This project will conduct a randomized community-level trial of a theory-based and culturally tailored multilevel HIV/AIDS risk reduction intervention for men and women who drink alcohol in informal drinking establishments (shebeens) in Cape Town South Africa. As many as one in five South Africans is HIV positive and there are an estimated 1,500 new HIV infections in South Africa each day. The multilevel intervention we are testing is grounded in Social Action Theory and incorporates behavioral skills for HIV risk reduction, risk-related alcohol use, and social communication skills for community activation. The intervention consists of three weekly 3-hour group workshops with a community-level intervention component. We will recruit 75 men from shebeens in 12 impoverished neighborhoods (N=900). The neighborhoods will be matched on key characteristics and randomly assigned to either (a) the multilevel HIV/alcohol risk reduction intervention or (b) a time-matched HIV/alcohol information-only education control condition. Participants will be enrolled using chain recruitment to reach men who drink in shebeens and engage in high-risk sexual activities. Following community level randomization, participants will be baseline assessed, intervened with, and followed for 12 months post intervention. We will also monitor changes in alcohol expectancies, AIDS stigmas, social norms and other social environmental factors among men who did not participate in the intervention workshops and women recruited from the same shebeens. Multilevel modeling will test the associations of environmental and individual changes in alcohol use, social norms, alcohol expectancies, and sexual risk behaviors over time. This community level randomized trial will determine the efficacy of a risk reduction intervention for South Africans who drink and are at high-risk for HIV. The study will directly test the effects of alcohol-related social influences at the community level on behavior change and maintenance of change at the individual level. Alcohol is associated with sexual risks for HIV/AIDS in South Africa. Interventions aimed at reducing HIV transmission among individuals who drink alcohol have short-lived effects. Interventions that target both individual and social environmental level behavior change may result in greater and sustained HIV risk reduction. This study will test the effects of a multilevel alcohol and HIV risk reduction intervention for South African men who drink at informal alcohol serving establishments (e.g., shebeens). We will examine community-level intervention effects for men not attending the intervention sessions as well as women sampled from the shebeens. This research will determine social and alcohol contextual influences at the community level that predict individual behavior change over-time.
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