality), experience 
of gender based violence (victimisation and perpetration), pregnancy, livelihood 
strengthening activities, engagement with crime.    
 
Data analysis: The data will be analysed by intention to treat. IPV incidence will be 
compared between arms in the study.  The primary analysis will be carried out by fitting a 
Poisson regression model, which will include terms for age of participant, cluster, baseline 
prevalence of IPV (for males or females) and treatment (arm). Other quantitative variables 
will be analysed with change from baseline compared between arms using GLMMs.  
 
Qualitative: The data will be analysed using thematic network analysis. Coding will take 
place focused on the key questions to be answered in the study with separate analysis for 
women and men. 
 

 
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Integrated process evaluation: An integrated process evaluation will be conducted to explore 
how facilitators delivering the intervention to so. Ethnographic and qualitative methods will 
be used.  
 
Costing analysis: The costing data will be analysed using a provider and client perspective 
using incremental cost-effectiveness will be calculated using the primary outcome, with costs 
set at 2017 rates. 
 
Project management: The intervention is funded through the What Works to Prevent 
Violence Global Programme. Access to communities, recruitment of participants for the 
research and intervention delivery is the responsibility of Project Empower. The research is a 
project of HEARD at the University of KwaZulu Natal, with collaborators from the Medical 
Research Council.  The study will be conducted over 3 years with recruitment commencing 
soon after ethics approval.  The research will be conducted over 24 months and there will be 
6 months for data analysis and writing up the findings and dissemination, and 6 months for 
intervention scale up if the findings are positive.  
 
OUTCOME: This research will generate knowledge on the efficacy of an intervention to 
prevent IPV among an extremely vulnerable and disadvantaged sector of South African 
society. The study will extend knowledge globally of interventions to prevention of gender-
based violence.  
 
INTENDED FEEDBACK OF THE STUDY: The findings will be published in peer review 
journal articles, presented at international and local conferences and shared at a workshop 
with stakeholders interested in economic empowerment especially of vulnerable youth. If the 
study is successful we will endeavour to scale up the intervention over a year through other 
NGOs working in KwaZulu Natal with funding already allocated to achieve this. The What 
Works to Prevent Violence Global Programme is developing a dissemination strategy to give 
the highest possible profile to the findings of evaluation research funded through the 
programme and this study’s findings will be disseminated through these avenues.  

 
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Table of contents 
1.0 Introduction .......................................................................................................................... 7 
2.0 The objective ........................................................................................................................ 8 
3.0 Background ........................................................................................................................ 8 
3.1 Theoretical framing of the research ............................................................................. 8 
3.2. Behavioural and Structural Change ................................................................................ 9 
4.0 Rationale for the selection of interventions ....................................................................... 10 
4.1 Gender Transformative: ................................................................................................. 10 
4.2 Sustainable Livelihoods ................................................................................................. 10 
In accordance with the theoretical understanding that contexts of poverty and livelihood 
insecurity heighten the experiences and perpetration of IPV, strengthening livelihoods to 
reduce IPV is also critical. ................................................................................................... 10 
Often interventions to strengthen livelihoods have narrow conceptualisations of livelihoods 
[21]. The sustainable livelihoods framework ....................................................................... 11 
Creating Futures uses the broad conceptualisation of livelihoods to support young people 
to think through the multiple forms of capital they could draw on to construct or sustain a 
stronger livelihood [46]........................................................................................................ 11 
4.3 Combining Interventions: Reviews of interventions and cross-sectional analyses clearly 
highlight the importance of combining gender transformative and livelihood strengthening 
interventions to improve IPV and HIV-risk behaviour outcomes [47]. Most clearly in a 
cross-sectional study comparing a control arm, a microfinance arm and a microfinance plus 
gender empowerment arm to each other, the impact on IPV amongst women was only seen 
in the combined microfinance plus gender empowerment arm [48]. .................................. 11 
6.0. Intervention methodology ................................................................................................. 11 
6.1 Combining Stepping Stones and Creating Futures: ....................................................... 11 
9.10 
Relief Fund ............................................................................................................ 12 
6.2 Pilot research and field testing.................................................................................... 13 
7.0 Study methods .................................................................................................................... 13 
7.1 Objective of the RCT ..................................................................................................... 13 
7.2 Study design ................................................................................................................... 13 
7.3 Setting ............................................................................................................................ 13 
7.4 Cluster Definition/Inclusion........................................................................................... 13 
7.5 Inclusion criteria ............................................................................................................ 14 
7.6 Randomisation and blinding to study arm ..................................................................... 14 
7.7 Sample size and sample size calculation ....................................................................... 15 
7.8 Study’s main outcomes .................................................................................................. 15 
7.8 Questionnaire for main outcome assessment ................................................................. 16 
7.9 Assessment of main outcomes ....................................................................................... 16 
7.10 Timing of data collection for main outcomes .............................................................. 17 
7.11 Retention of cohort ...................................................................................................... 17 
8.0 Management of the study ................................................................................................... 20 
8.1 Investigator team and staffing .................................................................................... 20 
9.0 Ethics.................................................................................................................................. 20 
9.1 Community mobilisation and access ............................................................................. 21 
9.2 Recruitment of participants ............................................................................................ 22 
9.2 Informed Consent........................................................................................................... 22 
9.3 Maintaining the cohort data linking ............................................................................... 24 
9.4 Confidentiality & anonymity ......................................................................................... 24 
9.5 Potential risks related to the interviews ..................................................................... 25 
9.6 Harm due to the study ................................................................................................. 26 

 
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9.7 Intervention Challenges ................................................................................................. 26 
9.8 Referral ......................................................................................................................... 27 
9.9   Research reimbursements ......................................................................................... 27 
9.11 
Working in informal settlements ........................................................................... 28 
9.12 Additional Review bodies .......................................................................................... 28 
9.13 Similar studies ............................................................................................................ 28 
10.0 Data handling and analysis .............................................................................................. 28 
10.1 Data management and data analysis from the main RCT ............................................ 28 
10.2 Data analysis ................................................................................................................ 29 
11.0 Challenges ........................................................................................................................ 30 
12.0 Timeline ........................................................................................................................... 31 
13.0 Funding ............................................................................................................................ 32 
14.0 Details of researchers ....................................................................................................... 33 
15.0 References ........................................................................................................................ 55 
16.0 Appendices ....................................................................................................................... 60 

 
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1.0 Introduction 
 
Intimate partner violence is highly prevalent in South Africa and immensely destructive. 
Violence and injuries are the second leading cause of death and lost disability-adjusted life 
years in the country[3]. Population-based estimates from 2010, show a lifetime prevalence in 
adult women of physical intimate partner violence (IPV) victimisation of 33% and past-year 
prevalence of 13%[4]. Studies with men have shown that more than 40% of men disclose 
having been physically violent to a partner [4, 5]. A quarter of women have been raped, and 
between 28-37% of men disclose rape perpetration in surveys [4, 6].  
 
Urban informal settlements, globally and in South Africa, are rapidly expanding [7]. Data 
shows that urban informal settlements are spaces with particularly high prevalence of major 
health problems, including HIV and sexually transmitted infections (STIs) and gender-based 
violence (GBV), which particularly affect young people [7-10]. UNAIDS estimates that 28% 
of people living with HIV/AIDS in southern and eastern Africa live in 14 cities in the region 
(approximately 15% of the global epidemic) and in South Africa the HIV prevalence in 
informal settlements is twice that of people in formal housing [11, 12]. Our own data 
suggests that rates of IPV-incidence within young people (18-30) in urban informal 
settlements is between 3-5 times more than national estimates [13]. 
 
A range of different theories have been put forward to explain why urban informal 
settlements are particular spaces of risk. A substantial body of work has linked the high levels 
of poverty and material inequality found in urban informal settlements to HIV and IPV risk 
[14, 15]. Others also emphasise the high levels of mobility and weak social relationships that 
exist in urban informal settlements, undermining social forms of power that have a tendency 
to constrain certain behaviours [16]. Another arguments suggests  how weak service delivery, 
informal housing and a general sense of lack of structure and support, undermine people’s 
sense of wellbeing, contributing in indirect ways to people’s poorer health [17]. A cross-
cutting theme of all this work is the ways in which gender inequalities, particularly in the 
contexts of poverty, are pronounced and place women in economically and socially 
dependent relationships with men, and thus at higher risk of experiencing violence and HIV-
vulnerability [14, 18]; while for men it is argued that their experience of marginalisation from 
the economy limits them from achieving respectability and a sense of identity through 
providing for households.  In turn they seek other forms of identity and respect, namely 
through dominance over women sexually and physically [14, 19, 20]. 
 
Despite the significant health challenges that are evident in urban informal settlements, few 
interventions have been successfully evaluated that show impacts on reducing IPV in such 
spaces across the region [21]. This has been recognised by the South African National AIDS 
Council (SANAC), who have prioritised responding to HIV within these spaces with a 
particular focus on young women. As such there remains an urgent need for interventions that 
are deliverable in the challenging contexts of urban informal settlements that can develop an 
evidence base on reducing IPV perpetration and experience and HIV-risk behaviours.  
 
The Gender & Health Research Unit (GHRU), HEARD and Project Empower (PE) have been 
developing, implementing and evaluating IPV prevention interventions for over a decade. 
GHRU with its evaluation of Stepping Stones used with youth outside school, resulted in the 
first evidence of effectiveness of a rigorously evaluated intervention to reduce IPV 
perpetration from a developing country [22].  For over 13 years PE have been implementing 
participatory interventions in urban informal settlements to reduce HIV-risk and IPV. 

 
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Collectively the team have for the past four years been developing and piloting a 
participatory intervention called Stepping Stones and Creating Futures for implementation in 
urban informal settlements, through transforming gender relationships and strengthening 
livelihoods for women and men.  
 
This proposal outlines research on an ambitious new study that seeks to evaluate a multi-
faceted intervention to prevent IPV delivered to young men and women living in informal 
settlements, building on promising pilot data.  
 
2.0 The objective  
The objective of the study is to determine whether the combined Stepping Stones and 
Creating Futures interventions are effective in enabling women in informal settlements to 
reduce their exposure to intimate partner violence (IPV) and men in informal settlements to 
reduce their perpetration of IPV.   
 
3.0 Background 
 
3.1 Theoretical framing of the research 
 
This project blends a number of theoretical perspectives in the theory of change which 
underpins the development of the intervention. These theories operate at different levels. In 
understanding IPV causation, we  draw on the theoretical model that was presented in Jewkes 
[23] which posits that IPV is a product of both patriarchy and a culture of violence. Both are 
necessary in order to give rise to situations in which women experience abuse in intimate 
relationships and both need to be tackled as part of IPV prevention. Patriarchy is manifested 
in distinct gender roles and hierarchy, male sexual entitlement, the low social value and 
power of women and expectations of male control of women. Expressions and manifestations 
of patriarch include women’s lack of power in gender relations, low levels of education and 
economic power, and lack of family and social support for women in relations with men. 
Limited education and economic opportunities for men generates perceptions of insecurity of 
male identity, which lead to an accentuated need to express masculinity in terms of control of 
women [24].   
 
In South Africa the culture of violence is a product of the country’s violent past [2, 18]. The 
history of apartheid, State repression, forced impoverishment of the country’s Black majority 
and context of resistance has led to a normalisation of the use of violence to gain and wield 
power. Violence is common in all areas of life, from community violence, to homes where 
witnessing parental IPV is an every-day event, to schools where corporal punishment persists 
even though it is illegal.  
 
In order to understand how particular understandings of masculinity legitimate unequal and 
often violent relationships with women we use Raewyn Connell’s theory [25] of gender and 
power and specifically her concept of hegemonic masculinity (see also [26-28]). In this 
context, masculinity is understood as a configuration of male practice, constructed to give 
expression and legitimacy to patriarchy, but also recognised as multiple, dynamic and fluid. 
Connell argues for the existence in a particular setting of a hegemonic masculinity, which is a 
cultural ideal of manhood that gains its legitimacy from acceptance that is shared between 
those who embody and benefit from the ideal and those subordinated through it[25]. This 
legitimacy is not inherently based on the use of violence, but rather on a cultural ideal that it 
embodies the notion of how to be a ‘good’ or ‘successful’ man. Writing about South African 

 
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youth masculinity, authors have described how young men’s inabilities to secure ‘success’ 
through earning money and providing for a household, have led them to develop alternative 
visions of success, premised around acquiring and keeping female partners.  Thus, a central 
construction of successful manhood includes an implicit dominance and control of women, 
providing a basis for the use of violent behaviour to pursue and demonstrate manhood [24, 
26]. This configuration of masculinity underpins the high levels of violence against women 
and resulted in, for example, 42% of men disclosing perpetration of intimate partner violence 
and 28% disclosing rape [6, 29].  
 
This understanding of gender recognises that women are actively involved in shaping the 
contours of patriarchy and its expressions, and that they have an important role in the 
reproduction of cultural models of gender identities. This is done in heterosexual 
relationships through acquiescence, or resistance, to prevailing gendered power relations. It is 
also done at multiple other levels for example through girls influencing the femininities of 
their peers in replication of ideas about how to be a ‘good’ girl/woman and stigmatising (or 
supporting) alternative constructions of femininity. In the same way boys apply pressurise 
their peers to supports particular constructions of masculinity over others. Gender identities 
are also reproduced in all other important social spaces, and critically in the home, through 
very similar mechanisms, but which extend from very early in a child’s life. Parents play a 
key role in this process. Again, the wider contextual factors of poverty and lack of economic 
security further entrench women’s social dependence on men, through their economic 
dependence [30].  In this way we embrace a theoretical perspective on gender relations which 
extends considerably beyond the idea that women are just on the receiving end of patriarchal 
power and defenceless in negotiating and reproducing heterosexual relations [31], while 
recognising the significant economic constraints in their lives.  
 
 
3.2. Behavioural and Structural Change 
 
Tackling gender inequalities is central to any effective intervention that seeks to reduce IPV 
[32]. Much of the work around transforming gender norms and attitudes has been based on 
Paulo Freire’s theorisation of dialogue and critical thinking [33]. Broadly this argues that 
through engaging people in safe social spaces in dialogue and discussion they can start to 
understand not only the behaviours that place them at risk of violence, but more importantly 
the underlying factors driving this behaviour [34]. In so doing they can collectively create 
new identities that are not so tightly bound to the ones of masculinity and femininity that 
have shaped their risk; essentially they can start to develop new ways of conceptualising what 
it means to be a man or a woman [34]. This can be understood as both an internal psychic 
process, as well as a broader social process of developing new identities [35]. Freire’s [33] 
work also suggests that these processes of identity work and behaviour change generates 
forms of social action, both individually or collectively through community mobilisation. 
Small group intervention processes tend to focus on individual social action and behaviour 
change, while wider community mobilisation emerges through sustained support and 
community engagement. 
 
 
For small group processes increasing research has also highlighted how challenging social 
contexts limit the ability of men and particularly women in act in new ways [20, 36]. In South 
Africa the Stepping Stones evaluation showed the effect of a substantive gender 
transformative intervention by reducing men’s perpetration of IPV after 24 months; however 

 
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the intervention showed no sustained impact on women [37]. One argument to explain the 
lack of impact on women was their high economic dependency on men [18, 38]. 
 
