This is a randomized, controlled, community-level trial of a behavioral HIV prevention program tailored for men who patronize beerhalls in Harare, Zimbabwe. The broad, long-term objective of the study is to measure the efficacy of the intervention in reducing men's sexual risk behavior related to alcohol use. Alcohol use is a significant correlate of HIV transmission in Africa and sex while intoxicated is a strong predictor of recent HIV seroconversion in the target population. The intervention program will be implemented in twelve beerhalls and twelve beerhalls will serve as controls. The primary study aim is to demonstrate a significant reduction in sex while intoxicated among men who attend beerhalls in the intervention arm compared with men attending control arm beerhalls. Inference on the primary study aim will be strengthened by reductions in other HIV risk behavior including paying for sex, unprotected sex with casual or commercial sex partners, and history of STD. The study will also measure the prevalence of recent HIV seroconversion using the less-sensitive EIA in order to characterize the relationship between alcohol use, sexual risk behavior, and HIV transmission. Finally, the prevention program acceptability, costs, and sustainability will be monitored and evaluated. The name of the intervention program is the """"""""Sahwira HIV Prevention Program."""""""" It will effect behavioral change among beerhall patrons by capitalizing on the strong bonds between male drinking friends as expressed in the cultural concept of the """"""""sahwira""""""""-a best friend, mentor, and advocate. In intervention beerhalls, trained """"""""Sahwira"""""""" Peer Educators will promote the diffusion of accurate HIV information, teach strategies for reducing HIV sexual risk, and will promote the importance of friends intervening with friends who are about to engage in HIV risk behavior. Beerhalls will be randomized in clusters in order to minimize contamination between beerhalls. The impact of the intervention will be measured using four waves of cross-sectional surveys with representative samples of beerhall patrons (n=1,200 per wave). Two pre-intervention baseline surveys conducted nine months apart will establish the comparability of intervention and control beerhall patrons over time. Two post-intervention surveys, one conducted at the end of the intervention and the another one year later will assess the immediate and long-term outcomes of the intervention.
|Fritz, Katherine; McFarland, Willi; Wyrod, Robert et al. (2011) Evaluation of a peer network-based sexual risk reduction intervention for men in beer halls in Zimbabwe: results from a randomized controlled trial. AIDS Behav 15:1732-44|