Cluster-randomized controlled trial of an HIV/sexually transmitted infection risk-reduction intervention for South African men

Abstract

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.

Figures

FIGURE 1—

Progress of participating neighborhoods and men through the trial: Eastern Cape Province, South Africa, 2007–2010. Note. STI = sexually transmitted infection. Eligible men not enrolled failed to return for intervention session 1 for unknown reasons. The enrollment rate did not differ between treatment (88.8%) and control (90.6%) arms (P = .264). Men who did not complete the 6-mo follow-up were deceased (n = 9) or in prison (n = 4), had permanently moved from the area (n = 17), or were absent from the scheduled follow-up sessions or make-up sessions for unknown reasons (n = 58). Men not followed up at 12 months were deceased (n = 14) or in prison (n = 2), had permanently moved from the area (n = 34), or were absent for unknown reasons (n = 25).