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

描述（由申请人提供）：南非18-25岁的青年男子面临艾滋病毒、酗酒和吸毒以及失业等相互交织的流行病。该R34旨在通过解决现有循证方案（EBP）的三个问题来降低年轻男性的风险：干预措施的设计没有考虑到男性的战斗-逃跑应对策略；捐赠者不愿投资于滥用药物的男性；而现有的职业培训并没有考虑到年轻人的不良习惯。我们的目标是将行为经济学家的策略应用于对年轻人极具吸引力的新交付模式：足球和职业培训。社区一级的艾滋病预防策略将在有组织的足球联赛中塑造男性积极的日常生活：准时、完成训练、清醒和不吸毒、表现出体育精神和非暴力。在两个月的时间里，有80%的时间表现出积极的日常生活习惯的年轻人，将由工匠培训师/导师提供就业培训。将两个社区的乡镇青年男性随机分为两组，一组接受足球、职业培训和应急管理的行为塑造干预（N=1个社区，N= 60名男性），另一组接受足球和职业培训不进行应急管理的对照条件（N=1个社区，60名男性）。评估将在基线和6个月的随访。我们假设该计划将显著减少与艾滋病毒相关的性风险行为和药物滥用，并维持更多的就业机会。我们将评估人生目标、日常生活的一致性、亲社会行为和家庭关系。我们将初步评估干预的可行性和可接受性，并初步评估干预对减少HIV风险行为和药物使用的影响和中介因素。我们还将通过对关键信息人的采访，记录利益相关者对项目挑战和成功的看法，通过观察，记录年轻男性的数量随时间的变化，以及Sonke性别正义（一个男性倡导运动）社会运动战略的主要特征。

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.