Recognising the need to simultaneously tackle gender inequalities and poverty a number of 
IPV prevention interventions have been evaluated. The IMAGE study in rural South Africa 
combined a microfinance intervention with a gender-transformative intervention for women. 
After two years women in the intervention reported a 55% reduction in IPV experienced [39]. 
Similarly, a Village Savings and Loans Association (VSLA) intervention in the Ivory Coast 
for women added a couples intervention to reduce violence, consisting of 8 session ‘gender 
dialogue groups’ for women and their spouse, and evaluated this in a RCT (n = 1198 women 
randomised). While not showing positive results overall (overall the effect was non-
significant and the reduction in physical and/or sexual IPV was 8%), it did show women who 
attended more than 75% of sessions with their male partner, experienced a 55% reduction in 
physical IPV, although this was not seen in the high adherence group for sexual IPV or the 
combined measure [40].  
 
Yet similar interventions for young people have struggled to attain strong outcomes; 
microfinance interventions tend not to work for young people as they have high levels of 
mobility [21, 41], other approaches have sought to increase savings [42]. However one study 
with younger women in rural Uganda reported a reduction in coerced sex amongst female 
participants using a combination of economic strengthening interventions, including 
livelihoods training and microfinance [43]. There are also limitations to the reach of 
microfinance based interventions as these can only be built on existing well managed 
microfinance schemes, and these have limited coverage. Cash transfers have also been 
explored, but the major limitation of these is their cost. South Africa already has taken to 
scale through social grants programmes, particularly child support grants up to age 18, 
without clear impact on HIV incidence and violence.  
 
 
4.0 Rationale for the selection of interventions  
 
4.1 Gender Transformative:  
There is a clear rationale for IPV prevention interventions to seek to transform gender 
relations, norms and attitudes amongst participants. While there are a number of short 
interventions of around 6 hours based on cognitive behavioural theories of change, these have 
shown no evidence of impact on IPV [32]. Interventions therefore that seek to transform 
gender relationships, premised on assumptions of dialogue and discussion, are recognised as 
being the basis of any successful IPV prevention intervention [44].  
 
Stepping Stones, alongside being evaluated in the Eastern Cape in South Africa and showing 
reductions in alcohol use at 12 months and men’s perpetration of IPV at 24 months [37], has 
also been evaluated globally and shows promise [45]. As such, it provides a solid foundation 
programmatically to build off a well-established intervention. 
 
 
4.2 Sustainable Livelihoods 
 
In accordance with the theoretical understanding that contexts of poverty and livelihood 
insecurity heighten the experiences and perpetration of IPV, strengthening livelihoods to 
reduce IPV is also critical.  

 
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Often interventions to strengthen livelihoods have narrow conceptualisations of livelihoods 
[21]. The sustainable livelihoods framework recognizes that people construct a living through 
drawing on various forms of capital, often identified as: financial capital, human capital, 
social capital, natural capital and physical capital [46]. Yet typically livelihoods interventions 
are narrowly focused on economic and human capital, excluding the importance of other 
forms of capital [21].  
 
Creating Futures uses the broad conceptualisation of livelihoods to support young people to 
think through the multiple forms of capital they could draw on to construct or sustain a 
stronger livelihood [46]. 
 
 
4.3 Combining Interventions: Reviews of interventions and cross-sectional analyses clearly 
highlight the importance of combining gender transformative and livelihood strengthening 
interventions to improve IPV and HIV-risk behaviour outcomes [47]. Most clearly in a cross-
sectional study comparing a control arm, a microfinance arm and a microfinance plus gender 
empowerment arm to each other, the impact on IPV amongst women was only seen in the 
combined microfinance plus gender empowerment arm [48].  
 
 
 
6.0. Intervention methodology 
 
6.1 Combining Stepping Stones and Creating Futures:  
 
The purpose of the combined intervention is to both provide the necessary skills for 
strengthening relationships and building gender equity for women and men which are 
essential for IPV prevention, and provide a means of alleviating the grinding poverty which 
poses a barrier to women’s ability to use informational and attitudinal empowerment skills 
and messages.  
 
The intervention methodology will include a total of 21 sessions: 10 sessions of Stepping 
Stones delivered before 11 sessions of Creating Futures. Sessions are all approximately three 
hours long and are delivered twice a week, over approximately 12 weeks. Both interventions 
are delivered primarily to single sex groups of about 20 people and use a similar participatory 
methodology.  
 
The key sessions of Stepping Stones cover: gender and peer influences our actions; sex and 
love; conception and contraception; STIs and HIV; safer sex and condoms; GBV; 
motivations for behaviour (including influences of alcohol and poverty); and communication 
skills. 
 
The key sessions of Creating Futures cover: my life and the resources I have used in my life 
and livelihood, setting medium term livelihood goals and the need for assets for livelihoods 
and coping with crises; social resources for livelihoods (trust and community participation); 
education and learning including past experiences and how to build on these; getting and 
keeping jobs including work expectations and how ones on own behaviours may impede or 
increase our ability to get a job and to keep it, appropriate work opportunities and increase 
owns own ability to market ones skills and apply for work and overcome challenges in job 

 
12 
seeking and maintaining a job; income generating activities and how to identify viable 
business opportunities, the  resources necessary to respond to such opportunities, basic 
business principles and business risks;  saving and coping with shocks including spending 
patterns and strategies for saving, and causes and consequences of getting into debt and ways 
of overcoming debt. 
 
6.2 Relief Fund 
In addition to the structured and manualised intervention the project will establish a ‘relief 
fund’. This relief fund will provide small amounts of immediate relief for participants during 
the intervention component of the project for immediate and pressing challenges that young 
people may experience. A significant and on-going issue in urban informal settlements are 
crises such as housing burning down. As the intervention’s facilitators will engage with 
participants on a twice-weekly basis, they are likely to come across participants facing 
immediate and pressing challenges, over and above their daily lives, which require a humane 
response to provide small amounts of immediate support. In order to provide some ability to 
relive these pressures and to respond in a humane way, the team will establish a relief fund, 
totalling R10,000.  
 
The relief fund will be overseen by three project members (one from each organisation – 
HEARD, MRC, Project Empower). It will be able to provide a maximum of R1000 to a 
participant who faces an immediate life crisis such as: house burning down; an immediate 
personal medical crisis, which the state cannot respond effectively to.  
 
This fund only aims to provide immediate relief to a participant during the intervention 
period (when there is regular contract with participants), which Project Empower will support 
directly. A clear set of guidelines will be developed. In the pilot (see 6.3) the project 
established a similar process. Over the intervention period of approximately 3 months, with 
232 people the fund was used three times: 
 To buy shoes for the sister (aged 7) of a participant who’s both parents had died to 
allow the sister to attend school. The participant had also applied for a social grant 
which was being processed at the time of request; 
 A private consultation with a gynaecologist. One participant had a recurring vaginal 
infection. They had repeatedly sought treatment through the public system. The 
project paid for a consultation with a private gynaecologist and the prescribed 
medication; 
 A participant had a seizure shortly after a session. They were currently in care of the 
state system. The project paid for a private consultation which enabled referral into 
the state system to a tertiary hospital and diagnosis of epilepsy and subsequent 
medication 
 
None of these could substantially affect the outcomes of the intervention. A major criteria is 
that participants have sought treatment/support extensively through the current systems. 
Moreover, given a duty of care to participants established during the trial these low levels of 
support provide a way of the team providing relatively little inputs, which have major 
impacts. 
 
The relief fund will be overseen by three team members and will adhere to all financial 
reporting and auditing requirements. Each ‘use’ of the relief fund will be recorded and 
documented for future review.   
 

 
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6.3 Pilot research and field testing 
 
The SS CF combined intervention was piloted among young adults in Durban informal 
settlements in 2012-13. 123 women and 110 men were recruited and interviewed on two 
occasions and then invited to participate in the intervention. They were then followed up 6 
months later and `12 months later. Overall retention at 12 months in the study was 88%. Data 
suggests that attendance at sessions was approximately 60%. 
 
The results of the pilot were assessed in long term qualitative research and observational 
research and have been published [49-52]. The analysis showed that men’s mean earnings in 
the past month increased by 247% from R411 (~$40) to R1015 (~$102, and women’s by 
278% R 174 (~$17) to R 484 (about $48) (trend test, p<0.0001). There was a significant 
reduction in women’s experience of the combined measure of physical and/or sexual IPV in 
the prior three months from 30.3% to 18.9% (p=0.037). Both men and women scored 
significantly better on gender attitudes and men significantly reduced their controlling 
practices in their relationship. The prevalence of moderate or severe depression 
symptomatology among men and suicidal thoughts decreased significantly (p<0.0001 and 
p=0.01) [13]. 
 
 
 
7.0 Study methods 
7.1 Objective of the RCT 
 
i) 
The primary objective is to determine the effectiveness of the combined 
intervention in reducing IPV experience in women and perpetration by men, 
including reducing controlling behaviours.   
ii) 
The secondary objective is to determine the impact of the combined intervention 
in strengthening livelihood seeking activities, improving mental health reducing 
sexual risk taking and reducing participation in crime due to lack of money.  
 
7.2 Study design 
 
The study is a randomised controlled trial with two arms:  
 
1. Stepping Stones and Creating Futures 
2. Control communities (cash incentive for study participation and delayed intervention) 
 
The control arm will be given a cash incentive for study participation which is large enough 
to incentivise participation in interviews in the absence of an intervention over the two years 
prior to them being offered the intervention.  
 
7.3 Setting 
 
The study is set in informal settlements in and around eThekwini (Durban).  
 
7.4 Cluster Definition/Inclusion 
A cluster will be defined as a discrete urban informal settlement.  

 
14 
 
Eligibility criteria for informal settlements: 
 
* Informal settlements in the eThekwini Municipality.  
*Informality is defined by not having formal service provision within the home e.g. 
no electricity legally supplied, and no piped water to housing. 
*Project Empower have assessed that it is safe to work in these communities 
 
Another 
criteria 
– 
although 
hard 
to 
‘enforce’ 
or 
assess 
is 
that 
no 
large 
development/intervention studies or programmes are identified at recruitment into the 
intervention 
 
The nature of urban informal settlements in eThekwini is such that they are typically 
discretely geographically bounded; in essence they tend to be in clearly defined spaces.  The 
variation in size of informal settlements is dealt with in three primary ways: 
1) Small informal settlements close to each other will be clustered together to form a 
larger informal settlement cluster where we can recruit n=40 participants 
2) Large informal settlements, if possible, will be split into separate clusters using 
naturally occurring boundaries and space to limit the potential for contamination 
(although this is a minor issue in this study as it is group-based) 
3) In analyses we will account for variation in baseline characteristics of clusters – 
although there is nothing to suggest that size of informal settlement will vary 
measured characteristics 
 
 
Clusters will be identified using a list of urban informal settlements provided by the 
Municipality. These name and provide basic information about all informal settlements in 
eThekwini, including location and approximate number of residential dwellings. While 
contamination is a concern, as it is a group intervention – rather than community mobilisation 
– spill over effects are likely to be minimal.  
 
Given the challenging nature of working in urban informal settlements we will identify 
clusters based on pragmatic decisions around security and safety. 
 
7.5 Inclusion criteria 
 
Participants must be normally resident in an informal settlement, aged 18-30 years, not in 
formal employment, able to communicate in the main languages of the study (isiXhosa or 
isiZulu) and not suffering from a mental deficit (learning difficulty, mental illness or 
substance abuse) which would impair their ability to consent to participation in the trial.   
 
Our age grouping is based on the requirement that participants provide informed consent, 
those under 18 cannot do so and require parental consent to participate, which may be 
challenging in informal settlements where young people do not live with their parents. Our 
pilot data suggests that an upper-age limit of 30 is reasonable; while the majority of 
participants are under 25, a significant minority were older and faced similar life challenges. 
 
7.6 Randomisation and blinding to study arm 
 

 
15 
Randomisation will be undertaken by cluster after clusters have agreed to participate in the 
study. Community gate keepers will provide permission to work in a cluster/informal 
settlement (see 9.1 below). Clusters thereafter will not be blind to their study arm.  
 
All clusters will be allocated numbers and the randomisation will be performed by Esnat 
Chirwa, MRC biostatistician, using a system of numbers. At the time of randomisation she 
will not know which number is allocated to which cluster. We are not doing public 
randomisation because of political sensitivities and that clusters are within wards, rather than 
wards themselves. 
 
7.7 Sample size and sample size calculation 
 
There will be 17 clusters in each of the two study arms.  
 
7.7.1 Sample size calculation:   
 
In the pilot study conducted in 2012-13 the past year prevalence of physical and/or sexual 
IPV perpetration and victimisation was 45% among men and 41% among women. These 
levels of violence are exceptionally high by South African standards, so we have modelled 
the sample size on a range of possible baseline rates (see the table).  The sample size assumes 
14 will be followed up per cluster (of the 20), but figures are robust to a follow up of only 12 
in each cluster.  Assuming a coefficient of variation k=0.2 and modelling 80% power. The 
table shows that with 14 male (and 14 female) participants per cluster and 16 clusters we will 
have power to detect a range of possible incidence and impact scenarios and to analyse men 
and women separately (see table). Our power will be further enhanced by having multiple 
assessments and an additional two clusters.   
 
IPV incidence (12 
months) 
  
  
# of clusters required by arm 
  
  
  
  
l1 
l2 
power 
  
36 
29 
80 
16 
45 
36 
80 
15 
41 
33 
80 
16 
24 
19 
80 
14 
18 
14 
80 
13 
30 
24 
80 
15 
 
 
7.8 Study’s main outcomes 
 
Primary outcome: 
The past year incidence of IPV (perpetration of physical and/or sexual IPV for men and 
victimisation for women), including change in controlling behaviour.  
 
Secondary outcomes 
gender attitudes (more equitable) 
depression (past week) 

 
16 
suicidal thoughts in the past month 
quarrelling in last 12 months over drinking 
problem drinking 
last sex with main partner 
transactional sex in last 3 months 
condom use on last sex 
mean earnings in last month 
stole in the last month due to lack of money for food 
Tertiary outcomes: other livelihood strengthening outcomes 
Frequency of livelihood strengthening efforts  
Work stress mean  score  
Feelings about work situation mean score  
Receiving a grant 
Crime participation score  
Very difficult to find R 200 in an emergency 
 
 
 
7.8 Questionnaire for main outcome assessment 
 
The primary and secondary outcomes will be measured using a standard questionnaire.  
Separate male and female questionnaires are available for baseline (Appendix 01 – male; 
Appendix 02 – female) and 12 and 24 months (Appendix 03 – male; Appendix 04 – female). 
 
The primary outcome for women will be assessed using standard measures developed by the 
World Health Organisation for its multi-country study [53] and for men those developed and 
tested in the UN multi-country study on men and violence [54].   These have been tested in 
South Africa over many years in different populations and most recently used in the pilot of 
Stepping Stones and Creating Futures (SS CF pilot) [49].  
 
The background variables, secondary outcomes measures and other outcomes were used in 
South Africa in the SS CF pilot and elsewhere by the Gender & Health Research Unit (and 
others). The questionnaire, and its translations, will be largely the one used in the pilot.  
 
