HIV This Week

Exner TM, Mantell JE, Adeokun LA, Udoh IA, Ladipo OA, Delano GE, Faleye J, Akinpelu K. Mobilizing men as partners: the results of an intervention to increase dual protection among Nigerian men. Health Educ Res. 2009 Apr 9. [Epub ahead of print]

This quasi-experimental, proof-of-concept study evaluated the effects of an intervention designed to help Nigerian men decrease risk for HIV, sexually transmitted infections, and unintended pregnancy. The intervention was delivered in groups during two 5-hour workshops, with a monthly 2-hour check-in session. A comparison condition consisted of a group-based half-day didactic workshop. Based on recruitment area, 149 men were assigned to the intervention and 132 to the comparison. Men were evaluated at baseline and 3-month post-intervention. At follow-up, men assigned to the intervention were almost four times more likely than comparison men to report condom use at last intercourse (P < 0.001) and to report fewer unprotected vaginal sex occasions, greater self-efficacy for negotiation, a more egalitarian power dynamic in their primary relationship, more positive expectations for condom use, and greater intention for future consistent condom use (all P values < 0.05). Findings suggest that this intervention is both feasible and effective.

Editors’ note: In addition to reducing HIV-related stigmatizing beliefs, this group-based cognitive-behavioural ‘mobilising men as partners’ intervention, tailored to the needs and culture of Nigerian men, resulted in significantly higher safer-sex self-efficacy and yet significantly less male-dominated power dynamics in primary relationships. Whether the results seen at 3 months would be sustained over time, whether there was community level influence supporting the positive changes (the intervention men were from different communities than the control men), and whether their female partners would corroborate the findings are all questions deserving further investigation.

Kalichman SC, Simbayi LC, Cloete A, Clayford M, Arnolds W, Mxoli M, Smith G, Cherry C, Shefer T, Crawford M, Kalichman MO. Integrated Gender-Based Violence and HIV Risk Reduction Intervention for South African Men: Results of a Quasi-Experimental Field Trial. Prev Sci. 2009 Apr 8. [Epub ahead of print]

South Africa is in the midst of one of the world’s most devastating HIV epidemics and there is a well-documented association between violence against women and HIV transmission. Interventions that target men and integrate HIV prevention with gender-based violence prevention may demonstrate synergistic effects. A quasi-experimental field intervention trial was conducted with two communities randomly assigned to receive either: (a) a five session integrated intervention designed to simultaneously reduce gender-based violence and HIV risk behaviours (N = 242) or (b) a single 3-hour alcohol and HIV risk reduction session (N = 233). Men were followed for 1-, 3-, and 6-months post intervention with 90% retention. Results indicated that the gender-based violence/HIV intervention reduced negative attitudes toward women in the short term and reduced violence against women in the longer term. Men in the gender-based violence/HIV intervention also increased their talking with sex partners about condoms and were more likely to have been tested for HIV at the follow-ups. There were few differences between conditions on any HIV transmission risk reduction behavioural outcomes. Further research is needed to examine the potential synergistic effects of alcohol use, gender violence, and HIV prevention interventions.

Editors’ note: Negative attitudes toward women in South Africa and societal acceptance of violence against women impede men from acting responsibly to reduce HIV risks for themselves and their partners. More than half of the men in this study reported a history of physically assaulting a sex partner and one in five had been detained for domestic violence. Although the study had an inherently weak study design (randomising two communities but examining individual level behaviour change), was conducted in one cultural group only (Xhosa), and 89% of the participants were unemployed and able to attend lengthy workshops, the findings are intriguing. The gender-based violence prevention group reported a number of positive changes in attitudes and behaviours toward women, but the alcohol prevention group appears to have offered greater potential for sexual risk reduction. A three-component programme of HIV sexual risk reduction, alcohol reduction, and gender violence prevention may achieve greater impact. However, until South Africa and other countries worldwide intervene effectively to penalise gender-based violence and create new social norms of respect and gender equality, counting on individual behaviour change alone is like swimming upstream against powerful currents.