Encouraging Safe Dates: Reducing Intimate Partner Violence in South African Youth

描述（由申请人提供）：南非的艾滋病毒感染率是世界上最高的；传播主要是异性恋，年轻人，尤其是年轻女性，受到的影响不成比例。人们越来越认识到，在这一脆弱人群中促进安全性行为的努力可能会因亲密伴侣暴力（IPV）的高发率而受到破坏。在南非青年中进行的流行病学和人种学研究，其中大部分是由本研究小组的成员进行的，提供的数据支持了一个模型，该模型表明，男性优越感和文化暴力的意识形态表现在性别不平等中。在这种情况下，男孩被鼓励加强等级制度，并使用暴力来惩罚违法行为，扼杀由此产生的冲突。女孩很少得到社会支持来保护她们免受这种咄咄逼人的控制。酒精和药物的使用与更高程度的关系冲突和更大的发生暴力的可能性有关。强奸和强迫性行为的高发率与过早开始性行为、不使用避孕套以及多性、高风险的性伙伴关系有关，这增加了艾滋病毒传播的风险。因此，建议制定一项干预措施，通过以下方式减少南非青年中的IPV：增加对女孩的社会支持；质疑男性的优越感、性权利和对女孩的控制；减少酗酒和吸毒；改善沟通，减少在解决关系冲突时使用暴力。该方案还将纳入有效的干预措施，以延迟性行为的开始，促进正确和持续地使用避孕套，并劝阻多种危险的性伙伴关系。干预措施将改编自一项以学校为基础的计划，“安全日期”，该计划大大减少了美国东南部八年级和九年级学生的IPV （Foshee, Bauman， Ennet等人，2004）。它还将纳入两个南非干预项目的材料，我们的时代，我们的选择。齐默尔曼和库普)和铺路石（Jewkes, Nduna & Jama 2002; Jewkes et al., 2007）对关键结果有显著影响。具体而言，我们建议：1)调整安全日期作为一种干预措施，以减少南非学校青少年的IPV，并整合针对艾滋病毒风险行为的干预措施；2)在南非在校青少年中开展经改编的“安全约会”项目的试点研究，以：a)减少IPV，这是干预的主要目标；b)延迟性行为的开始，增加避孕套的使用，减少性伴侣的数量，并减少危险的性伙伴关系，这是干预的次要目标。试点研究将采用实验设计，六个月的随访期，并使用音频增强的个人数字助理（apda）来优化诚实的自我报告。拟议项目的主要目标是证明在南非实施经过调整的安全日期计划的可行性，并提供效应大小的估计，以便可以设计随机对照试验来评估其有效性。

DESCRIPTION (provided by applicant): HIV prevalence rates in South Africa are among the highest in the world; transmission is largely heterosexual, and young people, especially young females, are disproportionately affected. It is increasingly understood that efforts to promote safer sexual practices in this vulnerable population may be undermined by high rates of intimate partner violence (IPV). Epidemiologic and ethnographic research among South African youth, much of it conducted by members of this research team, has provided data to support a model suggesting that ideologies of male superiority and cultural violence are manifested in gender inequality. In this setting, boys are encouraged to enforce the hierarchy, and to use violence to punish transgressions and stifle resultant conflicts. Girls receive little social support to protect them from such aggressive control. Alcohol and drug use are associated with higher levels of relationship conflict and a greater likelihood that violence will occur. High rates of rape and coerced sex are associated with early initiation of sex, failure to use condoms, and multiple, risky sexual partnerships, increasing risk of HIV transmission. Accordingly, it is proposed that an intervention be developed to reduce IPV among South African youth by: increasing social support for girls; questioning male norms of superiority, sexual entitlement, and control of girls; reducing alcohol and drug use; and improving communication to reduce the use of violence in resolving relationship conflicts. Efficacious interventions to delay sexual initiation, promote correct and consistent condom use, and discourage multiple risky sexual partnerships will also be integrated into the program. The intervention will be adapted from a school-based program, Safe Dates, which significantly reduced IPV among 8th and 9th grade students in the southeastern United States (Foshee, Bauman, Ennet, et al., 2004). It also will incorporate materials from two South African intervention programs, Our Times Our Choices (Drs. Zimmerman and Cupp) and Stepping Stones (Jewkes, Nduna & Jama 2002; Jewkes et al., 2007) which have shown significant effects on key outcomes. Specifically, we propose to: 1) Adapt Safe Dates for use as an intervention to reduce IPV among in- school South African adolescents and integrate interventions targeting HIV risk behavior; 2) Conduct a pilot study of the adapted Safe Dates program with in-school South African adolescents to: a) reduce IPV, the primary target of the intervention, and b) delay initiation of sex, increase condom use, decrease the number of sexual partners, and decrease risky sexual partnerships, the secondary targets of the intervention. The pilot study will employ an experimental design, a six-month follow-up period, and audio-enhanced personal digital assistants (APDAs) to optimize honest self-report. The primary goals of the proposed project are to demonstrate the feasibility of implementing the adapted Safe Dates program in South Africa and to provide estimates of effect sizes, so that a randomized control trial can be designed to assess its efficacy.