Measures for Secondary outcomes 
 
gender attitudes (more equitable) 
GEMS adapted for South Africa 
depression (past week) 
CES-D 
suicidal thoughts in the past month 
CES-D 
quarrelling in last 12 months over drinking 
One item – from AUDIT 
problem drinking 
AUDIT 
last sex with main partner 
Single item – used in pilot 
transactional sex in last 3 months 
Measured using scale derived 
from Dunkle et al 2004 
condom use on last sex 
Single item – used in pilot 
mean earnings in last month 
Single item– used in pilot 
stole in the last month due to lack of money for food 
Single item– used in pilot 
 
 
7.9 Assessment of main outcomes 

 
17 
 
The study will use self-completion questionnaires on cell phones lent to participants to collect 
data. The questionnaire will be administered in English, isiXhosa or isiZulu. Project staff will 
be available to provide further explanation or assistance.  
 
Previously in the pilot participants used self-completion questionnaires using paper and pen. 
Despite general low levels of literacy almost all participants had functional literacy to 
complete questionnaires by themselves. The availability of project staff enabled participants 
who struggled with words of phrases to clarify their meaning before answering them 
privately.  
 
7.10 Timing of data collection for main outcomes 
 
The baseline survey will be administered just after recruitment of participants and follow up 
surveys will be administered to the learners after 12 months and 24 months. 
 
7.11 Retention of cohort 
Retention and loss to follow up is a major concern for the project given the high levels of 
mobility of young people in urban informal settlements and patterns of migration. We have in 
place a range of strategies to retain the cohort throughout the two years of follow up. Specific 
strategies include: 
A) We will send SMSes throughout the follow up period reminding participants to 
contact us if they move and also enabling us to remain in contact; 
B) We will call each participant at data collection points to identify where they are 
and how to secure an interview with them; 
C) For 12 and 24 months, Project Empower will re-enter the community to secure 
access as for initial entry. In so doing they will identify 2 young people per 
community to act as ‘community guides’ to support identification of participants 
who were in the original study and help guide fieldworkers around the community 
D) Participants will have provided us with details of friends and family members they 
are willing for us to contact if we lose direct contact with them. We will contact 
these people if our other strategies have failed.  
 
In addition we have an escalating cash incentive for both the control and intervention arm. 
Such an approach has been used before to retain cohorts over time. For the intervention arm 
the cash incentive is: baseline – R100; 12 months – R150; 24 months – R300. For the control 
arm this will increase as such: baseline – R300; 12 months – R450; 24 months – R600.  
 
The impact of what could be considered unconditional cash transfers is likely to be minimal. 
Previous research on the impact of cash transfers only show impact either when transfers are 
over several months, or they are of a large value and the impact has often been shown to be 
negligible on violence measures or inconsistent. For instance in Latin America cash transfers 
over time have shown mixed outcomes. One study of a long-term transfer of US$15 per 
month (approx. 6-10% of income) showed a marginal increase in controlling behaviours by 
partners, but no impact on physical or sexual violence [55]. Another of US$40/month over 6 
months, showed a reduction in physical and/or sexual violence at end line [56]. Once off cash 
transfers have needed to be of a high value to show impact, e.g. Give Directly in Kenya 
provided once-off payments of US$1100 direct transfers to households and showed impacts 
on sexual violence [57].  
 

 
18 
As such, our incentives are neither of a long-enough duration (i.e. repeat payment every 
month) nor of enough significant value, to be likely to have impact on the primary or 
secondary outcomes of the study.  
 
7.12 Integrated process evaluation 
In addition, we will undertake ethnographic research on the delivery of the intervention. 
Understanding how manualised interventions are delivered by facilitators is critical to 
understanding how they work and the challenges of delivery in real life contexts. We will 
achieve this through three main processes: 
1. Trained fieldworkers will shadow facilitators over the delivery of the intervention and 
observe how they deliver the intervention, with a focus on content and methods of 
delivery, as well as the issues discussed (see Appendix 15 for detail). As this is 
ethnographic participatory research the fieldworker will participate in groups and 
make written notes, before recording thoughts into an electronic recorder outside of 
the intervention setting. 
2. In-depth one-on-one interviews will be conducted with facilitators (2/facilitator) on 
their experiences of delivering the intervention in informal settlements, reflecting on 
similar issues as are observed for (Appendix 16 for topic guide) 
3. Focus groups (n=5) with facilitators will allow facilitators to discuss in detail amongst 
themselves the challenges and successes of the intervention (Appendix 17). 
 
All interviews and focus groups will be conducted by trained research assistants in Zulu and 
be electronically recorded before translation and transcription into English.  
 
 
Qualitative thematic analysis using standardised approaches, including data management in 
Nvivo will be used. 
 
7.13 Integrated costing of the study 
An integrated retrospective and prospective costing from a provider and client perspective of 
the study will be conducted. The costing strategy will follow the Gates Reference Case [58] 
approach to costing. Specific components of the costing include: 
1. Retrospective costing of the development of the Creating Futures intervention. 
Between 2011 and 2013 CF was developed by the main trial team. Through purposive 
sampling of the trial team using semi-structured in-depth interviews (Appendix 19) 
costs related to developing CF will be identified (e.g time, resources, indirect costs). 
In addition, review of financial records of Project Empower and HEARD will occur. 
This will enable an estimation of the cost to develop the intervention; 
2. Prospective costing of the intervention. During the intervention delivery a prospective 
costing of the intervention will occur. Financial data will be collected based on the 
following categories of expenditure outlined fully in Appendix 20: 
a. Capital costs (e.g. vehicles buildings) 
b. Staff costs (project team, facilitators) 
c. Transport costs (taxi and car travel) 
d. Current costs (electricity, internet, stationary etc.) 
Data will be extracted from financial records of the implementation organisation 
(Project Empower) and will be checked on a quarterly basis to account for any 
differences. 
3. Time-motion data of facilitators. To understand how facilitators use their time and to 
estimate improvements in efficiency, we propose for fieldworkers to shadow between 

 
19 
6 and 8 purposively selected facilitators and record their time use based on the table in 
Appendix 21. This records the activities of the facilitators using paper and pencil 
before being translated into electronic records; 
4. Social costs. Data will be collected only from participants in the intervention arm on 
the direct and indirect costs they may have incurred in attending the intervention (for 
example child care, opportunities lost etc.). Data will be collected through a two-page 
questionnaire administered by paper and pencil at the second to last session of the 
intervention. Data will be anonymised using participant codes as per the main trial 
data (Appendix 22). In addition, to those in the intervention arm, we will include 6 
items on willingness to pay in their baseline interviews (Appendix 01 and 02 ). 
  
A gatekeeper letter from the Director of Project Empower is included approving the costing 
study and agreeing to allow the team to access the relevant information. 
 
7.14 Integrated qualitative process evaluation 
An integrated qualitative process evaluation will also occur as part of the study. At baseline 
we will purposively select 40 participants (20 men, 20 women) from two intervention clusters 
for inclusion. These same people will be followed up at baseline (2 interviews), 6m, 12m and 
18m post intervention and participant observation throughout the period as well. A separate 
informed consent process will also be used to separate out participation in the main study and 
participation in this sub-study (Appendix 24 men and Appendix 25). When we approach 
participants we shall make it clear their participation in the sub-study (or not) does not affect 
their participation in the main study. 
 
In-depth interviews will focus on exploring the processes of change and the barriers to 
change in the intervention. The focus of this component will be on participants’ life 
experiences around the intersection of gender, livelihoods and sexual risk and the impact of 
the intervention on these. This will include a specific focus on gender power and control in 
intimate relationships, sexual risk behaviours, understandings of masculinity and femininity 
(as appropriate), experiences and understanding of transactional sex and a focus on how 
young people ‘get by’ and survive in their everyday lives. It will also include a specific focus 
encouraging participants to reflect on the impact of the intervention. Specifically it will also 
explore the intervention and whether young people have changed or not - Appendix 26 = 
women’s baseline interviews; Appendix 27 = women’s follow up interviews at 6m, 12m and 
18m. Appendix 28 = men’s baseline interviews; Appendix 29 = men’s follow up interviews 
at 6m, 12m and 18m.  
 
They will be undertaken by same sex fieldworkers who have been trained in research and 
have undertaken similar research before. Interviews will take place in a private and secure 
location. Participants will be bought a small meal (value R100) to support rapport and relax 
participants. Interviews will be recorded electronically in English and isiZulu and transcribed 
and translated by fieldworkers.  
 
For women and men who have completed in-depth interviews, they will also be subject to 
participant observation. Participant observation will be undertaken from baseline through to 
18m, every second week to begin with and curtailing as time progresses. Participant 
observation enables ‘real world’ discussion and understanding of people’s lives and the 
impact of the intervention on people’s worlds [59]. Every second week a trained fieldworker 
will spend a day shadowing participants and talk to them about their lives as well as observe 
them in their everyday life, making notes in a fieldwork notebook (the frequency will decline 

 
20 
over time). Their discussions will be guided by Appendix 30 for men and Appendix 31 for 
women and reflect the overall objectives of the study and the in-depth interviews. 
 
10 women already enrolled in the qualitative sub-study, will be offered the opportunity to 
participate in a PhotoVoice process [60]. PhotoVoice is a qualitative methodology that uses 
pictures as a way to build alternative understandings of issues, particularly where language 
challenges exist [60]. Participants will be asked to participate in four workshops (each 
comprising of two half-day sessions), at baseline, 6m, 12m and 18m. Before each session, 
there will be a reiteration of informed consent verbally, with the offer to withdraw if they 
wish. The workshops will be guided by the PhotoVoice Appendix 32. 
 
  
8.0 Management of the study 
 
8.1 Investigator team and staffing 
 
The principal investigator with overall responsibility for the study is Andrew Gibbs, he will 
have final scientific responsibility for the study including the design, research conduct and 
data analysis and reporting. The other investigators were all part of the team for the SS CF 
pilot study. Rachel Jewkes was the principal investigator of the Eastern Cape RCT evaluation 
of Stepping Stones and Yandisa Sikweyiya and Nwabisa Jama-Shai were both employed on 
that study and they will bring their expertise to inform this evaluation.  Samantha Willan 
(HEARD) was also a co-investigator on the SS CF pilot study and will bring this learning to 
bear on the study design and evaluation. The project will hire a range of temporary staff 
through HEARD to administer the questionnaires, and will hire a counsellor to support 
participants and assist in cohort retention. Project Empower will manage the intervention and 
hire staff to facilitate it. The study statistician is Esnat Chirwa (MRC) who will be 
responsible for randomisation, data management and data analysis.  
 
The costing component of the study is supported by LSHTM staff. For the costing component 
the PI is Prof Anna Vassall, who has over 20 years of work globally on costing, including TB 
costings in South Africa. Giulia Ferrari is a research fellow in SaME at the LSHTM. She has 
over 10 years’ experience in evaluating the effectiveness and cost-effectiveness of 
interventions for the prevention of violence and for the support of violence survivors. Mike is 
a research fellow at HEARD and has been conducting primary quantitative and qualitative 
research in the field of healthcare and HIV since 2012. The oversight of this component 
remains with the trial PI, Andrew Gibbs. 
 
 
9.0 Ethics 
 
This research proposal is structured in accordance with the ethical principles provided by the 
World Medical Association Declaration of Helsinki (last updated in 2013), and the Belmont 
report (1979). Both these documents emphasize respect for person’s autonomy, justice, 
beneficence, and non-maleficence (do no harm) in the conduct of research with human 
participants.  
 
Ethical approval for the study will be sought from the South African Medical Research 
Council’s Ethics Committee and the University of KwaZulu-Natal’s Humanities & Social 
Sciences Research Ethics Committee.  

 
21 
 
This study aims to determine whether the combined Stepping Stones and Creating Futures 
interventions are effective in empowering young women in informal settlements to decrease 
their exposure to IPV and young men in informal settlements to lessen their perpetration of 
IPV including controlling behaviours. This is premised on the assumption that this combined 
curriculum will build a critical approach to thinking, learning and promoting healthy sexual 
behaviours and conflict resolution skills and ways of strengthening livelihoods. We therefore 
assume that this curriculum will enable the research participants to translate the skills learned 
into multiple and shifting livelihoods on strengthening livelihoods. 
 
This trial has been designed to ensure that the project does not expose participants to more 
than minimal risk (more than everyday risk). The study design has measures in place to 
minimise the potential of harm to participants and be able to respond to any adverse 
consequences i.e. emotional or psychological harm that may result from the questions that 
will be asked in this study (see below).  
 
We believe the findings of this trial will advance knowledge on the effectiveness of the 
combined curriculum of Stepping Stones and Creating Futures intervention among young 
people in informal settlements.  
 
We expect that participants may benefit from participating in this trial. The findings of the 
pilot which was conducted in 2012-2013 suggest that young people derive important benefits 
from this combined intervention, as shown above (see 6.2 Pilot research and field testing). 
Additional to this, the Stepping Stones behavioural intervention tested in a RCT was proven 
to be beneficial to the young people in the rural Eastern Cape. Participants who went through 
the Stepping Stones workshop demonstrated improvement in HIV-related knowledge, 
gender-based violence attitudes and behaviours and practices at 24 months (last evaluation 
stage) as compared to the control group [37]. Therefore we anticipate that participants in the 
intervention arm will benefit from going through the combined intervention. We plan to 
provide the combined intervention to the participants in the control group after we have done 
the last evaluation at 24 months. 
 
All data will be stored at HEARD’s and MRC’s offices in locked filing cabinets or in 
password protected computers. Data will be kept in a secure store for at least 5 years, after it 
has been analysed and different reports have been written. The intervention implementers and 
research assistants (where data is not anonymous) will sign a confidentiality agreement (see 
Appendix 05). 
 
All project staff will receive training – on gender, gender-based violence, and HIV and 
research ethics – prior to implementing the trial.  
 
The following measures will be put in place to ensure that the study is conducted in an ethical 
correct manner.  
 
9.1 Community mobilisation and access 
Community mobilisation, access and recruitment of participants will be led by the 
implementing organization Project Empower, a gender and HIV non-governmental 
organization based in Durban, South Africa. Project Empower has extensive experience 
working and delivering a range of interventions in informal settlements. Thus in accessing the 
trial clusters (communities) and recruiting participants, this project will draw from Project 

 
22 
Empower’ s experience and knowledge of the trial setting to ensure that this process is 
conducted in an ethical correct and culturally appropriate manner. Throughout the process of 
accessing communities the study will be described as a project that hopes to help young 
people improve their lives – as such it will not focus on either the violence or livelihoods 
aspects of the work.  
 
Accessing communities will be done through a process of community engagement and 
mobilization, whereby Project Empower will identify key community organisations – ward 
councillors, local development committees and so forth and request permission to work in the 
communities. We will provide permission letters for working in communities (Appendix 07) 
to ethics committees. Without permission letters from Ward Counsellors conduct this 
research and intervention we will not  be allowed into the communities. We will ensure Ward 
Counsellors remain fully aware of the study and progress through yearly meetings hosted by 
Project Empower, enabling ongoing access and community buy-in. 
 
