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Tokaut na Tokstret marital relationship training. Leah Hoffman Deputy Program Director, PSI/Papua New Guinea 31 January 2011. HIV Epidemic in PNG. Generalized in many provinces (1-2%) Mobile men with money a key affected population Associated with gender-based violence. Risk Behaviour.

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tokaut na tokstret marital relationship training

Tokaut na Tokstretmarital relationship training

Leah Hoffman

Deputy Program Director, PSI/Papua New Guinea

31 January 2011

hiv epidemic in png
HIV Epidemic in PNG
  • Generalized in many provinces (1-2%)
  • Mobile men with money a key affected population
  • Associated with gender-based violence
risk behaviour
Risk Behaviour
  • Half of men aged 18-49 with multiple sexual partners
  • Half of men use condoms with transactional and casual partners
  • <20% with regular partners
  • Strong anti-condom stigma
factors for concurrency
Factors for Concurrency
  • MCP: factors are…in regular, primary relationship (marriage):
    • low relationship satisfaction
    • Poor couple communication
    • Intimate partner violence
    • Gender and social norms (unequal power)
  • Gender dynamics <in bed, in life>
gender based violence in png
Gender-based Violence in PNG
  • 55% of women reported ever being raped, among them (61% >1x) (1994)
  • 58% women physically abused (2008)
  • 45% sexually abused by partner (2008)
  • Most reported that refusing sex, asking to use condoms, or their husband’s drinking alcohol triggered the violent episode.
  • 35.5% of men believe it is okay for a man to force his wife (2011)
  • Gender (social norms) + sexual issues
tokaut na tokstret tnt
Tokaut na Tokstret (TnT)

4-day workshop targeting couples

Mobile men with money aged 20-39 + wives

Simultaneous training- separate rooms

Uses case studies, group work, discussion, role playing, presentations, and practice

Couple goal-setting

slide7

TnT History

Quantitative (TRaC) baseline

2008

Qualitative

Assessment

2009

Rapid PEER

Assessment

2011

Quantitative Evaluation

(TRaC)

2011-12

2007

ADB Project Starts

NGO Closes

2010

Changed Strategy

2008

PSI begins TnT for Pastors

2008

Expanded for all men

rapid peer
Rapid PEER

Qualitative Assessment Target group plays key role

Uses elements of purposeful sampling

Results in weeks, not months

Analysis by theme to identify key successes, challenges, and ways forward for future programming

rapid peer findings 3 6 months after tnt
Rapid PEER Findings (3-6 months after TnT)
  • Improved relationship satisfaction and couple communication
  • Increased HIV risk perception
  • Reduced MCP
  • Reduced intimate partner violence
  • Other unexpected benefits
  • Did not increase condom use
  • Sexually explicit content caused

some embarrassment

  • Couple homework hard to do
  • Evidence to restrict participants to target group
reduced extra marital sex
Reduced Extra-Marital Sex

“After the training he changed some of his behaviours... When he gets his Fortnight <salary> he spends it on the family and he doesn’t go out and look for other women, but he stays at home with his family.” [PI.5M, F1]

Our husbands are no longer going out; we spend time together and because we are happy this helps us satisfy our husbands’ needs.” (Female Peer Interviewer, Site 1).

hiv risk perception
HIV Risk Perception

“We’ve learnt a lot of different things about the training but the part I liked is about HIV/AIDS and how you can get infected from going around with different people because my husband does that and learning about this has helped us – my husband is scared after knowing this and does not go out anymore to hang with friends in the night or watch movies – he just stays at home – this is a very big change.” [Site 1, P.I.F]

improved communication
Improved Communication

“Before the training they don’t really budget and each husband and wife spends separately and don’t discuss how to spend the money. There is no communication in the marriage.”

improved communication1
Improved Communication

“After the training now we sit and discuss. Now there is communication between husband and wife. Now we have a budget for the family. Previously when there was no communication there were arguments and fights between husband and wife. After communication husband and wife sit down and take time to listen to each other. Now there is a budget for all needs: for food, school fees, clothes, books and biros for the kids.”

holistic impact households before the marital relationship training
Holistic impact: Households Before the Marital Relationship Training

“When the training did not happen this is how the family lives. Husband stands by himself and wife stands by herself. Around them are two girls and one boy child. Husband always goes drinking and when he comes home he fights with the mother so they don’t stay together. They go their separate ways.” Cont...

(The dots around the people represent the tears shed by members of the household).

households after the marital relationship training
Households After the Marital Relationship Training

“After training they have changed their way of living. Now they are working and living together. This drawing of everyone in the canoe represents everyone living peacefully together. In the canoe the husband sits at the back and steers the canoe, and the wife sits in the front. In between the husband and the wife are the children. They have in the canoe: sago to represent food, fish, firewood (for cooking the food), an axe for cutting firewood, and bush knives and arrows. The arrows represent the husband and the wife paddling together.” (Male Peer Interviewers, Site 2)

what we re learning
What we’re learning
  • TnT reached ~3,000 people. Looking at ways to reach more.
  • Couple interventions can reduce concurrency by helping couples improve their relationships. Mass media can further change social/gender norms and extend reach.
  • Similar factors shape concurrency and intimate partner violence. They can be addressed together.