Previous studies in South Africa have identified problem drinking, sexual risk, and gender-based violence as high prevalence interrelated behaviors. Research has shown that empowering interventions that increase self-efficacy through skills-building activities have reduced risky behavior. However, there is still a substantial gap in knowledge regarding how interventions might address the interrelationships of these risky behaviors between men and women and how these behaviors are influenced by environmental factors (e.g., place where people drink, violence in and around these drinking venues, and neighborhood characteristics). This suggests a need to test interventions that target patrons of drinking venues where these risk behaviors occur as well as conducting HIV prevention interventions in close proximity to these venues to challenge community behaviors. This proposal responds to this need by conducting a venue-based recruitment from drinking venues in randomized neighborhood blocks identified through geographic information systems (GIS) mapping to three study conditions. The proposed team of U.S. and South African investigators will build upon its initial studies to address these interrelated risk behaviors by first focusing on the environmental context and on refining the proposed interventions for the group randomized trial of neighborhoods to one of three intervention conditions in which individual assessments, HIV testing, and group interventions will be conducted in a mobile unit outside drinking venues. The three interventions are Condition 1-Men's Control Group and Women's CoOp;Condition 2-Men as Partners and Women's CoOp;and Condition 3-Men as Partners, Women's CoOp, and Couples'Sessions. Both the Women's CoOp and the couples are evidenced- based HIV interventions that have been adapted internationally. Men as Partners is conducted in South Africa, as well as worldwide.
The specific aims of this proposal are:
Aim 1. To characterize the types of drinking venues (e.g., licensure status and size), their immediate context (e.g., observed availability of other drugs, violence and sexual activity), and surrounding neighborhood characteristics (e.g., number of drinking venues) in the sampled neighborhood blocks in two large Black/African and Coloured communities in Cape Town, South Africa.
Aim 2. To refine through qualitative methods the proposed interventions in relation to skills-building to address gender-role expectations, sexual partnering, gender power, violence, and environments where drinking and sexual risk behaviors occur.
Aim 3. To conduct a randomized group trial to compare the relative efficacy of a comprehensive intervention (Condition 3: Enhanced Couples) to the gender-focused intervention (Condition 2: Gender) and to Condition 1: Men's Control and Women's CoOp on AOD use, sexual risk behavior, and gender-based violence at 6- and 12-month follow-ups.
Although there has been substantial focus on the HIV/AIDS epidemic in South Africa, particularly among at-risk women, less attention has been given to environmental factors that may promote risky behaviors and interfere with intervention efficacy, such as where one drinks and use of other drugs. Reaching men, who have much of the control over sexual decision-making, is essential in reducing HIV risk among women and men. It is time to merge successful, evidence-based interventions for both genders into an innovative and testable approach that considers sociocultural traditions, including AOD use, sexual partnerships, violence against women, and men's reluctance to use condoms;and environmental context (e.g. venues where drinking occurs, neighborhoods) to reach men to recruit couples to improve their resilience to these high risk neighborhoods and empower positive behavior change.