 
9.2 Recruitment of participants 
Once permission to access communities has been granted and clusters have been identified 
and randomised Project Empower will host a number of open community meetings where 
they will brief community members about the trial, its nature and design. Community 
meetings are relatively regular in informal settlements and as such are well known. Also, 
flyers with adequate information about the trial and project contact details will be handed out 
during the community meetings. During these community meetings, Project Empower will 
request those eligible and interested in the trial to contact the project staff by sending free 
‘please call me’ messages from cell phones. The majority of young people in informal 
settlements have access to cell phones. Those who do not can easily access cell phones 
through vendors at the side of the road who offer low-calls for people. In addition, ‘please 
call me’ messages are free to send, as such young people are likely to be able to borrow cell 
phones to make initial contact.  
 
In addition, Project Empower will hire two young people from the local community to 
support recruitment. In clusters where there will be an intervention, these two will become 
facilitators delivering the intervention. These young people will also support recruitment in 
the communities and hand out flyers to potential participants encouraging contacting of 
Project Empower. 
 
Those who made contact with the project staff will then be invited to meet with the project 
staff in a central location in their community. These spaces will vary depending on 
communities – but could include a community hall, a spare room off a shop, or sports field. 
There will be a two day window where Project Empower and HEARD staff will be at this 
location. Upon arriving potential participants will have further details about the trial will be 
explained to them, after which they will be invited to participate in the trial (e.g. what it 
entails, length of study etc.). Informed consent process will only occur after initial agreement 
of participants.  
 
 
9.2 Informed Consent 
All research participants will be asked to give written informed consent (consent forms in 
Appendix 06) before participating. Adequate information about the trial will be given to 
prospective participants prior to giving consent. They will be informed of the purpose of the 

 
23 
trial, procedures involved, risk and benefits of the trial and their rights as participants. 
Prospective participants will be informed that they do not have to participate in the trial 
unless they are happy with the trial procedures and understand what the trial is about. All 
participants will be told that participation is voluntary, that they may withdraw at any stage, 
skip any question in the research and that there will be no adverse effects on them should 
they decide not to participate.   
 
For the success of the project we require all research participants to agree in principle to 
multiple interviews (i.e. baseline, 12m and 24m) - although they may change their mind. For 
this reason we propose to stagger the consent process over a period of time and ensure that no 
interviews are conducted on the first day that a person has been introduced to the idea of the 
research.    
 
The participant information leaflets consent forms are written in simple English, however to 
enhance understanding, the explanation and discussion may be in isiZulu, isiXhosa or English 
depending on the participant’s language preference. A researcher will be present throughout 
the informed consent process and will clarify any questions the participants are not clear 
about.  
 
Participant in-depth interviews, observation and PhotoVoice 
The participant indepth interviews, participant observation and PhotoVoice process (only for 
women) rely on exploring participants lives in great deal, and building up rapport with 
participants. As such there are additional ethical considerations. First, we will take 
participants selected through a second informed consent process only for this component 
(beyond the quantitative research informed consent) (Appendix 24 and 25). Second, we will 
continually check in with participants around their willingness to be involved in the research, 
this will include before any sessions are run and through ongoing verbal consent processes by 
research team members. At each point it will be made clear to them that they can choose to 
opt out of the study with no harm coming to them.  
 
As the team will build relationships with participants over this time, it is likely that there will 
emerge instances where participants inform researchers about harms that have happened to 
them (for instance being beaten up). If participants disclose issues that require further 
intervention the researcher will alert the PI of the study and they will agree a process, and 
where appropriate inform the ethics committees. Strategies could include: referral to 
counselling, support to report issues to the police, support in going to hospital or so forth. 
These will be supported at the project’s expense.   
 
 
Costing and facilitator research 
Both the costing study and the research on the delivery of the intervention relies on 
observation, interviews and focus groups with facilitators. As such one integrated informed 
consent will be provided for facilitators (Appendix 18) before participating. They will be 
informed of the different methods of research (observation, time motion analysis, interviews 
and focus groups) and the purpose of the research – to understand intervention delivery and 
costing the intervention and the risks, benefits and rights as participants. They will be 
informed that they do not have to participate in the study if they do not wish to.  
 
Interviews with trial team members around the development of Creating Futures for the 
retrospective costing requires a separate informed consent (Appendix 23). All potential 

 
24 
interviewees will be provided with an informed consent outlining the methods of research, 
the purpose of research and their rights as participants. They will be informed that they do not 
have to participate in the study if they do not wish to.  
 
In addition, we have modified the informed consents for participants in the main study 
(Appendix 6) to reflect that they may be observed as part of this study and the additional set 
of questions that the costing component entails.  
 
9.3 Maintaining the cohort data linking 
In order to maintain the cohort it will be necessary to collect personal information and store 
this. We propose to record name, address, cell phone number and the cell number of two 
close friends or family members. This will be kept in a separate computer which will include 
in the database for each participant their study ID and will be password protected. All 
participants will be allocated unique study IDs. Only the study ID will be kept with the 
completed interview files. After the link is no longer needed all the cohort tracking details 
will be erased.  Participants will be informed that it is necessary to keep this information for 
the study.  
 
 
9.4 Confidentiality & anonymity 
All participants will be assured that the information they provide in the trial will be handled 
confidentially and findings reported with complete anonymity. Once the data has been 
uploaded and sent to the MRC and HEARD it will be stored in password protected systems.  
 
This trial will use self-administered cell phones for collecting the quantitative data. Electronic 
handheld devices have been used by the MRC Gender and Health Research Unit in previous 
research with young and adult men and women in the Eastern Cape, KwaZulu-Natal and 
Gauteng, and with great success with both literate and illiterate people.  
 
Use of cell phones in this trial will ensure anonymity of information given by participants as 
they will not write their names in the cell phone. Participants will have unique study codes 
that will not be linked to their names and thus their responses will not be traceable back to 
them. Using cell phones will allow us to collect data anonymously and this will therefore 
protect both researchers and participants should the latter disclose illegal activities or 
practices in the interviews. 
 
However, we recognise that there are limits to confidentiality and have highlighted this in 
Appendix 06 – Informed Consent. Specifically, we have included the words: “If during a 
workshop the person running the workshop feels you may be about to provide too much 
information (such as an intention to harm someone else in the future) they will warn you not 
to reveal any further information. If you did continue to tell them about this, we may be 
required to report the information to the authorities (e.g. Police or Social Workers).” 
 
We assume that this is unlikely to happen. Facilitators will be trained to stop participants in 
workshops before they reveal issues that may need to be reported, however there are cases 
where unsolicited reports that may emerge [61]and if participants do report such activities to 
fieldworkers, facilitators or team members we may have to report onwards. In an unlikely 
event that a disclosure of incriminating information is made, the principal investigator will 
report this information to the ethics committee for advice and guidance. The principal 

 
25 
investigator and the EC will discuss the gravity of the disclosure and the course of action to 
be taken.  
 
Research with facilitators and costing 
To ensure confidentiality the data on facilitators (both costing and delivery) will be kept away 
from the implementing organisation (Project Empower) until the data’s anonymity is secure. 
Research assistants will report to the PI and provide the PI with data, who will ensure 
anonymity for the participants before the data is shared more widely within the project team. 
Facilitators will be promised that this information will not be provided to Project Empower in 
any way that could lead to facilitator’s being identified nor be linked to their job.  
 
In-depth interviews, Participant observation and PhotoVoice 
To ensure participant confidentiality, any notes and audio recordings will be written up as 
anonymised data, with false names. During PhotoVoice a key component is ensuring 
anonymity of photos, through strategies such as not taking photos of faces, this will be 
discussed extensively with participants during the study (Appendix 32).  
 
All field researchers (data collectors and facilitators) will be required to sign an Agreement of 
Confidentiality (Appendix 5). This agreement will bind them to uphold the confidentiality of 
all information encountered during the research.   
 
All computers and study databases will have password authentication for access. Data from 
the trial will be anonymously processed and written into a study report and also published in 
peer reviewed journals. Study data, informed consents and confidentiality agreements will be 
kept at the HEARD’s & MRC offices for a period of 5 years after writing the findings of the 
trial.  
 
9.5 Potential risks related to the interviews 
Participants will be guaranteed that the information will be kept confidential. At the point of 
data analysis information will be anonymously processed in order to minimise the possibility 
of data, in particular disclosed illegal behaviour, to be linked back to individual participants. 
Further we will not collect sufficient information about any act in the questionnaire to enable 
a prosecution of any crime.  
 
Research with facilitators 
As facilitators are employees of the implementing agency, there is significant risk to them in 
their professional life. We will ensure that no data is seen by the implementing agency on the 
experiences of facilitators until it has been full anonymized. 
 
Indepth Interviews, Participant observation and PhotoVoice 
As participants build up relationships with the research team over the course of participant 
observation and PhotoVoice sessions, there is a risk that they will disclose information that is 
illegal. As with other studies where the team have undertaken qualitative research on illegal 
behaviours [20, 30, 61] we will make participants aware when they start telling stories which 
we may be forced to tell others (e.g. social workers, police) to reduce this from happening. 
Any instances where we may be forced to compromise the privacy of will be discussed with 
ethics committees beforehand [61]. 
 
 
 

 
26 
9.6 Harm due to the study 
We will collect data on potential risks related to the study. It is a sad fact in South Africa that 
large randomised controlled trials always experience deaths of study participants. It is critical 
that these are investigated and shown to be not study related. For example, during the pilot 
study of 232 participants who we intended to follow for a year there were three deaths and 
one participant went to jail. Similarly in the first Stepping Stones evaluation there were 16 
deaths in 2800 people followed for 2 years. We investigated all these and found none to be 
study related. The investigation of study participant deaths will be conducted by the 
counsellor. At an appropriate time, he or she will be asked to visit the family (or friends if no 
family are available) to collect information on the circumstances of the death. A report will 
be sent to the ethics committee. We will inform participants that if there should be a death 
that they learn of we must be informed and we may also learn of deaths when conducting 
follow up interviews. We are not administering medication to participants and the basic 
interventions are known to be safe (Stepping Stones has been used with 10s of thousands of 
participants globally) so we do not anticipate any study related deaths.  
 
Given that this is a study on violence we will also undertake investigations for any reported 
hospitalisations or escalating violence that are reported to study staff. The counsellor will at 
an appropriate time collect information on the causes of hospitalisation or escalation of 
violence and provide a written report that will be forwarded to the ethics committee for their 
review.  
 
This research includes a number of sensitive topics. It has been well established that there is a 
potential for harm to participants in research on gender-based violence.  The most important 
concerns relate to the risk of re-victimisation of women for engagement in the study; the risk 
of retribution against perpetrators disclosing in these studies; and the risk of psychological 
distress to participants through being asked to re-remember traumatic events. 
 
The World Health Organisation developed guidance on safety in conduct of research in this 
area [62] and guidance for safe conduct of research on male perpetration of sexual violence 
has been developed by the Sexual Violence Research Initiative (Sexual Violence Research 
Initiative, forthcoming).  These documents recommend that the nature of gender-based 
violence research be concealed from non-interviewees until after the completion of fieldwork. 
The risk of retribution against men disclosing perpetration is guarded against by using self-
completion for disclosure of acts that are socially stigmatised or involve the most severe 
forms of violence. This is implemented here. In the few cases where self-completion cannot 
be implemented due to illiteracy, fieldworkers will be trained to keep information 
confidential.  The third area of risk relates to psychological distress experienced by 
participants. Research from diverse global settings (such as Nicaragua and South Africa) has 
shown that women victims of violence are saddened by talking about their exposure to 
violence but overwhelmingly they welcome a chance to talk and many describe the research 
interview as a life changing occurrence, further men who have raped can find discussing it in 
interviews makes them realise that it was wrong [53, 63-65]. Thus research has shown that if 
these guidelines are followed there are minimal risks attached to survey research on gender-
based violence [63, 66].  The present study has included the guidance from these documents 
in its design. However, in cases where participants demonstrate distress or report being 
emotionally impacted by the research questions or intervention, they will be provided 
professional support as explained below.   
 
9.7 Intervention Challenges 

 
27 
In the pilot a number of women described having arguments with their main male partners 
about their participation in the intervention (rather than research). This was related to the fact 
that they had been unable to discuss openly with their partner their participation. To minimise 
potential risk and harm participants may face we have added in additional guidance and 
focused discussion with facilitators around supporting participants to actively think through 
discussing their participation with partners or family members and the potential benefits and 
risks of this.  
 
9.8 Referral 
Project Empower will employ a counsellor who can be accessed by all participants via a cell 
phone (please call me messages) and will be able to provide support over the period of the 
study. If referral to another agency is required (e.g. to a Thuthuzela Care Centre after rape) 
the counsellor will be able to facilitate this. This will be given to all study participants. The 
decision to use Project Empower is that participants will have greater contact with Project 
Empower over the study and will be more likely to contact Project Empower – rather than 
HEARD – in the case of concerns about their wellbeing.  
 
All participants will be informed that should they feel they have been upset or affected 
negatively by the research questions or content of the intervention, they are welcome to speak 
to the study counsellor at no cost to them. All participants will be provided with the study 
counsellor’s number for them to contact.  The facilitators and research assistants will be 
trained to identify participants who are visibly distressed during the interviews or intervention 
sessions and with their permission refer them to the trial counsellor.  
 
 
9.9   Research reimbursements 
Participants in the intervention arm will receive a financial reimbursement of R100 for 
participating in the research.  This will be given after each interview. No incentives will be 
provided for intervention participation, but if an out-of-cluster site is needed for holding the 
workshops we will support travel costs to the venue. Refreshments for participants will be 
provided during the workshops.   
 
Those participating in the control arm will receive R300 per interview. This amount has been 
chosen as it is a considerable incentive to participate, and we anticipate that it will be similar 
to the child support grant monthly amount in 2015 (which was R320 in 2014).  
 
At follow up data collection points the amount of financial reimbursement and incentive for 
both arms will increase. For the intervention arm this will increase as such: baseline – R100; 
12 months – R150; 24 months – R300. For the control arm this will increase as such: baseline 
– R300; 12 months – R450; 24 months – R600.  
 
Retention in studies, particularly for control arms is highly challenging. Financial incentives 
have been used previously to improve retention.  Research elsewhere has shown that financial 
incentives alone are not enough to prevent violent experiences or practices and so we 
anticipate that we can meaningfully incentivise the control arm without interfering with the 
study main outcome.   
 
Facilitators and trial team members will receive no reimbursements for their time being 
interviewed, observed or during focus groups. If they need to travel for any specific research 
reason this will be reimbursed.  

 
28 
 
 
9.10 
Working in informal settlements 
There are significant challenges to working and researching in informal settlements. To 
minimise these risks to our fieldwork team we build on the experience of delivering the pilot. 
At baseline Project Empower will have already secured access and provide us with detailed 
information about the local community, fieldwork will take place in a secure location and 
none of the fieldworkers will carry cash. All incentives will be transferred via cell phone 
through providing a reference number.  
 
At 12 and 24 months Project Empower will once again re-establish entry to these 
communities to ensure security. In addition, they will hire community guides who will 
provide additional support as fieldworkers move around the community identifying 
participants. This has proved incredibly successful previously as community guides can 
provide local knowledge and are more likely to ensure safety. 
 
Other strategies include fieldworkers only carrying cellphones for data collection – rather 
than laptops or tablets. Cell phones have a value of R1000 and are easy to hide, compared to 
lap tops or tablets. We also brief fieldworkers on fitting in e.g. by wearing appropriate 
clothes.  
 
