HIV prevalence rates in South Africa are among the highest in the world;transmission is largely heterosexual, and young people, especially young females, are disproportionately affected. It is increasingly understood that efforts to promote safer sexual practices in this vulnerable population may be undermined by high rates of intimate partner violence (IPV). Epidemiologic and ethnographic research among South African youth, much of it conducted by members of this research team, has provided data to support a model suggesting that ideologies of male superiority and cultural violence are manifested in gender inequality. In this setting, boys are encouraged to enforce the hierarchy, and to use violence to punish transgressions and stifle resultant conflicts. Girls receive little social support to protect them from such aggressive control. Alcohol and drug use are associated with higher levels of relationship conflict and a greater likelihood that violence will occur. High rates of rape and coerced sex are associated with early initiation of sex, failure to use condoms, and multiple, risky sexual partnerships, increasing risk of HIV transmission. Accordingly, it is proposed that an intervention be developed to reduce IPV among South African youth by: increasing social support for girls;questioning male norms of superiority, sexual entitlement, and control of girls;reducing alcohol and drug use;and improving communication to reduce the use of violence in resolving relationship conflicts. Efficacious interventions to delay sexual initiation, promote correct and consistent condom use, and discourage multiple risky sexual partnerships will also be integrated into the program. The intervention will be adapted from a school-based program, Safe Dates, which significantly reduced IPV among 8th and 9th grade students in the southeastern United States (Foshee, Bauman, Ennet, et al., 2004). It also will incorporate materials from two South African intervention programs, Our Times Our Choices (Drs. Zimmerman and Cupp) and Stepping Stones (Jewkes, Nduna &Jama 2002;Jewkes et al., 2007) which have shown significant effects on key outcomes. Specifically, we propose to: 1) Adapt Safe Dates for use as an intervention to reduce IPV among in- school South African adolescents and integrate interventions targeting HIV risk behavior;2) Conduct a pilot study of the adapted Safe Dates program with in-school South African adolescents to: a) reduce IPV, the primary target of the intervention, and b) delay initiation of sex, increase condom use, decrease the number of sexual partners, and decrease risky sexual partnerships, the secondary targets of the intervention. The pilot study will employ an experimental design, a six-month follow-up period, and audio-enhanced personal digital assistants (APDAs) to optimize honest self-report. The primary goals of the proposed project are to demonstrate the feasibility of implementing the adapted Safe Dates program in South Africa and to provide estimates of effect sizes, so that a randomized control trial can be designed to assess its efficacy.
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|Gevers, Aník; Mathews, Cathy; Cupp, Pam et al. (2013) Illegal yet developmentally normative: a descriptive analysis of young, urban adolescents' dating and sexual behaviour in Cape Town, South Africa. BMC Int Health Hum Rights 13:31|