HIV & Drug Abuse Prevention for South African Men

 描述：在非洲，艾滋病毒预防在女性身上最为成功，而不是男性。例如，18-29岁的南非青年男子艾滋病毒感染率仍然很高，经常吸毒，艾滋病毒检测率很低，同时存在性伴侣，艾滋病毒检测率和医疗利用率很低。我们需要在如何、何时、何地让男子参与艾滋病毒预防工作方面进行创新。在R34的资助下，我们成功地证明了让年轻人参加足球和职业培训以减少毒品使用的可行性。我们将两个社区随机分配到：干预（足球和职业培训取决于足球行为）;或延迟交付控制社区。几乎所有符合条件的邻居男性都被招募（95%; N=142），90%在6个月时重新评估。在干预条件下，80%的年轻人经常参加足球比赛，55%的人参加职业培训。与对照组男性相比，干预组男性在足球比赛中完成了药物测试（随着时间的推移，药物使用量增加，药物使用量减少），并在六个月内增加了就业。仅根据自我报告，艾滋病毒检测没有增加。对男子、教练和家庭成员的定性访谈表明，该方案在改变男子在家庭和社区中的作用方面有好处，尽管对妇女的态度变化不大。 基于这些结果，提出了一项随机对照试验（RCT），以测试将一个社区的所有年轻男性随机接受以下训练的有效性：1）足球训练（8个社区，400名男性）; 2）足球和职业培训（8个社区，400名男性）;或3）对照条件（8个社区，400名男性）。主要结果将是减少物质使用（用快速诊断测试[RDT]测试），增加重复HIV检测（HIV感染男性中的联系、保留和坚持医疗护理），没有同时的伴侣关系，增加避孕套的使用，没有暴力/逮捕。斯泰伦博斯大学的面试官将在招聘，6，15和24个月（使用移动的电话）进行评估。教练将实施生活技能手册，并将认知行为技能融入游戏/练习中出现的问题情况，并通过移动的电话真实的报告所有干预联系人和内容。将对教练和年轻男子进行定性访谈（每6个月一次，n=30）。如果RCT成功，国际足球联合会（FIFA）可能会在南非政府NEET（非教育，就业或培训）职业培训计划的国家资助下推广全球计划，该计划的年度资金通常未得到充分利用。

 DESCRIPTION: In Africa, HIV prevention has been most successful with women, not men. For example, young, South African men aged 18-29 years continue to have a high incidence of HIV, frequent drug use, low HIV testing rates, concurrent sexual partnerships, and low rates of HIV testing and utilization of medical care. Innovations are needed in how, when, and where we engage men in HIV prevention. With R34 funding, we successfully demonstrated the feasibility of engaging young men with soccer and vocational training to reduce drug use. We randomized two neighborhoods to either: an intervention (soccer and vocational training contingent on behaviors at soccer); or a delayed-delivery control neighborhood. Almost all eligible neighborhood men were recruited (95%; N=142) and 90% reassessed at 6 months. In the intervention condition, 80% of young men regularly attended soccer and 55% earned entry to vocational training. Intervention men completed drug tests at soccer (with uptake rising over time and drug use decreasing), and increased employment over six months, compared to control men. HIV testing did not increase, based only on self-reports. Qualitative interviews of men, coaches, and family members demonstrated the program's benefits in shifting men's role in their homes and communities, although attitudinal shifts towards women were minor. Based on these results, a randomized controlled trial (RCT) is proposed to test the efficacy of randomizing all young men in a neighborhood to receive: 1) soccer training (8 neighborhoods, 400 men); 2) soccer and vocational training (8 neighborhoods, 400 men); or 3) a control condition (8 neighborhoods, 400 men). The primary outcomes will be decreased substance use (tested with rapid diagnostic tests [RDT]), increased repeat HIV testing (linkage, retention, and adherence to medical care among HIV-infected men), no concurrent partnerships, increased condom use, and no violence/arrests. Stellenbosch University interviewers will conduct assessments at recruitment, 6, 15, and 24 months (using mobile phones). Coaches will implement a Life Skills manual, as well as integrating cognitive-behavioral skills into problem situations that arise at games/practices, and reporting in real time via mobile phones all intervention contacts and content. Qualitative interviews will be conducted with coaches and young men (n=30 at each 6 month interval). If the RCT is successful, global program diffusion is probable by the Fédération Internationale de Football Association (FIFA) with national funding by the South African government NEET (Not in Education, Employment or Training) vocational training program, whose annual funding is typically underspent.