9.12 Additional Review bodies  
 
The University of KwaZulu Natal will also give ethics approval through its Human and 
Social Science Ethics Research Committee. 
 
9.13 Similar studies 
 
We are not aware that the MRC Ethics Committee has previously been asked to approve a 
similar study.  
 
10.0 Data handling and analysis 
 
10.1 Data management and data analysis from the main RCT 
 
All data will be co-owned by HEARD, the MRC and Project Empower.  
 
Data will be uploaded by wireless from cell phones. The cell phone system is likely to be 
Mobenzi researcher. This is an online system that will automatically upload data if a 
connection is available. Given that this is in urban settings it is highly likely that a 3G 
connection will be continually available. If no signal is available, the cell phone stores the 
data until a connection is available. The cell phones have approximately 8 hours of battery 
time. Every evening they will be charged in readiness for the next day of work.  
 
There is no direct data entry stage. The data is wireless uploaded onto a web-based data base 
that is preconfigured into the necessary dimensions. On a weekly basis the data base will be 
downloaded on to a staff computer in excel before being entered into STATA. Data will be 
managed, cleaned and stored by the Medical Research Council Gender and Health Research 
Unit. Data analysis for the main study outcomes will be conducted by the MRC Biostatistics 
Unit. 

 
29 
 
10.2 Data analysis 
The main analysis will be by intention to treat but a per protocol analysis will also be 
conducted as a secondary analysis.  
 
Any participant who responds affirmatively to any one of the five questions on physical 
intimate partner violence or three questions on sexual intimate partner violence in the past 12 
months at the 24 month data collection points will be deemed to be an incident case of IPV 
victimisation (if female) or perpetration (if male).   
 
IPV incidence will be compared between the study arms. The person years of exposure will 
be estimated as the time from the baseline to the first report of IPV (if this is reported during 
the study) or to the last interview, if they remain IPV free at the end of the study.  Separate 
analyses will be done for males and females.  The primary analysis will be carried out by 
fitting a Poisson regression model, which will terms for age of participant, cluster, baseline 
prevalence of IPV (for males or females) and treatment (arm).  For each secondary outcome a 
Generalised Linear Mixed Models (GLMMs) will be fitted with similar terms as in the 
Poisson regression model for the main outcome. These will be fitted for time from baseline to 
interview (12 months and 24 months).    Secondary analysis of the main outcome will also be 
done using a multi-level model for change. Generalised Linear Mixed model for binary 
outcome will be used.  
 
Analyses for secondary outcomes will follow the same approach for variables where 
incidence can be measured. For outcomes using scales, the difference in the score/scale 
between baseline and 24 months measure will be assessed. For each of the scales a linear 
mixed model will be fitted with fixed terms for treatment arm. Separate models will be fitted 
for males and females. The scores will be directly calculated from the component items, 
while the scales will combine the items using weights determined by carrying out a principal 
component analysis on the items at baseline (separately for males and females), and using the 
loadings for the first principal component as the weight for each item. The baseline weights 
(separate for males and females) will be used to construct the scale at each time point. These 
analyses will firstly be carried out in the ITT population and then repeated for the per 
protocol population. 
 
For any categorical variables where incidence cannot be calculated the following approach 
will be taken. First a cluster level analysis will be carried out with the response being the 
overall cluster proportion of participants who reported the practice, with this cluster level 
proportion being calculated separately for males and females. This response will be compared 
between clusters using an analysis of covariance model with terms for the overall cluster 
proportion of participants (males or females respectively) who reported the practice at 
baseline and treatment arm. The model will give the rate difference for the practice for 
participants in one arm versus those in the comparison, together with 95% confidence limits 
and a test of the null hypothesis that there is no difference between the two study arms in the 
proportion of participants who reported the practice. Separate estimates will be given for 
males and females as for the other responses. Further individual level analyses will be carried 
out by fitting Generalized Linear Mixed Models to the binary outcome variable.  The model 
will have fixed terms for treatment arm and whether or not the participant reported the 
practice at baseline, with separate models fitted for males and females. 
Costing Analysis 

 
30 
In order to estimate the total cost of the SS/CF intervention, the cost of both the retrospective 
and prospective components of the study outlined above will be analysed. This includes the 
direct and indirect costs from the perspective of the service providers and the participants. 
Research related costs will be excluded from the analysis.  
 
In order to conduct the cost-effectiveness analysis, incremental cost-effectiveness will be 
calculated using primary and selected secondary outcomes of the SS/CF intervention. The 
primary outcome in the RCT is incidence in the past year of intimate partner violence 
(perpetration of physical and/or sexual IPV for men and victimisation for women), including 
change in controlling behaviour. Key secondary outcomes include gender attitudes; 
depression; problem drinking; sexual behaviour and mean earnings in last month. The time 
and motion data will be used together with the salary costs paid to the facilitators to identify 
the proportion of labour resources used and costs relating to core activities in the 
intervention, administrative activities and non-core activities.  
 
Costs and outcomes are compared against the control group, who receive no intervention in 
the initial timeframe as set out in the RCT design. Cost-effectiveness will be assessed as the 
intervention cost per participant divided by the effectiveness of the intervention.  
 
The cost data collected at different time points in the study will also be used to estimate the 
incremental efficiency gains as the facilitators become familiar with the intervention and the 
material they present. These data will be used to better understand resource use as the 
intervention rolls out and has implications for estimating the costs of scale-up. 
 
We will use a standard annual discount rate of 3%, and run sensitivity analyses will be 
conducted using local discount rates, to check the robustness of results to these changes. 
Total costs will be reported in USD2017, using official exchange rates.  
 
Concentrating on health outcomes exclusively would not do it justice and risk overlooking a 
large portion of its impact. Therefore impact on economic outcomes – including income, 
consumption, savings behaviour and preferences – will be assessed using the main analysis 
model, similarly to main outcomes, and analysed alongside willingness to pay. Estimation of 
willingness to pay will be based on participant responses to an open-ended contingent 
valuation question, and will include a multivariable regression analysis to identify key 
predictors of willingness to pay. This will not only provide a full representation of 
intervention impact, but also contextualise the willingness to pay results in relation to 
participants’ socio-economic status and relevant changes as a consequence of the 
intervention. 
 
11.0 Challenges  
 
We recognise that attendance at the intervention will be voluntary, the intervention is long 
and it is difficult to know exactly what the level of sustained participation will be. We will 
collect data on attendance so that we can use this information in the data analysis. In the pilot 
study we found approximately 60% of sessions were attended, and this showed promise of 
impact. We do not expect attendance to be lower than in the pilot. We also may encounter 
loss to follow up. We have inflated the necessary sample size to allow for a possible 40% loss 
to follow up without critical loss of power for the evaluation. Retention of participants is 
always a challenge in cohorts and plans for this are outlined below.  
 

 
31 
Informal settlements are tricky areas to work in because they can be dangerous for staff and 
also sometimes have quite complex local politics. Project Empower has been working in 
informal settlements in Durban since it was established 13 years ago and so we are confident 
that they have the necessary understanding of the issues in these areas to be able to undertake 
the mobilisation for the study and intervention safely.  
 
11.0 Dissemination 
The trial will be registered on clinicaltrials.gov and information about the trial is available on 
the What Works to Prevent Violence website (www.whatworks.co.za). The Stepping Stones 
manual is available through the MRC and the Creating Futures manual can be found on the 
HEARD website [67]. A paper on the methodology used and the main study findings from 
the RCT will be published in international peer reviewed journal articles.  
 
The study team will form a local stakeholder group with representatives of participating 
communities through the structures consulted for consent, representatives from provincial 
Government in KwaZulu-Natal and NGOs working in similar areas who will be informed of 
the trial and emerging results. One meeting of this stakeholder group will be held annually for 
the four year duration of the project. During these meetings, participants will be informed 
about project progress, consulted on challenges, and informed of findings as these emerge. 
 
 Information about the trial will be disseminated to conferences and at meetings with 
stakeholders in the health, violence, gender and economic empowerment fields.  Multiple 
strategies will be used to disseminate the important learnings that will be gained and to 
ensure the integration of these lessons into practices at a provincial level and beyond where 
possible. These strategies include: meetings and workshops, written outputs including fact 
sheets and brochures; global dissemination and discussions via SVRI platforms and activities. 
Initially, meetings will be held with decision-makers, both provincially and nationally to 
inform them of the project and to invite them to form part of the advisory bodies. Once these 
bodies have been established, regular meetings will be scheduled to keep members informed 
of project progress and to get input on various aspects of the project. Fact sheets, briefing 
papers and presentations will be developed to support project activities and assist with 
sharing project outcomes.  
 
Finally, a national workshop with policy makers, community members, donors and other 
stakeholders will held to discuss the findings of the project and map a way forward for 
scaling up.  
 
In addition, the team will create a short film (approximately 5 minutes) using interviews with 
facilitators and participants about their experiences of the intervention and the approach. The 
film will be ‘promotional’ and emphasise positive aspects of the intervention and approach.  
The film rationale is outlined in Appendix 33, with a short topic guide (Appendix 34) and 
informed consent for the participation in the film (Appendix 35).  
 
 
12.0 Timeline 
 
 
Jan-Jun 
2015 
Jul-Dec 
2015 
Jan-Jun 
2016 
Jul-Dec 
2016 
Jan-Jun 
2017 
Jul-Dec 
2017 
Jan-Jun 
2018 
Jul-Dec 
2018 
Community mobilisation in Durban 
informal settlements  

 
32 
Gain ethics approval and access for 
the study 
 
 
 
Develop questionnaire and 
evaluation materials, gain ethics 
approval 
 
 
 
Intervention delivery (Stepping 
Stones/ Creating Futures) 
 
 
 
Baseline measures 
 
 
 
 
12 month follow up 
24 month follow up 
Data analysis 
Writing  
Dissemination including finalising 
and publishing curriculum 
 
13.0 Funding 
 
The research is funded by the United Kingdom Government’s Department for International 
development (DFID).  
 
The total project for the budget is £800,000. The summary of the budget is provided here. 
 
 
2015 
2016 
2017 
2018 
Intervention 
£150,000 
 
 
 
Fieldwork R1 
£80,000 
 
 
 
Fieldwork R2 
 
£120,000 
 
 
Fieldwork R3 
 
 
£150,000 
 
Data analysis 
 
 
£50,000 
£50,000 
Control Intervention 
 
 
 
£200,000 
 
 

 
33 
 
14.0 Details of researchers 
 
CURRICULUM VITAE FOR ANDREW ROBERT GIBBS 
 
Title of study/ Research proposal: Stepping Stones and Creating Futures Intervention 
Trial 
 
Protocol no if applicable:  N/A 
 
Designation/ Profession: Researcher, Health Economics and HIV/AIDS Research 
Division (HEARD), University of KwaZulu-Natal 
 
1. Personal Details 
Name 
Andrew Robert Gibbs 
Tel. no. 
 
Address 
HEARD, Private Bag 
X54001, Durban, 4000 
Work tel. no. 
031 260 7737 
 
 
Fax no. 
031 260 2587 
 
 
Cell phone no 
079 342 1918 
 
 
Email  
gibbs@ukzn.ac.za 
 
 
 
 
2.  Academic and professional qualifications 
 
 
 
 
Degree 
Field of study  
University  
Year 
PhD 
Psychology 
UKZN 
In progress (being marked) 
MSc 
Social Psychology 
London School of 
Economics 
2006 
BSc (Hons) 
Economics and 
Development 
University of 
Bath 
2004 
 
 
 
 
 
 
3.  Professional body registration number if applicable  
        PLEASE ATTACH COPY: N/A 
 
4. Current personal medical malpractice insurance details [medical and dental 
practitioners] where applicable 
 
  
5. Relevant related work experience (brief) and current position 
 
Period 
Position 
Employer 
2008- Present 
Researcher 
HEARD, UKZN 
2007-2008 
Research Fellow, HIVAN 
UKZN 
2006-2007 
Research Assistant 
LSE 
 
 
 
 
6.  Participation in research in the last three years (title, protocol number, designation) [If 
multiple proposals/ studies, only list those with relevance to this application, or in the last 
year.]  
 

 
34 
Protocol ID: N/A 
Protocol title: A two-pronged service and community mobilisation intervention to reduce 
gender-based violence and HIV vulnerability in rural South Africa. Canadian Institute for 
Health Research (CIHR), 2011-2016 
Designation: Co-Investigator 
 
Protocol ID: N/A 
Protocol title: Sexual & reproductive health and rights of young people living with HIV 
Designation: Co-PI 
 
Protocol ID: N/A 
Protocol title: The development and evaluation of gender transformative and livelihood 
strengthening intervention to reduce IPV in urban informal settlements, South Africa 
Designation: Co-PI 
 
Protocol ID: N/A 
Protocol title: A three-year follow up to the Community Responses to HIV/AIDS Project 
Designation: Co-PI 
 
7.  Peer-reviewed publications in the past 3 years 
1. 
Gibbs, A., Campbell, C. & Maimane, S. (2014) Can local communities ‘sustain’ 
HIV/AIDS programmes? A South African example. Health Promotion International 
2. 
Gibbs, A., Jewkes, R., Sikweyiya, Y. & Willan, S. (2014) Reconstructing 
Masculinities? A qualitative outcomes evaluation of Stepping Stones and Creating 
Futures. Culture, Health and Sexuality 
3. 
Stern, E., Cooper, D. & Gibbs, A. (2014) Gendered differences among South African 
men and women’s informal sources and evaluation of information related to sex and 
HIV risk. Sex Education 
4. 
Olinyk, S., Gibbs, A. & Campbell, C. (2014) Implementing global gender policy to 
reduce HIV/AIDS in low-and middle -income countries: Policy makers’ perspectives. 
African Journal of AIDS Research 
5. 
Gibbs, A., Campbell, C., Akintola, O. & Colvin, C. (2014) Creating social spaces for 
effective peer-to-peer communication: three case studies of the role of volunteers in 
HIV/AIDS communication in South Africa. Journal of Applied and Community 
Social Psychology 
6. 
Gibbs, A., Jewkes, R., Mbatha, N., Washington, L. and Willan, S. (2014) Jobs, food, 
taxis and journals: complexities of implementing a structural and behavioural 
intervention in urban South Africa. AJAR 13:2, 161-167 
7. 
Gibbs, A., Jewkes, R. & Sikweyiya, Y. (2014) “Men value their dignity”: securing 
respect and identity construction in urban informal settlements in South Africa. 
Global Health Action. 7: 23676 
8. 
Zelnick, J., Gibbs, A., Loveday, M., Padayatchi, N. & O’Donnell, M. (2013) Health 
Care Worker Perspectives on Workplace Safety, Infection Control and Drug-Resistant 
Tuberculosis in a High Burden HIV setting. Journal of Public Health 
Policy.34(3):388-402 
9. 
Gibbs, A., Crone, E.T., Willan, S. & Mannell, J. (2012) The inclusion of women, girls 
and gender equality in National Strategic Plans for HIV and AIDS in southern and 
eastern Africa. Global Public Health. 7:10, 1120-1144. 

