Structural Pathways for South African Men to Reduce Substance Abuse & HIV

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DESCRIPTION (provided by applicant): Young men aged 18-25 years in South Africa face the intersecting epidemics of HIV, alcohol and drug abuse, and unemployment. This R34 is designed to reduce young men's risk by addressing three problems with existing evidence-based programs (EBP): interventions are not designed considering men's fight-flight coping strategy; donors are unwilling to invest in substance abusing men; and existing job training does not consider young men's poor habits. Our goal is to apply behavioral economists' strategies to new delivery formats that are highly attractive to young men: soccer and job training. A neighborhood-level HIV prevention strategy will shape men's positive daily routines at an organized soccer league: being on time, completing practice, arriving sober & drug free, showing sportsmanship, and being nonviolent. Employment training by artisan trainers/mentors will be contingently offered to young men who demonstrate positive habits-of-daily-living on 80% of days over two months. Young township men in two neighborhoods will be randomized to receive the intervention that includes soccer, job training, and contingency management to shape behaviors (N=1 neighborhood; n=60 males) or to receive the control condition of soccer and job training without contingency management (n=1 neighborhood; 60 males). Assessments will be at baseline and 6 months follow-up. We hypothesize the program will significantly reduce HIV-related sexual risk acts and substance abuse, and sustain more employment. We will evaluate life goals, consistency of daily routines pro-social acts, & family relationships. We will primarily evaluate intervention feasibility and uptake, and preliminarily evaluate intervention impacts and mediating factors for reducing HIV risk acts & substance use. We will also document stakeholders' perceptions of the program's challenges and successes via Key informant interviews, the number of young men in shebeens over time via observations, and the key features of the social movement strategies of the Sonke Gender Justice, a men's advocacy movement. PUBLIC HEALTH RELEVANCE: In South Africa, young men aged 18-25 years face some of the highest rates globally of HIV, alcohol and drug abuse, and unemployment. Men are at multiple disadvantages for accessing and utilizing HIV prevention programs. Our goal is to create a successful, neighborhood-level HIV prevention strategy and structural pathway out of poverty for young men via non-stigmatizing, pro-social soccer and artisan vocational mentoring.