HIV/AIDS Risk Reduction and Domestic Violence Prevention Intervention for South African Men
Kalichman, Seth C., Simbayi, Leickness C., Cloete, Allanise, Cherry, Chauncey, Strebel, Anna, Kalichman, Moira O., Shefer, Tammy, Crawford, Mary, Thabalala, Mokgethi, Henda, Numvo, Cain, Demetria, International Journal of Men's Health
South Africa has among the worst HIV/AIDS epidemics in the world, and HIV/AIDS is closely associated with adversarial attitudes toward women and with domestic violence. This article reports the development of a social-cognitive and social-constructionist, gender-based intervention for working with HIV/AIDS patients and preventing domestic violence. Five three-hour group sessions were tailored to and targeted African men. They included elements of reframing gender relations and teaching skills to reduce HIV risk and change social norms. The intervention was also network-based. Group members were recruited by former group members using techniques derived from respondent driven sampling and network-based HIV prevention efforts. A test of the intervention with 99 men living in a Cape Town township demonstrated its feasibility and provided evidence that it increased knowledge about AIDS, improved understanding of stigma associated with the illness, and led to behavior changes in self-efficacy. The intervention shows promise for understanding the relation between HIV/AIDS and domestic violence prevention among South African men.
Keywords: HIV/AIDS, men, Africa, domestic violence
South Africa's HIV/AIDS epidemic is among the worst in the world and behavioral interventions offer the only available means of stemming new HIV infections. It is estimated that between 20% and 30% of South Africans living in urban townships and informal settlements are infected with HIV (Shisana et al., 2005). Nationally, HIV prevalence among men is 9% and HIV prevalence among women is 13% (Shisana et al., 2005). In some areas of South Africa, twice as many women are living with HIV/AIDS as men (UNAIDS/WHO, 2006) and the gender gap is increasing principally because men are more likely than women to have multiple, concurrent sex partners (Carter et al., 2007; Shisana et al., 2005).
In South Africa, the gender system fosters power imbalances that facilitate women's risks for sexual assault and sexually transmitted infections (STI, Farmer et al., 1996; Jewkes, Penn-Kekana, Levin, Ratsaka, & Schrieber, 2001). South African men, like men in all societies, possess greater control and power in their sexual relationships (Ajuwon et al., 2002; Jewkes & Abrahams, 2002; Wojcicki & Malala, 2001). Men are therefore the most potent agents of change for reducing sexual risks associated with the spread of HIV. Behavioral interventions for reducing high-risk sexual practices among South African men are therefore urgently needed.
In this paper we report on the development of a gender-tailored HIV risk reduction intervention targeted to men living in the Eastern and Western Cape region of South Africa. The intervention is grounded in social cognitive theory (Bandura, 1997) and social constructionist theory of gender, and integrates components that directly address HIV-preventive behavior change and gender inequalities, including adversarial attitudes toward women and current acceptance of domestic violence. This new intervention is multi-level in that it focuses on individual behavior change in men, is delivered to small groups, and aims to change the social norms governing men's peer networks.
We first describe the theoretical and empirical background underlying the intervention and examine the interplay between HIV transmission risks and gender power disparities. We then provide the bases for the development of our intervention, which includes previous HIV prevention interventions that targeted heterosexual men, social constructionist theories of gender, and network-based approaches to HIV prevention. The intervention and its development are then described, followed by the results of an initial test of concept. We conclude by discussing the implications of the intervention for future HIV prevention research with men in South Africa.
The Intersection of HIV/AIDS and Gender-Power Disparities
Across cultures, research shows that women experience multiple barriers in their efforts to reduce their risks for HIV infection, including sexual violence in gender-power imbalanced relationships in which they request their partners to use condoms (Kalichman et al. …