 
35 
10. 
Gibbs, A., Mushinga, M., Crone, E.T., Willan, S. & Mannell, J. (2012) How do 
National Strategic Plans for HIV and AIDS in southern and eastern Africa integrate 
gender-based violence? Health and Human Rights. 14(2), 1-11. 
11. 
Daku, M., Gibbs, A. & Heymann, J. (2012) Representations of MDR and XDR-TB in 
South African Newspapers. Social Science and Medicine, 75, pp. 410-418. 
12. 
Gibbs, A., Willan, S., Misselhorn, A. & Mangoma, J. (2012) Structural Interventions 
for Gender Equality and Livelihood Security: A critical review of the evidence from 
southern and eastern Africa. JIAS – Journal of the International AIDS Society, 
15(S2): 17362 
13. 
Campbell, C., Nair, Y., Maimane, S., Sibiya, Z. & Gibbs, A. (2012) Dissemination as 
Intervention: Building local AIDS competence through the report-back of research 
findings to a South African rural community. Antipode, 44(3), p702-724 
 
8.  Any additional relevant information supporting abilities to participate in conducting 
this trial. [Briefly] 
 
 
NAME IN FULL: ANDREW ROBERT GIBBS 
 
 
 
 
 
 
 
22/1/2015 
___________________ 
 
 
 
 
     _______________ 
Signature:  
 
 
 
 
 
 
 
  Date: 

 
36 
 
CURRICULUM VITAE FOR RACHEL KATHERINE JEWKES 
 
Title of study/ Research proposal: Stepping Stones and Creating Futures Intervention 
Trial  
Protocol no if applicable: N/A   
 
Designation/ Profession: Director (Gender and Health Research Unit) 
 
1. Personal Details 
Name 
Rachel  Katharine 
Jewkes 
Tel. no. 
 
Address 
Gender and Health 
Research Unit, MRC, 
Private Bag X385, 
Pretoria 0001 
Work tel. no. 
012 339 8525 
 
 
Fax no. 
012 339 8582 
 
 
Cell phone no 
0824423655 
 
 
Email  
rjewkes@mrc.ac.za 
 
 
 
 
2.  Academic and professional qualifications 
 
 
 
 
Degree 
Field of study  
University  
Year 
MBBS 
Medicine 
St Thomas’ Hospital, University 
of London 
1986 
MSc Community  
Medicine 
Public Health 
London School of Hygiene 
& Tropical Medicine, University 
of London 
1991 
MFPHM 
Public Health 
Medicine 
North Thames Regional Health 
Authority, London UK 
1993 
Doctor of Medicine (MD) 
Public Health 
London School of Hygiene 
& Tropical Medicine, University 
of London 
1994 
 
 
3.  Professional body registration number if applicable  
        PLEASE ATTACH COPY: 
 
4. Current personal medical malpractice insurance details [medical and dental 
practitioners] where applicable 
 
  
5. Relevant related work experience (brief) and current position 
 
Period 
Position 
Employer 
2001- Present 
Director, Gender and Health  
Research Unit 
MRC 
1997 - 2000 
Division Head: CERSA 
MRC 
1995 - 1996 
Specialist Scientist & Coordinator: 
 CERSA 
MRC 

 
37 
 
 
 
 
6.  Participation in research in the last three years (title, protocol number, designation) [If 
multiple proposals/ studies, only list those with relevance to this application, or in the last 
year.]  
 
 Protocol ID: EC022-9/2012  
Protocol title: SHARE: Schools intervention for healthier relationships evaluation 
Designation: PI 
7.  Peer-reviewed publications in the past 3 years 
1. 
Mathews S, Abrahams N, Jewkes R. Exploring Mental Health Adjustment of Children 
Post Sexual Assault in South Africa. Journal of Child Sexual Abuse 2013; 22:639–
657. 
2. 
Jina R, Jewkes R, Hoffman S, Dunkle K, Nduna M, Jama Shai N. (2012) Adverse 
health outcomes associated with emotional abuse in young rural South African 
women: a cross-sectional study. Journal of Interpersonal Violence. 27(5):862-80  
3. 
Sikweyiya Y, Jewkes R (2012) Potential Research participants’ motivations and 
perceived risks in research participation: Reflections on the implications of ethics in 
health research. PLoS One 7(4): e35495. doi:10.1371/journal.pone.0035495 
4. 
Jewkes R, Morrell R, Sikweyiya Y, Dunkle K, Penn-Kekana L. Transactional 
relationships and sex with a woman in prostitution: prevalence and patterns in a 
representative sample of South African men. BMC Public Health 2012, 12:325 
doi:10.1186/1471-2458-12-325 
5. 
Jewkes R, Nduna M, Jama Shai N, Dunkle D. (2012) Prospective study of rape 
perpetration by young South African men:  incidence & risk factors. PLoS One 7(5), 
e38210. 
6. 
Sikweyiya Y, Jewkes R ‘Why did they want to know if I hit you?’ Perceptions and 
experiences of research participants on gender-based violence community based 
survey: Implications for ethical guidelines to protect participants. Qualitative Health 
Research 2013 Jul;23(7):999-1009. Epub 2013 May 9. 
7. 
Jewkes R, Morrell R, Sikweyiya Y, Dunkle K, Penn-Kekana L. (2012) Men, sex and 
the provider role: Crime, violence, correlated psychological attributes associated with 
South African men’s engagement in prostitution and transactional sex in South Africa. 
Plos One 7(7): e40821. doi:10.1371/journal.pone.0040821 
8. 
Jama-Shai N, Jewkes R, Nduna M, Dunkle K. Masculinities and condom use patterns 
among young rural South Africa men: a cross-sectional baseline survey.  BMC Public 
Health 2012, 12:462 doi:10.1186/1471-2458-12-462 
9. 
Jewkes R, Sikweyiya Y, Nduna M, Jama Shai N, Dunkle K Motivations for, and 
perceptions and experiences of participating in a cluster randomized controlled trial of 
a HIV behavioural intervention in rural South Africa. Culture Health & Sexuality 
2012 Nov;14(10):1167-82. doi: 10.1080/13691058.2012.717305. Epub 2012 Sep 14  
10. 
Gevers A, Jewkes R, Mathews C, Flisher A, “I think it’s about experiencing, like, 
life”: A qualitative exploration of contemporary adolescent intimate relationships in 
South Africa. Culture, Health & Sexuality 2012 Nov;14(10):1125-37. doi: 
10.1080/13691058.2012.723752. Epub 2012 Sep 20. 
11. 
Nduna M, Jewkes R. Denied and disputed paternity in teenage pregnancy: Topical 
Structural Analysis of case studies of young women from the Eastern Cape Province, 
South Africa. Social Dynamics 2012; 38(2): 314-330. 

 
38 
12. 
Jewkes R,  Dunkle K, Nduna M, Jama-Shai N (2012). Transactional sex and HIV 
incidence in a cohort of young women in the Stepping Stones trial. Journal of AIDS & 
Clinical Research  3:158. doi:10.4172/2155-6113.1000158 
13. 
Abrahams N, Jewkes R (2012) Managing and resisting stigma: a qualitative study 
among people living with HIV in South Africa. Journal of the International AIDS 
Society 15, 17330. http://dx.doi.org/ 10.7448/IAS.15.2.17330 
14. 
Dartnall E, Jewkes R (2013) Sexual violence against women: the scope of the 
problem. Best Practice & Research Clinical Obstetrics & Gynaecology 27(1):3-13 
15. 
Abrahams N, Jewkes R, Mathews S. Depressive symptomatology after a sexual 
assault: Understanding victim-perpetrator relationships and the role of social 
perceptions. African Journal of Psychiatry 2013;16:288-293. 
16. 
Nduna M, Jewkes R, Colman I. Prevalence and factors associated with depressive 
symptoms among young women and men in the Eastern Cape, South Africa. Journal 
of Child and Adolescent Mental Health (in press) 
17. 
Mayosi BM, Lawn JE, van Niekerk A, Bradshaw D, Abdool Karim SS, Coovadia 
HM; Lancet South Africa team. Health in South Africa: changes and challenges since 
2009. Lancet. 2012 Dec 8;380(9858):2029-43. doi: 10.1016/S0140-6736(12)61814-5. 
Epub 2012 Nov 30. 
18. 
Abrahams N, Mathews S, Jewkes R,  Martin LJ, Lombard C (2013) Intimate femicide 
in South Africa: repeat retrospective survey. PLoS Med 10(4): e1001412. 
doi:10.1371/journal.pmed.1001412 
19. 
Wechsberg WM, Jewkes R, Novak S, Kline K, Myers B, Browne FA, Carney T, 
Morgan Lopez AA, Parry C. A Brief Intervention for Drug Use, Sexual Risk 
Behaviours, and Violence Prevention with Vulnerable Women in South Africa: A 
Randomised Trial of the Women's Health Co-Op BMJ Open 2013 May 28;3(5). 
doi:pii: e002622. 10.1136/bmjopen-2013-002622. Print 2013. 
20. 
Dunkle KL, Jewkes R, Murdock DW, Sikweyiya Y, Morrell R Prevalence of 
consensual male-male sex and sexual violence, and associations with HIV in South 
Africa: a population-based cross-sectional study. Plos Med 10(6): e1001472. 
doi:10.1371/journal.pmed.1001472  
21. 
Gevers A, Jewkes R, Mathews C, Cupp P, Russell M Illegal yet developmentally 
normative: Young, urban adolescents’ dating and sexual behaviour in South Africa 
Illegal yet developmentally normative: Young, urban adolescents’ dating and sexual 
behaviour in South Africa. BMC International Health 2013 Jul 10;13(1):31. [Epub 
ahead of print] 
22. 
Mathews S, Abrahams N, Jewkes R, Lombard C, Martin L. The Epidemiology of 
Child Homicides in South Africa Research. World Health Bulletin  2013;91:562–568 | 
doi: http://dx.doi.org/10.2471/BLT.12.117036 
23. 
Jina R, Jewkes R, Christofides N Knowledge and confidence of South African health 
care providers regarding post-rape care: a cross-sectional study. BMC Health Services 
Research 2013, 13:257 doi:10.1186/1472-6963-13-257 
24. 
Jewkes R Intimate partner violence: the end of routine screening. The Lancet 2013; 
Apr 15. pii: S0140-6736(13)60584-X. doi: 10.1016/S0140-6736(13)60584-X 
25. 
Gevers A, Jewkes R, Mathews C. What do adolescents think makes their relationships 
good? An exploratory analysis of factors associated with South African adolescents’ 
assessments of their dating relationships. Culture Health and Sexuality 
2013;15(9):1011-25. doi: 10.1080/13691058.2013.803295. Epub 2013 Jun 27. 
26. 
Morrell R, Jewkes R, Lindegger G, Hamlall V. (2013) Hegemonic Masculinity: 
Reviewing the Gendered Analysis of Men's Power in South Africa. South African 
Review of Sociology 44 (1),  3-21. 

 
39 
27. 
Russell M, Cupp P, Jewkes R, Gevers A, Mathews C, LeFleur-Bellerose C, Small J. 
Intimate Partner Violence among Adolescents in Cape Town, South Africa. 
Prevention Science 2013 Jun 8. [Epub ahead of print] 
28. 
Nduna M, Jewkes R, Dunkle K, Jama-Shai N, Coleman I (2013) Prevalence and 
factors associated with depressive symptoms among young women and men in the 
Eastern Cape Province, South Africa Journal of Child and Adolescent Mental Health 
25(1), 35-42. 
29. 
Mathews S, Abrahams N, Jewkes R, Martin LJ. (2013) Under-reporting child abuse 
deaths: experiences from a national study on child homicide. S Afr Med J. 
Mar;103(3):132-3. 
30. 
Jewkes R, Fulu E, Roselli T, Garcia-Moreno C (2013) Prevalence and risk factors for 
non-partner rape perpetration: findings from the UN Multi-country Cross-sectional 
Study on Men and Violence in Asia and the Pacific. The Lancet Global Health 
Published online September 10, 2013 http://dx.doi.org/10.1016/S2214-
109X(13)70069-X e1 
31. 
Fulu E, Jewkes R, Roselli T, Garcia-Moreno C (2013) Prevalence and risk factors for 
male perpetration of intimate partner violence: findings from the UN Multi-country 
Cross-sectional Study on Men and Violence in Asia and the Pacific. The Lancet 
Global Health Published online September 10, 2013 http://dx.doi.org/10.1016/S2214-
109X(13)70074-3 
32. 
Christofides N, Jewkes R, Dunkle K, Nduna M, Jama-Shai N, Sterk C. Early 
pregnancy increases risk of incident HIV infection in the Eastern Cape, South Africa: 
a prospective study.  Journal of the International AIDS Society. 2014 Mar 
19;17(1):18585. doi: 10.7448/IAS.17.1.18585. eCollection 2014. 
33. 
Gibbs A, Sikweyiya Y, Jewkes R. (2014) “Men value their dignity”: securing respect 
and identity construction in urban informal settlements in South Africa. Global Health 
Action 7, 23676. 
34. 
Gibbs A, Jewkes R, Mbatha N, Washington L, Willan S. (2014) Jobs, food, taxis and 
journals: complexities of implementing Stepping Stones and Creating Futures in 
urban informal settlements in South Africa. AJAR 13(2):161-7. doi:  
10.2989/16085906.2014.927777. 
35. 
Gibbs, Jewkes R, Sikweyiya Y, Willan S. (2014) Reconstructing Masculinity? A 
qualitative evaluation of the Stepping Stones and Creating Futures intervention in 
urban informal settlements in South Africa. Culture, Health & Sexuality 
http://dx.doi.org/10.1080/13691058.2014.966150. 
36. 
Christofides NJ, Jewkes RK,  Dunkle KL, McCarty F, Jama Shai N,  Nduna M, Sterk 
CE. (2014)  Risk factors for unplanned and unwanted teenage pregnancies over two years 
of follow up among a cohort of young South African women  Global Health Action 
7:23719 http://dx.doi.org/10.3402/gha.v7.23719 
37. 
Christofides N, Jewkes R, Dunkle K, Nduna M, Jama-Shai N. (2014) Perpetration of 
physical and sexual abuse and subsequent fathering of pregnancies among a cohort of 
young South African men. BMC Public Health 14:947. doi: 10.1186/1471-2458-14-
947. 
38. 
Jewkes R, Sikweyiya Y, Jama-Shai N (2014) The challenges of research on violence 
in 
post-conflict 
Bougainville. 
The 
Lancet 
June 
10, 
2014 
http://dx.doi.org/10.1016/S0140-6736(14)60969-7 
39. 
Jewkes R, Gibbs A, Jama-Shai N, Willan S, Misselhorn S, Mushinga M, Washington 
L,  Mbatha N, Sikweyiya Y. (2014) Stepping Stones and Creating Futures 
Intervention: Outcomes of a shortened interrupted time series evaluation of 

