The overall objective is to determine the effectiveness of a behavioral intervention, Stepping Stones, in reducing the transmission of HIV and promoting HIV risk reducing practices, among poor rural women and men in South Africa. The study seeks to determine the effectiveness of Stepping Stones, in changing aspects of gender dynamics in relationships, including violent practices, and measure the impact of this on HIV risk reduction. It also aims to determine the magnitude of risk of HIV attributable to sexual practices, other than condom use, unequal gender power in relationships and violence. The Stepping Stones intervention is a workshop series of 14 sessions which cover HIV, sexual and reproductive health, gender, communication and relationship skills. It was developed in Uganda and has been specifically adapted and used in many developing countries. The South African adaptation was made in 1998 and it has since been used widely in the country. The study design is a duster randomized controlled trial with randomization to receive Stepping Stones immediately or in two years. The setting is the rural Eastern Cape Province of South Africa. Study subjects are 1400 men and 1400 women of 16-30 years. There will be 70 clusters, with each having one group of 20 women and one of 20 men. Clusters will be randomized. The primary outcome measure will be the proportion of subjects HIV sero-converting between baseline and two years, by gender. The secondary outcomes include changes in knowledge, attitude and practices related to HIV, condom use, number of partners, gender relations and gender violence. Measurement will use Determine (Abbott Laboratories) rapid HIV tests and a standard questionnaire. Ethnographic research will be undertaken to inform the questionnaire design and interpretation of study findings. It will explore the relationships between gendered identities and sexual and violence practices. It will also seek to understand what are the barriers to behavior change and what strategies are used by which people to circumnavigate these.

Agency
National Institute of Health (NIH)
Institute
National Institute of Mental Health (NIMH)
Type
Research Project (R01)
Project #
5R01MH064882-03
Application #
6751998
Study Section
Special Emphasis Panel (ZMH1-NRB-W (01))
Program Officer
Pequegnat, Willo
Project Start
2002-06-01
Project End
2006-05-31
Budget Start
2004-06-01
Budget End
2005-05-31
Support Year
3
Fiscal Year
2004
Total Cost
$270,000
Indirect Cost
Name
Medical Research Council of South Africa
Department
Type
DUNS #
635909489
City
Cape Town
State
Country
South Africa
Zip Code
Jewkes, Rachel; Dunkle, Kristin; Jama-Shai, Nwabisa et al. (2015) Impact of exposure to intimate partner violence on CD4+ and CD8+ T cell decay in HIV infected women: longitudinal study. PLoS One 10:e0122001
Christofides, Nicola J; Jewkes, Rachel K; Dunkle, Kristin L et al. (2014) Perpetration of physical and sexual abuse and subsequent fathering of pregnancies among a cohort of young South African men: a longitudinal study. BMC Public Health 14:947
Christofides, Nicola J; Jewkes, Rachel K; Dunkle, Kristin L et al. (2014) Early adolescent pregnancy increases risk of incident HIV infection in the Eastern Cape, South Africa: a longitudinal study. J Int AIDS Soc 17:18585
Christofides, Nicola J; Jewkes, Rachel K; Dunkle, Kristin L et al. (2014) Risk factors for unplanned and unwanted teenage pregnancies occurring over two years of follow-up among a cohort of young South African women. Glob Health Action 7:23719
Gevers, Anik; Jewkes, Rachel; Mathews, Cathy (2013) What do young people think makes their relationships good? Factors associated with assessments of dating relationships in South Africa. Cult Health Sex 15:1011-25
Jewkes, Rachel; Nduna, Mzikazi; Jama Shai, Nwabisa et al. (2012) Prospective study of rape perpetration by young South African men: incidence & risk factors. PLoS One 7:e38210
Jina, Ruxana; Jewkes, Rachel; Hoffman, Susie et al. (2012) Adverse mental health outcomes associated with emotional abuse in young rural South African women: a cross-sectional study. J Interpers Violence 27:862-80
Jewkes, R; Morrell, R (2012) Sexuality and the limits of agency among South African teenage women: theorising femininities and their connections to HIV risk practices. Soc Sci Med 74:1729-37
Shai, N Jama; Jewkes, R; Nduna, M et al. (2012) Masculinities and condom use patterns among young rural South Africa men: a cross-sectional baseline survey. BMC Public Health 12:462
Jewkes, Rachel K; Dunkle, Kristin; Nduna, Mzikazi et al. (2010) Associations between childhood adversity and depression, substance abuse and HIV and HSV2 incident infections in rural South African youth. Child Abuse Negl 34:833-41

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