Marseille 2007
| Abstract #643 - Impact of Stepping Stones on HIV, HSV-2 and sexual behaviour in rural South African youth: cluster randomised controlled trial with qualitative research | ||||
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Session: 18.1: Risk Perception (Parallel) on Monday @ 14.00-16.00 in CP Chaired by Elizabeth Brown, Yusef Azad Authors: Presenting Author: Prof Rachel Jewkes - Medical Research Council, South Africa |
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| Additional Authors: Ms Mzikazi Nduna, Dr Jonathan Levin, Ms Nwabisa Jama, Dr Kristin Dunkle, Prof Mary Koss, Dr Adrian Puren, Dr Nata Duvvury, Dr Kate Wood, | ||||
| Aim: Background: Stepping Stones (Welbourn 1995) is an HIV prevention behavioural intervention that was originally developed for use in Uganda and adapted for South Africa in 1998. It uses participatory learning approaches and aims to transform gender relation in the course of HIV prevention. This was the first evaluation with biological and behavioural outcomes of an established and gender transformatory HIV intervention in Africa. It aimed to determine the impact of Stepping Stones on HIV (primary outcome) and HSV-2 incidence and sexual behaviour two years after the intervention. | ||||
| Method / Issue: Methods: 1423 women and 1371 men aged 15-26 years were recruited from 70 villages in the rural Eastern Cape. The villages were randomly allocated to the two study arms. HIV and HSV-2 prevalence and sexual behaviour were assessed at baseline, 12 months and 24 months through blood tests and a face to face interview. Analysis followed intention to treat. Qualitative research was also conducted with 10 men and 10 women. They had 2-3 in-depth interviews before the intervention and one some months afterwards. | ||||
| Results / Comments: Results: Baseline HIV prevalence was 11% in women and 2% in men. 87% of participants contributed HIV incidence data at 12 or 24 months. Stepping Stones women acquired less HIV [IRR = 0.85 (95% CI 0.60, 1.20)] and HSV 2 [IRR= 0.69 (95% CI 0.47, 1.03)]. There was little difference in behavioural outcomes. Stepping Stones men had fewer partners, more condom use, less transactional sex and perpetrated less severe IPV, they also had less substance use and a lower HSV 2 incidence rate [IRR 0.72 (95% CI 0.36, 1.46)]. Their HIV incidence was not different. The findings are supported by the qualitative research, which showed both a high level of awareness of HIV and generally constructive attitudes towards people with HIV/AIDS. Improved communication and changes in mens attitudes towards and reported use of violence were very prominent findings. The interviews showed that knowledge and confidence discussing HIV increased substantially, and that men, and some women, were empowered to use condoms. The qualitative research also pointed to multiple ways in which the subordinate position of women in relationships and ideas of gender inequity, particularly gendered dimensions of communication and gossip, constrained womens ability to fully engage with some aspects of the intervention. Women were seen in some relationships to lack agency to change aspects of their behaviour and were particularly concerned about possibly jeopardising the success of a relationship. | ||||
| Discussion: Conclusions: The study provides some evidence that Stepping Stones is a useful HIV prevention intervention and is gender transformative, with success in changing a range of mens behaviours. It deserves further development and investigation. The findings highlight the importance of understanding womens sexual behaviour within the context of broader ideas of femininity when intervening with women. | ||||
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