 
40 
behavioural and structural intervention for young people in informal settlements in 
Durban, South Africa BMC Public Health 1325: DOI 10.1186/1471-2458-14-1325 
40. 
Sikweyiya Y, Dunkle K, Jewkes R (2014) Impact of HIV on and the constructions of 
masculinities among HIV positive men in South Africa: Implications for secondary 
prevention programs. Global Health Action  7: 24631 -
 http://dx.doi.org/10.3402/gha.v7.24631 
41. 
Jewkes R, Flood M, Lang J (2014) From working with men and boys to changing 
social norms and reducing inequities in gender relations: a paradigm shift in 
prevention of violence against women and girls. The Lancet  
 http://dx.doi.org/10.1016/ S0140-6736(14)61683-4 
42. 
Mathews S, Jewkes R, Abrahams N. (2014) “So now I’m the man”: Intimate partner 
femicide and its interconnections with expressions of masculinities in South Africa. 
British Journal of Criminology. doi:10.1093/bjc/azu076 
43. 
Jewkes R (2014) (How) Can we reduce gender-based violence by 50% over the next 
30 years? Plos Medicine 11(11): e1001761. doi:10.1371/journal.pmed.1001761 
44. 
Jewkes R. (2015) SHARE: a milestone in joint programming for HIV and intimate 
partner violence. The Lancet Global Health vol 3 
http://www.thelancet.com/pdfs/journals/langlo/PIIS2214-109X(14)70374-2.pdf 
45. 
Jina R, Jewkes R, Vetten L, Christofides N, Sigsworth R, Loots L (in press) Genito-
anal injury patterns and associated factors in rape survivors in an urban province of 
South Africa: a cross-sectional study. BMC Public Health 
8.  Any additional relevant information supporting abilities to participate in conducting 
this trial. [Briefly] 
Honors 
 NRF Rating 2011  
 
A2 
 
 Acting MRC President  
 
 
 
 
December 2012-January 
2013 
 
 Acting Vice-President (Research Support)  
 
February2013–
September 2014 
 
 Millenium Health Award. International award to support cooperation in health 
research for development. Rockefeller Foundation, 2000.  
 Polgar prize, professional prize for the best paper published in Medical Anthropology 
Quarterly in 2008 for paper "Showing Roughness in a Beautiful Way": Talk about 
Love, Coercion, and Rape in South African Youth Sexual Culture.  
 Appointed by the Director General of the World Health Organisation as a member of 
the WHO Expert Advisory Panel on Injury and Violence Prevention and Control from 
1 June 2010 for four years.  Renewed in 2014.  
 Appointed by PEPFAR to their Scientific Advisory Board, established in 2010.   
 Appointed as a member of WHO's Strategic and Technical Advisory Committee for 
HIV-AIDS (STAC-HIV) for the period 2011 – 2012 
 2014 Thomsons Reuters World’s Most Highly Influential Scientific Minds list 
 2014 awarded Gold Medal by the Medical Research Council of South Africa 
 Secretary of the Sexual Violence Research Initiative from 2006- present, this is a 
global initiative to promote evidence based action to end sexual violence  

 
41 
 Appointed as a member of WHO's Strategic and Technical Advisory Committee for 
HIV-AIDS (STAC-HIV) for the period 2011 – present 
 Steering Group, WHO guidelines on the health sector response to partner violence 
and sexual violence. 2010-2013 
 Member of the Expert Group on Intimate Partner Violence, Childhood Sexual Abuse 
and Non-partner Sexual Violence, Global Burden of Disease Study 2008-12 
 Steering Committee Member for the WHO Multi-Country Study on Domestic 
Violence Against Women. From 1998 - 2006 
 
 
NAME IN FULL: RACHEL KATHARINE JEWKES 
 
 
 
 
 
 
 
22/1/2015 
___________________ 
 
 
 
 
     _______________ 
Signature:  
 
 
 
 
 
 
 
  Date: 
 

 
42 
CURRICULUM VITAE FOR ESNAT DOROTHY CHIRWA 
 
Title of study/ Research proposal: Stepping Stones and Creating Futures Intervention 
Trial  
 
Protocol no if applicable:  N/A 
 
Designation/ Profession: Senior Statistician, Gender & Health Research Unit 
 
1. Personal Details 
NAME 
 
 
 
ADDRESS 
Gender and Health 
Research Unit, MRC, 
Private Bag X385, 
Pretoria 0001 
Work tel. no. 
012 339 8556 
 
 
Fax no. 
012 339 8582 
 
 
Cell phone no 
072 119 3527 
 
 
Email  
Esnat.Chirwa@mrc.ac.za 
 
 
 
 
2.  Academic and professional qualifications 
 
 
 
 
Degree 
Field of study  
University  
Year 
BSc 
Statistics and 
Computer Science  
University of Malawi 
1994 
Post-grad. Diploma 
Statistics 
University of Reading, UK 
2001 
MSc 
Biometry 
University of Reading, UK 
2002 
 
3.  Professional body registration number if applicable  
        PLEASE ATTACH COPY:  N/A 
 
4. Current personal medical malpractice insurance details [medical and dental 
practitioners] where applicable 
 
  
5. Relevant related work experience (brief) and current position 
 
Period 
Position 
Employer 
2014- present 
Senior Statistician 
MRC 
2010-2014 
PhD student/ Faculty  
Biostatistics Tutor 
University 
Witwatersrand 
2004-2013 
Lecturer 
University of Malawi 
1994-1998 
High School Maths Teacher 
Mulunguzi Sec Sch. 
 
6.  Participation in research in the last three years (title, protocol number, designation) [If 
multiple proposals/ studies, only list those with relevance to this application, or in the last 
year.]  
  
 

 
43 
 
7.  Peer-reviewed publications in the past 3 years 
1. Gradidge PJ, Crowther NJ, Chirwa ED, Norris SA, Micklesfield LS: Patterns, levels 
and correlates of self-reported physical activity in urban black Soweto women.  BMC 
Public Health 2014, 14:934  doi:10.1186/1471-2458-14-934 
2. Chirwa E.D, Griffiths PL, Maleta K, Ashorn P, Pettifor J.M, Norris S.A. Postnatal 
growth velocity and overweight in early adolescents: A comparison of rural and urban 
African boys and girls.  American Journal of Human Biology. 2014 Jun; 26(5): 643-
651. 
3. Chirwa ED, Griffiths PL, Maleta K, Norris SA, Cameron N. Multi-level modelling of 
longitudinal child growth data from the Birth-to-Twenty Cohort: a comparison of 
growth models. Annals of Human Biology. 2014 Mar; 41(2):166-177.  
4. Chirwa T.F., Nyasulu P.S., Chirwa E.D., Ketlogetswe A., Bello G.A., Dambe I., 
Ndalama D., Joshua M.C. Treatment adherence levels in the intensive and 
continuation phases among pulmonary TB patients from Zomba Central Hospital, 
Malawi, 2007-8. PLOS One 8(5): e63050. doi:10.1371/journal.pone.006305 
 
 
8.  Any additional relevant information supporting abilities to participate in conducting 
this trial. [Briefly]  
 
HONOURS AND AWARDS 
 
 
      
NAME IN FULL: Esnat Dorothy Chirwa 
 
 
 
_____________ 
 
 
 
 
                23-01-2014 
Signature:   
 
 
 
 
 
 
  Date: 
 

 
44 
CURRICULUM VITAE FOR NWABISA JAMA SHAI 
 
Title of study/ Research proposal: Stepping Stones and Creating Futures Intervention 
Trial 
 
Protocol no if applicable:  N/A 
 
Designation/ Profession:  
 
1. Personal Details 
 
Name 
Nwabisa Jama Shai 
Tel. no. 
012 3398528 
Address 
1 Soutpansberg Rd 
Work tel. no. 
012 3398528 
 
Pretoria 
Fax no. 
012 3398582 
 
 
Cell phone no 
0719003651 
 
 
Email  
nshai@mrc.ac.za 
 
 
 
 
2.  Academic and professional qualifications 
 
 
 
 
Degree 
Field of study  
University  
Year 
Masters in Public Health  
Public Health 
Western Cape 
2006 
Diploma in Public Health  Public Health 
Western Cape 
2004 
 
 
3.  Professional body registration number if applicable  
        PLEASE ATTACH COPY: N/A 
 
4. Current personal medical malpractice insurance details [medical and dental 
practitioners] where applicable 
 
  
5. Relevant related work experience (brief) and current position 
 
Period 
Position 
Employer 
Jan 2011- present 
Senior Scientist 
Medical Research Council  
Aug 2012 - present 
Honorary Lecturer 
University of the Witwatersrand 
Jul 2009-Jul 2010 
Research Manager 
Gender Links 
Apr 2005-Jun 2007 
Scientist 
Medical Research Council  
 
6.  Participation in research in the last three years (title, protocol number, designation) [If 
multiple proposals/ studies, only list those with relevance to this application, or in the last 
year.]  
 
None.  
7.  Peer-reviewed publications in the past 3 years 
  
1. 
Jina R, Jewkes R, Hoffman S, Dunkle K, Nduna M, Jama Shai N. (2012) Adverse 
health outcomes associated with emotional abuse in young rural South African 
women: a cross-sectional study. Journal of Interpersonal Violence. 27(5):862-80  
2. 
Jewkes R, Nduna M, Jama Shai N, Dunkle D. (2012) Prospective study of rape 
perpetration by young South African men:  incidence & risk factors. PLoS One 7(5), 
e38210. 

 
45 
3. 
Jama-Shai N, Jewkes R, Nduna M, Dunkle K. Masculinities and condom use patterns 
among young rural South Africa men: a cross-sectional baseline survey.  BMC Public 
Health 2012, 12:462 doi:10.1186/1471-2458-12-462 
4. 
Jewkes R, Sikweyiya Y, Nduna M, Jama Shai N, Dunkle K Motivations for, and 
perceptions and experiences of participating in a cluster randomized controlled trial of 
a HIV behavioural intervention in rural South Africa. Culture Health & Sexuality 
2012 Nov;14(10):1167-82. doi: 10.1080/13691058.2012.717305. Epub 2012 Sep 14  
5. 
Jewkes R,  Dunkle K, Nduna M, Jama-Shai N (2012). Transactional sex and HIV 
incidence in a cohort of young women in the Stepping Stones trial. Journal of AIDS & 
Clinical Research  3:158. doi:10.4172/2155-6113.1000158 
6. 
Nduna M, Jewkes R, Dunkle K, Jama-Shai N, Coleman I (2013) Prevalence and 
factors associated with depressive symptoms among young women and men in the 
Eastern Cape Province, South Africa Journal of Child and Adolescent Mental Health 
25(1), 35-42. 
7. 
Christofides N, Jewkes R, Dunkle K, Nduna M, Jama-Shai N, Sterk C. Early 
pregnancy increases risk of incident HIV infection in the Eastern Cape, South Africa: 
a prospective study.  Journal of the International AIDS Society. 2014 Mar 
19;17(1):18585. doi: 10.7448/IAS.17.1.18585. eCollection 2014. 
8. 
Christofides NJ, Jewkes RK,  Dunkle KL, McCarty F, Jama Shai N,  Nduna M, Sterk 
CE. (2014)  Risk factors for unplanned and unwanted teenage pregnancies over two years 
of follow up among a cohort of young South African women  Global Health Action 
7:23719 http://dx.doi.org/10.3402/gha.v7.23719 
9. 
Christofides N, Jewkes R, Dunkle K, Nduna M, Jama-Shai N. (2014) Perpetration of 
physical and sexual abuse and subsequent fathering of pregnancies among a cohort of 
young South African men. BMC Public Health 14:947. doi: 10.1186/1471-2458-14-
947. 
10. 
Jewkes R, Sikweyiya Y, Jama-Shai N (2014) The challenges of research on violence 
in 
post-conflict 
Bougainville. 
The 
Lancet 
June 
10, 
2014 
http://dx.doi.org/10.1016/S0140-6736(14)60969-7 
11. 
Jewkes R, Gibbs A, Jama-Shai N, Willan S, Misselhorn S, Mushinga M, Washington 
L,  Mbatha N, Sikweyiya Y. (2014) Stepping Stones and Creating Futures 
Intervention: Outcomes of a shortened interrupted time series evaluation of 
behavioural and structural intervention for young people in informal settlements in 
Durban, South Africa BMC Public Health 1325: DOI 10.1186/1471-2458-14-1325 
 
8.  Any additional relevant information supporting abilities to participate in conducting 
this trial. [Briefly] 
 
 
NAME IN FULL: Nwabisa Jama-Shai 
 
___________________ 
 
 
 
 
     23 Jan 2015 
Signature:  
 
 
 
 
 
 
 
  Date 
 
 

 
46 
CURRICULUM VITAE FOR Samantha Donna Willan 
 
Title of study/ Research proposal: Stepping Stones and Creating Futures Intervention Trial
 
 
Protocol no if applicable: N/A   
 
Designation/ Profession: Program Manager, Gender Equality & Health; Health Economics 
and HIV/AIDS Research Division (HEARD), University of KwaZulu-Natal, South Africa 
 
1. Personal Details 
Name 
Samantha Donna Willan 
 
 
Address 
HEARD, University of 
KwaZulu-Natal, 
Westville Campus, J 
Block, Durban, 4041, 
South Africa  
Work tel. 
no. 
031 2602592 
 
 
Cell phone 
no 
079 595 3680 
 
 
Email  
Samantha.willan@gmail.com 
 
 
 
 
2.  Academic and professional qualifications 
 
Degree 
Field of study  
University  
Year 
Bachelor of Arts 
Political Science & 
Labour Studies 
University of Natal, South Africa 
1994 
Bachelor of Arts 
Honors 
Political Science 
University of Natal, South Africa 
1995 
Master of Arts 
Political Science 
University of Natal, South Africa 
1999 
3.  Professional body registration number if applicable N/A 
        PLEASE ATTACH COPY: 
 
4. Current personal medical malpractice insurance details [medical and dental 
practitioners] where applicable N/A 
 
  
5. Relevant related work experience (brief) and current position 
Period 
Position 
Employer 
2010 – 
present 
Programme Manager, Gender Equality 
& Health, HEARD 
University of KwaZulu-Natal, 
SA 
2007-2010 
Independent Consultant – HIV, 
Sexuality and Gender Equality 
Self employed 
2004-2006 
Policy Advisor – Gender & HIV 
VSO, UK 
2000- 2004 
Operations Manager, HEARD 
University of KwaZulu-Natal 
1998-2000 
Researcher, Natal University 
Development Foundation 
University of Natal 
1996-1998 
Information Manager 
Truth & Reconciliation 
Commission, South Africa 
 

 
47 
6.  Participation in research in the last three years (title, protocol number, designation) [If 
multiple proposals/ studies, only list those with relevance to this application, or in the last 
year.]  
 
