HIV & Drug Abuse Prevention for South African Men

 描述：在非洲，艾滋病毒预防最成功的是妇女，而不是男子。例如，18-29岁的南非年轻男子艾滋病毒感染率高，经常吸毒，艾滋病毒检测率低，性伴关系多，艾滋病毒检测和医疗使用率低。我们需要在如何、何时、何地让男性参与艾滋病毒预防方面进行创新。在34兰特的资助下，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。我们随机将两个社区分为两组：干预组(足球和职业培训取决于在足球比赛中的行为)；或者延迟分娩控制区。几乎所有符合条件的邻里男性都被招募(95%；N=142)，90%在6个月后重新评估。在干预条件下，80%的青年男子定期参加足球比赛，55%的青年男子参加职业培训。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(吸食量随着时间的推移而上升，药物使用率下降)，并在六个月内增加了就业。仅基于自我报告，艾滋病毒检测并未增加。对男性、教练和家庭成员的定性采访显示了该项目在改变男性在家庭和社区中的角色方面的好处，尽管对女性的态度转变很小。基于这些结果，有人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几种情况的效果：1)足球训练(8个社区，400人)；2)足球和职业训练(8个社区，400人)；或3)对照条件(8个社区，400人)。主要结果将是减少药物使用(通过快速诊断测试[RDT]进行测试)，增加重复的艾滋病毒检测(艾滋病毒感染者之间的联系、保留和坚持医疗护理)，不同时发生伴侣关系，增加避孕套的使用，以及不发生暴力/逮捕事件。StellenBosch大学的面试官将在招聘后6个月、15个月和24个月(使用手机)进行评估。教练将实施生活技能手册，并将认知-行为技能整合到游戏/练习中出现的问题情景中，并通过手机实时报告所有干预联系人和内容。定性访谈将与教练和青年男子进行(每隔6个月30人)。如果RCT成功，国际足联(FIFA)可能会传播全球计划，南非政府的NEET(非教育、就业或培训)职业培训计划将提供国家资金，该计划的年度资金通常不足。

 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.