Preventive interventions are urgently needed during adolescence when risk for human immunodeficiency virus (HIV) and intimate partner violence (IPV) increases exponentially. Yet, few behavioral interventions integrate HIV-IPV prevention and are tailored for the unique age and developmental needs of adolescents. We utilize the insights of adolescent development theory in our preventive intervention strategy by capitalizing on adolescents? developmental propensities for maximum prevention gains. Adolescence presents an ideal age and develop- mental transition period for an integrated intervention targeting prevention of HIV behavioral risk reduction and perpetration of IPV including sexual violence. Developmental hallmarks of adolescence ? including for example, the role of social norms in motivating behaviors, the importance of peers in shaping behavioral choices, and the desire for increased responsibility ? can all be leveraged for prevention of sexual risk behavior driving acquisition of HIV infection and engagement in IPV. For example, we use social norms marketing to shift attitudes and motivations to engage in protective HIV behaviors and prevent IPV. We use positive peer pressure and tap into adolescents? desire to be responsible future leaders to motivate adolescents to intervene as bystanders when their peers are involved in HIV risk behaviors or sexual assault and aggression. The motivation and implemen- tation of these positive behaviors relating to prevention of HIV and IPV perpetration are occurring in a period when identity formation and life-long health patterns are being habituated; our intervention approach leverages the formation of identity and habits during adolescence to support long term prevention behaviors. An integrated approach for prevention or adolescent HIV and IPV perpetration has not yet been tested. We propose a study to investigate the acceptability and feasibility of Safe South Africa, an integrated HIV-IPV intervention to prevent adolescent HIV behavioral risk and perpetration of IPV among male adolescents 15-17 years of age. We work in South Africa, a country with the largest HIV epidemic and some of the highest rates of IPV perpetration in the world. We propose the following specific aims: (1) development aim - create Safe South Africa, an integrated male adolescent preventive intervention for HIV risk behavior and IPV perpetration; (2) acceptability aim ? eval- uate social ecology of HIV and IPV risk with a survey of N=100 male and female adolescents, and test the acceptability of Safe South Africa through an open pilot trial with N=20 male adolescents; and (3) feasibility aim - conduct a randomized controlled pilot trial with 1- and 6-month follow-up in a sample of N=60 male adolescents to assess the feasibility of a future fully powered efficacy trial and delivery fidelity. Findings will advance preven- tive intervention science for young people at elevated risk for HIV and IPV in a high impact setting.
/PUBLIC HEALTH IMPACT STATEMENT We explore the acceptability and feasibility of an integrated approach for preventing or reducing risk behavior related to acquisition of human immunodeficiency virus (HIV) and perpetration of intimate partner violence (IPV) among adolescents in South Africa. South Africa faces some of the highest global rates of HIV and IPV with sustained high incidence of HIV and alarming rates of IPV among adolescents. Developing preventive inter- vention science in this setting and population can advance our scientific understanding of how to intervene early in the life course, and to promote healthy long-term sexual and reproductive lives for adolescents, their future partners, and society.