Protocol ID: N/A 
Protocol title: A two-pronged service and community mobilisation intervention to reduce 
gender-based violence and HIV vulnerability in rural South Africa. Canadian Institute for 
Health Research (CIHR), 2011-2016 
Designation: Co-Investigator 
 
Protocol ID: N/A 
Protocol title: Sexual & reproductive health and rights of young people living with HIV 
Designation: Co-PI 
 
Protocol ID: N/A 
Protocol title: The development and evaluation of gender transformative and livelihood 
strengthening intervention to reduce IPV in urban informal settlements, South Africa 
Designation: Co-PI 
 
7.  Peer-reviewed publications in the past 3 years 
 Jewkes, R, Gibbs, A, Jama-Shai, N, Willan, S, Misselhorn, A, Mushinga, M, 
Washington, L, Mbatha, N, Skiweyiya, Y.  (2014) Stepping Stones and Creating 
Futures Intervention: shortened interrupted time series evaluation of a behavioural and 
structural health promotion and violence prevention intervention for young people in 
informal settlements in Durban, South Africa, BMC Public Health 
 Gibbs, A, Jewkes, R, Sikweyiya, Y, & Willan, S. (2015) Reconstructing masculinity? 
A qualitative evaluation of the Stepping Stones and Creating Futures interventions in 
urban informal settlements in South Africa, Culture, Health and Sexuality 17:2, 208-
222 
 Gibbs, A, Jewkes, R, Mbatha, N, Washington, L & Willan, S (2014) Jobs, food, taxis 
and journals: Complexities of implementing Stepping Stones and Creating Futures in 
urban informal settlements in South Africa, African Journal of AIDS Research, 13:2, 
161-167, DOI: 10.2989/16085906.2014.927777 
 Gibbs, A., Mushinga, M., Crone, E.,  Willan, S. & Mannell, J. (2012) How do 
national strategic plans for HIV and AIDS in Southern and Eastern Africa address 
gender-based violence? A women’s rights perspective. Health and Human Rights 
 Gibbs, A, Willan, S, Misselhorn, A & Mangoma J (2012) Combined structural 
interventions for gender equality and livelihood security: a critical review of the 
evidence from southern and eastern Africa and the implications for young people, 
Journal of the International AIDS Society 2012, 15(Suppl 1) 
 Gibbs, A., Crone, E.T., Willan, S. & Mannell, J. (2012) The inclusion of women, girls 
and gender equality in National Strategic Plans for HIV and AIDS in southern and 
eastern Africa. Global Public Health 
 
8.  Any additional relevant information supporting abilities to participate in conducting 
this trial. [Briefly]  
I was a core team member in the conceptualization, development and evaluation of 
the Stepping Stones and Creating Futures pilot study, building young women’s and men’s 

 
48 
livelihoods, while transforming gender norms, as a pathway to reduce VAWG. I am also Co-
PI of a UNAIDS Global study developing and providing in-country technical support to pilot 
an Implementation Framework to reduce GBV and HIV. 
 
     My contribution to the proposed study will include involvement in planning the project, 
ongoing oversight and management of the research and evaluation component, supporting 
development of research tools, qualitative data analysis and writing of the research findings.  
 
NAME IN FULL: Samantha Donna Willan 
 
 
 
 
 
 
     22 Janaury 2015 
Signature:  
 
 
 
 
 
 
 
  Date: 
 
 

 
49 
CURRICULUM VITAE FOR YANDISA MSIMELELO SIKWEYIYA 
 
Title of study/ Research proposal: Stepping Stones and Creating Futures Intervention Trial
 
 
Protocol no if applicable:  N/A 
 
Designation/ Profession: Specialist Scientist, Gender & Health Research Unit 
 
1. Personal Details 
NAME 
 
 
 
ADDRESS 
Gender and Health 
Research Unit, MRC, 
Private Bag X385, 
Pretoria 0001 
Work tel. no. 
012 339 8619 
 
 
Fax no. 
012 339 8582 
 
 
Cell phone no 
076 365 6169 
 
 
Email  
ysikweyiya@mrc.ac.za 
 
 
 
 
2.  Academic and professional qualifications 
 
 
 
 
Degree 
Field of study  
University  
Year 
BSc 
Health Promotion 
University of Transkei 
2000 
Post-grad. Diploma 
Health Promotion 
University of Transkei 
2002 
MSc 
Public Health 
Umea University, Sweden 
2005 
Post-graduate Certificate  Research Ethics 
University of Pretoria & 
University of KwaZulu-Natal 
2006 
PhD 
Public Health 
University of the 
Witwatersrand 
2013 
 
3.  Professional body registration number if applicable  
        PLEASE ATTACH COPY: 
 
4. Current personal medical malpractice insurance details [medical and dental 
practitioners] where applicable 
 
  
5. Relevant related work experience (brief) and current position 
 
Period 
Position 
Employer 
2013-present  
Specialist Scientist 
MRC 
2010- 2012 
Senior Scientist 
MRC 
2008-2009 
Scientist 
MRC 
2002-2007 
Senior Research Technologist 
MRC 
 
6.  Participation in research in the last three years (title, protocol number, designation) [If 
multiple proposals/ studies, only list those with relevance to this application, or in the last 
year.]  
Protocol title: The development and evaluation of gender transformative and livelihood 
strengthening intervention to reduce IPV in urban informal settlements, South Africa.  

 
50 
Designation: Co-investigator  
 
7.  Peer-reviewed publications in the past 3 years 
 
1. 
Jewkes R, Gibbs A, Jama-Shai N, Willan S, Misselhorn A, Mushinga L, Mbatha N, 
Sikweyiya Y. Stepping Stones and Creating Futures Intervention: shortened interrupted time series 
evaluation of a structural health promotion and violence prevention intervention for young people in 
informal settlements in Durban South Africa. BioMedical Central, Public Health, 2014, 14:1325. 
 
2. 
Baholo M, Christofides N.J, Wright A, Sikweyiya Y, Jama Shai N. Women’s experiences 
leaving abusive relationships – A shelter-based qualitative study. Culture, Health & Sexuality, 2014.  
 
3. 
Nkosi S, Sikweyiya Y, Kekwaletswe C, Morojele N. Male circumcision, alcohol use, and 
unprotected sex among patrons of bars and taverns in rural areas of North West province, South 
Africa. AIDS Care, 2014.  
 
4. 
Gibbs A, Jewkes R, Sikweyiya Y, Willan S. Reconstructing Masculinity? A qualitative 
evaluation of the Stepping Stones and Creating Futures intervention in urban informal settlements in 
South Africa. Culture, Health & Sexuality, 2014.  
 
5.        Sikweyiya Y, Jewkes R, Dunkle K. Impact of HIV on and constructions of masculinities 
among   HIV positive men in South Africa: Implications for secondary prevention programs. Global 
Health Action, 2014, 7: 24631 
 
6. 
Jewkes R, Sikweyiya Y, Jama Shai N. The challenges of research on violence in post-conflict 
Bougainville. Lancet, 2014, 383, 2038-2039 
 
7. 
Gibbs A, Sikweyiya Y, Jewkes R. ‘Men value their dignity’: securing respect and identity 
construction in urban informal settlements in South Africa. Global Health Action, 2014, 7: 23676 
 
8. 
Dunkle K.L, Jewkes R.K, Murdock D.W, Sikweyiya Y, Morrell R. Prevalence of consensual 
male-male sex and sexual violence, and associations with HIV in South Africa: A population based 
cross-sectional study. Plos Medicine, 2013, 10(6): e1001472. DOI: 10.1371/journal.pmed.100147 
 
9. 
Gevers A, Jama-Shai N, Sikweyiya Y. Gender-based violence and the need for evidence-
based primary prevention in South Africa. African Safety Promotion Journal, 2013, 11(2), 14-20 
 
10. 
Nduna M, Sikweyiya Y. Silence in Young Women’s Narratives of Absent and Unknown 
Fathers from Mpumalanga Province, South Africa. J Child Fam Stud. 2013, 22(8). DOI 
10.1007/s10826-013-9866-3 
 
11. 
Sikweyiya Y, Jewkes R. Potential Motivations For and Perceived Risks In Research 
Participation: Ethics in Health Research. Qualitative Health Research, 2013, 23(7), 999-1009 
12. 
Sikweyiya Y, Jewkes R, Dartnall E. Men’s perspectives on participating in violence against 
women perpetration research. Agenda, 2013, 27(1), 40-48 
13. 
Jewkes R, Morrell R, Sikweyiya Y, Penn-Kekana L. Transactional relationships and sex with 
a woman in prostitution: prevalence and patters in a representative sample of South African Men. 
BMC Public Health, 2012, 12: 325 
14. 
Jewkes R, Morrell R, Sikweyiya Y, Dunkle K, Penn-Kekana L. Men, Prostitution and the 
Provider Role: Understanding the Intersections of Economic Exchange, Sex, Crime and Violence in 
South Africa. PLoS ONE, 2012, 7(7): e40821. doi:10.1371/journal.pone.0040821 
 

 
51 
15.  
Sikweyiya Y, Jewkes R. Perceptions and Experiences of Research Participants on Gender-
based Violence Community based Survey: Implications for ethical guidelines. PLoS ONE, 2012, 7(4), 
1-9 
16.      Jewkes R, Sikweyiya Y, Nduna M, Jama Shai N, Dunkle K. Motivations for, and perceptions 
and experiences of participating in a cluster randomized controlled trial of a HIV behavioural 
intervention in rural South Africa. Culture, Health and Sexuality, 2012, 14(10), 1167-1182 
 
8.  Any additional relevant information supporting abilities to participate in conducting 
this trial. [Briefly]  
 
HONOURS AND AWARDS 
2014 Featured in the South African Public Sector Magazine May 2014 edition.  
2012   Selected as one of the Mail and Guardian top 200 young South Africans 
2011 Best Poster award for research under the age of 40, Sexual Violence Research 
Initiative 
2006: Best Poster award for Researcher less than 40 years old, Global Forum for Health 
Research 
 
      
NAME IN FULL: Yandisa Msimelelo Sikweyiya 
 
 
 
_____________ 
 
 
 
 
22-01-2014______________ 
Signature:  
 
 
 
 
 
 
 
  Date: 
 

 
52 
CURRICULUM VITAE FOR LAURA WASHINGTON 
 
Title of study/ Research proposal: Stepping Stones and Creating Futures Intervention Trial
 
 
Protocol no if applicable:  N/A 
 
Designation/ Profession: Director, Project Empower 
 
1. Personal Details 
NAME 
 
 
 
ADDRESS 
W218 Diakonia Centre, 
20 Diakonia Avenue, 
Durban 
Work tel. no. 
031 3103565 
 
 
Fax no. 
031 3103566 
 
 
Cell phone no 
083 303 8953 
 
 
Email  
laura@projectempower.org.z
a 
 
 
 
 
2.  Academic and professional qualifications 
 
 
 
 
Degree 
Field of study  
University  
Year 
BA 
English 
History 
University of Natal 
1982 
Post-grad. Diploma 
Education 
University of Natal 
1984 
M. Sc 
Development 
Studies 
University of Natal 
ongoi
ng 
 
3.  Professional body registration number if applicable  
        PLEASE ATTACH COPY: 
 
4. Current personal medical malpractice insurance details [medical and dental 
practitioners] where applicable 
 
  
5. Relevant related work experience (brief) and current position 
 
Period 
Position 
Employer 
2013- present  
Director 
Project Empower 
2002 - 2012 
Programmes Manager 
Project Empower 
1982 - 2001 
Consultant  
A range of NGOs 
 
6.  Participation in research in the last three years (title, protocol number, designation) [If 
multiple proposals/ studies, only list those with relevance to this application, or in the last 
year.]  
 
Joint Gender Fund, South Africa (No Number)  Project 
Empower 
(PIs)
 
01/01/2012-30/12/2014 
Mbokodo Project 

 
53 
A project aimed at raising consciousness of women and developing women’s leadership in 
addressing domestic and other forms of gender based violence in the rural setting.   
 
Oxfam Australia 
 
 
 
Project Empower (PIs) 
 
 
 
2012-/2014 
Mkabayi Project 
This project works with young women in urban informal settlements where people in general 
and women in particular are politically, economically and socially marginalized to encourage 
and enable access to a range of rights assured to them in the Constitution 
 
Completed Research Support 
Sida/UKZN: 51040023 
Gibbs (PI) 
 
 
 
 
 
01/06/2013-01/06/2014 
Young women and social grants: issues of access and impact 
Swedish International Development Agency (SIDA), Institutional Grant to HEARD, UKZN 
 
The goal of this qualitative exploratory work is to work with 45 young women (18-
25) in urban informal settlements who are eligible for the 
child support grant and either 
accessing or not, to understand both the difficulties they face in accessing social grants and 
how they use social grants in their lives. This work provides a foundation for development of 
an intervention around this.   
 
Role: Co-I 
 
 
Canadian International Development Agency 
Project Empower 
 
 
2012-2013 
Access to SRHR for young women in informal settlements and addressing IPV 
The project looked at the importance of knowledge and access to sexual and reproductive 
health rights for young women in urban informal settlements in understanding their own 
sexuality, sexual urgency, gender inequality and reducing incidences of HIV primary 
infection.  It further used this awareness around rights as means to addressing intimate 
partner violence, especially sexual violence, amongst young couples.  
 
Action Aid (No Number) 
 
 
Project Empower (PIs)  
 
 
2/2008 – 12/2008  
Gender and HIV Capacity 
The project was a test project for the Action Aid’s STaR approach in urban communities.  
The project looked at the interface of Gender and HIV and Rights and using this 
understanding of this interface and the impact it has on communities to mobilise communities 
and advocate for better services. 
 
Joint HIV/AIDS Programme (JOHAP), Oxfam Project Empower (PIs) 
 
6/2008 -6/2009 
Gender and gender based violence with young men in urban informal settlements 
This project worked with young men in informal settlements to explore and understand 
gender and how it impacts on their lives.  It aimed to help young men break the societal 
pressures of masculinity and challenged how these imposed ideals of masculinity played on 
and impacted the quality of relationships that they enjoyed with the intimate partners and 
community as a whole. 
 
7.  Peer-reviewed publications in the past 3 years 

 
54 
 
1. O’Reilly, M. & Washington, L. (2012) Young women from informal settlements report 
on their experiences of accessing sexual and reproductive and other health services from 
clinics. Agenda, Vol. 26, No.2 pages 126-138 
2. Misselhorn, A., Mushinga, M., Jama-Shai, N. & Washington, L. (2014) Creating 
Futures: lessons from the development of a livelihood strengthening curriculum for young 
people in eThekwini’s informal settlements. Sex Education, 14(5), 543-555 
3. Gibbs, A., Jewkes, R., Willan, S., Washington, L., Mbatha, N. (2014) Jobs, food, taxis 
and journals: complexities of implementing a structural and behavioural intervention in 
urban South Africa. AJAR, 13:2, 161-167  
4. Misselhorn, A, Jama Shai N, Mushinga M, Washington L, Mbatha N (2013) Creating 
Futures: Supporting young people in building  their livelihoods. Manual. 
http://www.heard.org.za/gender/creating-futures-stepping-stones 
5. Project Empower (Washington, L & Mbatha, N.) Building Positive Organisations 
through Policy Development: Learning from Project Empower’s Experiences. Oxfam 
Australia: Durban. 
http://www.oxfam.de/sites/www.oxfam.de/files/building_positive_organisations_through
_policy_development.pdf  
 
8.  Any additional relevant information supporting abilities to participate in conducting 
this trial. [Briefly]  
      
NAME IN FULL: Laura Washington 
 
 
_
 
 
 
                                 23-01-2014 
Signature:  
 
 
 
 
 
 
 
  Date: 
 

 
55 
  
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by young, rural South African men: Prevalence, patterns and risk factors. Soc Sci Med. 
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59 
 

 
60 
16.0 Appendices 
 
Please find separately attached: 
 Appendix 1: Male Baseline Quantitative Questionnaire 
 Appendix 2: Female Baseline Quantitative Questionnaire 
 Appendix 3: Male 12 and 24 month Quantitative Questionnaire 
 Appendix 4: Female 12 and 24 Month Quantitative Questionnaire 
 Appendix 5: Confidentiality Agreement 
 Appendix 6: Information Sheet and Informed Consent 
 Appendix 7: Gatekeeper Letter