Randomized community-level HIV prevention intervention trial for men who drink in South African alcohol-serving venues

South African alcohol-serving establishments (i.e., shebeens) offer unique opportunities to reduce HIV risks among men who drink. Purpose: To test an individual- and a social structural-level HIV prevention intervention for men who drink in shebeens. Methods: Twelve matched pairs of township neighbourhoods were randomized to receive either (i) an HIV prevention intervention (guided by Social Action Theory) to reduce sexual risk and increase risk reduction communication in social networks, or (ii) an attention-matched control intervention that focused on the prevention of relationship violence. At the individual level, the interventions delivered skills building workshops focused on sexual risk reduction. At the social structural level, the intervention aimed to increase conversations about safer sex among men in the shebeens, distributed small media and implemented community educational events. Individual-level outcomes were assessed by following the workshop cohorts for 1 year (N = 984), and community-level outcomes were examined through cross-sectional community surveys conducted for 1 year in the shebeens (N = 9,678). Results: Men in the HIV prevention workshops demonstrated greater condom use, more HIV prevention-oriented conversations and greater perceptions of safer sex norms than men in the comparison workshops. Changes at the community level demonstrated significant differences in condom use, although the pattern was not consistent over time. Conclusions: Multi-level interventions that target men who drink in South African shebeens may help reduce risks for HIV and other sexually transmitted infections.Web of Scienc

Determinants of multiple sexual partnerships in South Africa

This paper aims to examine determinants of multiple sexual partnerships (MSPs) among South African men and women using a nationally representative sample. Quantitative and qualitative data from a 2008 population-based cross-sectional survey were used. The analysis focused on the 6990 who were 15 years and older and reported sexual activity in the prior 12 months. The qualitative component consisted of 15 focus group interviews investigating values underlying MSP behaviors. Predictors of MSP common across gender were race, having a history of STI, being in a short relationships (1 year) and suspecting the current partner of infidelity. MSP among men enjoyed greater community acceptance and was mainly done for social status. Furthermore, men reporting MSP were mostly younger (15-24 years old) and use condom at last sex. Among women, determinants of MSP included economic vulnerability, younger age at sexual debut and living in formal urban rather than formal rural areas. The data presented in this paper reinforces the importance of MSP as a risk factor for HIV and outline factors that should strongly be considered in strengthening condom use promotion and of partner reduction programs messaging in South Africa.

Condom negotiation, HIV testing, and HIV risks among women from alcohol serving venues in Cape Town, South Africa.

Women in South Africa are at particularly high-risk for HIV infection and are dependent on their male partners' use of condoms for sexual risk reduction. However, many women are afraid to discuss condoms with male partners, placing them at higher risk of HIV infection.To examine the association between fear of condom negotiation with HIV testing and transmission risk behaviors, including alcohol use and sexual risks among South African women.Women (N = 1333) residing in a primarily Xhosa-speaking African township in Cape Town and attending informal alcohol-serving venues (shebeens) completed anonymous surveys. Logistic regression was used to test the hypothesis that fear of condom negotiation would be associated with increased risk for HIV.Compared to women who did not fear condom negotiation, those who did were significantly less likely to have been tested for HIV, were more likely to have experienced relationship abuse, and to report more alcohol use and more unprotected sex.For women in South Africa, fear of condom negotiation is related to higher risk of HIV. HIV prevention efforts, including targeted HIV counseling and testing, must directly address gender issues

Multivariate model for fear of negotiating condom use among women (<i>n</i> = 1333).

<p><i>Notes:</i> †<i>p</i><.10, *<i>p</i><.05, **<i>p</i><.01, ***<i>p</i><.001; Fear partner in condom negotiation (0 = no, 1 = yes)</p

Experiences and alcohol use in past 30 days by fear of partner in condom negotiation (<i>n</i> = 1333).

<p><i>Notes:</i> †<i>p</i><.10, *<i>p</i><.05, **<i>p</i><.01, ***<i>p</i><.001; Adjusted for age, children, and total sex partners in past 30 days; Fear partner in condom negotiation (0 = no, 1 = yes); Alcohol Frequency, Binge drinking frequency, Intoxication frequency, and Alcohol use in drinking venues frequency: 1 = never to 7 = nearly every day.</p

Demographics by fear of partner in condom negotiation (<i>n</i> = 1333).

<p><i>Notes:</i> *<i>p</i><.05, **<i>p</i><.01, ***<i>p</i><.001; Fear partner in condom negotiation (0 = no, 1 = yes).</p

Sexual risk behavior, STI and HIV status, and HIV testing by fear of partner in condom negotiation (<i>n</i> = 1333).

<p><i>Notes:</i> †<i>p</i><.10, *<i>p</i><.05, **<i>p</i><.01, ***<i>p</i><.001; Adjusted for age, children, and total sex partners in past 30 days; Fear partner in condom negotiation (0 = no, 1 = yes); ^aamong HIV tested persons; STI = sexually transmitted infection</p