Kalichman, S.C., Simbayi, L.C., Cain, D., et al. European Journal of Public Health (November 2013), E-publication ahead of print.
The authors evaluated a randomized individual- and community-level HIV prevention intervention seeking to reduce HIV-related sexual risks and shift social norms among South African men at high-risk, informal drinking venues (shebeens) in 12 Cape Town townships. Men randomized to the intervention workshops (497) received skill-building on risk reduction and communication to promote conversations about safer sex within social networks, along with related community events. Men in the control workshops (478) received messages on preventing violence in relationships. The intervention had greatest impact on condom use at the individual level, and a modest, inconsistent impact on community-level risk reduction and social norms. Men in the intervention group demonstrated significantly greater use of condoms over the one-year follow-up period, and engaged in more conversations about HIV and condom use. At the community level, at eight months post-baseline, condom use increased by 9 percent in the intervention shebeens while decreasing by 12 percent in the control communities. However, increased condom use was not found at the final follow-up at the community level. The authors suggested that individual- and community-level behavior, conversation, and normative changes may have synergistic effects. While more research is needed to evaluate multi-level interventions, the findings support previous research showing that shebeens may serve as platforms for HIV prevention.