Objectives. We tested the efficacy of a sexual risk-reduction intervention for men in South Africa, where heterosexual exposure is the main mode of HIV transmission.
Methods. Matched-pairs of neighborhoods in Eastern Cape Province, South Africa, were randomly selected and within pairs randomized to 1 of 2 interventions based on social cognitive theory and qualitative research: HIV/sexually transmitted infection (STI) risk-reduction, targeting condom use, or attention-matched control, targeting health issues unrelated to sexual risks. Sexually active men aged 18 to 45 years were eligible. The primary outcome was consistent condom use in the past 3 months.
Results. Of 1181 participants, 1106 (93.6%) completed the 12-month follow-up. HIV and STI risk-reduction participants had higher odds of reporting consistent condom use (odds ratio [OR] = 1.32; 95% confidence interval [CI] = 1.03, 1.71) and condom use at last vaginal intercourse (OR = 1.40; 95% CI = 1.08, 1.82) than did attention-control participants, adjusting for baseline prevalence. No differences were observed on unprotected intercourse or multiple partnerships. Findings did not differ for sex with steady as opposed to casual partners.
Conclusions. Behavioral interventions specifically targeting men can contribute to efforts to reduce sexual risk behaviors in South Africa.South Africa has more HIV cases than any other country, and like other sub-Saharan countries, has a predominantly heterosexual epidemic.
1 In such an epidemic, men have an especially critical role to play: they are the ones who don male condoms, a particularly effective and available means of prevention, and thus control their use. They have, it has been argued, more power than women in relationships
2–4 and are responsible for infecting women in many contexts, including forced intercourse and violence.
3 Although calls for male responsibility in sexual behavior related to HIV and other sexually transmitted infections (STIs) have been made repeatedly,
5–7 to our knowledge, only 1 study has evaluated an intervention created specifically for heterosexual men in South Africa.
8 Men who received the gender-based-violence-and-HIV-risk-reduction intervention were more likely to report talking with a partner about condoms and using condoms consistently 1-month postintervention compared with men in an alcohol-and-HIV-risk-reduction control intervention.The present study evaluated an HIV/sexually transmitted infection (STI) risk-reduction intervention for South African men who have intercourse with women. We used a cluster-randomized design to reduce the potential for contamination between treatment arms that would be present if we were to randomize individuals. We randomized randomly selected neighborhoods (i.e., clusters) to a 3-session intervention based on social cognitive theory
9 and extensive formative research
10 and designed to reduce HIV/STI risk behavior or to a 3-session attention-control intervention designed to promote health by improving diet and physical activity. We hypothesized that the HIV/STI risk-reduction intervention would increase self-reported consistent condom use during vaginal intercourse in the postintervention period, the primary outcome, compared with the attention-control intervention, controlling for baseline condom use.
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