Gender-Transformative Interventions to Reduce HIV Risks and Violence with Heterosexually-Active Men: A Review of the Global Evidence

December 2013 - Structural Prevention

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Dworkin, S.L., Treves-Kagan, S., and Lippman, S.A. AIDS and Behavior (November 2013), Vol. 17 No. 9, pp. 2845-2863.

The authors conducted a systematic review of published evidence on the effect of gender-transformative interventions targeting heterosexual men on outcomes for HIV and sexually transmitted infections (STIs) and gender. Evidence from 15 eligible studies in four continents suggests that gender-transformative strategies can lead to protective sexual behaviors, attitude changes, violence prevention, and reductions in STIs/HIV. Twelve interventions used small group learning, which was the most common intervention; five of these incorporated a community-level component. Three studies were randomized control/cluster trials. One study, Stepping Stones (South Africa), included biomarkers to evaluate impacts on HIV and herpes simplex virus-2 (HSV-2); although no effect on HIV was found, there was a 28 percent reduction in HSV-2 incidence among men. Further, results on sexual risk behavior outcomes (11 interventions; nine statistically significant reductions) provided partial evidence that these interventions decreased sexual risk behavior. Findings suggested that these interventions help reduce perpetration of violence against women (eight interventions; six statistically significant outcomes). Of 12 programs assessing change in gender norms, 11 found at least some statistically significant changes in normative attitudes. More rigorous study designs and intervention formats are needed, including initiatives to modify community-level norms. Future research should include interventions engaging both men and women. The authors concluded that gender-transformative interventions can reduce risk behaviors and partner violence, and should continue and be scaled up.

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