HIV & Drug Abuse Prevention for South African Men
Condition: Substance-Related Disorders; Human Immunodeficiency Virus; Alcoholism
MeSH terms: Acquired Immunodeficiency Syndrome; HIV Infections; Immunologic Deficiency Syndromes; Alcoholism; Substance-Related Disorders
Study type: Interventional
Phase: Phase 3

Summary: 
      The purpose of this study is to test the efficacy of randomizing all young men in a
      neighborhood to receive: 1) soccer training; 2) soccer and vocational training; or 3) a
      control condition, as a means to engage young men in HIV prevention. The investigators
      hypothesize that the intervention will reduce young men's substance use and increase HIV
      testing.
    

Detailed description: 
      South Africa has the highest number of HIV-infected persons of any nation, including 2.4
      million men, and from 2002-2011 young men have had a 3% incidence HIV rate that has remained
      stable. New infections occur later in men than in women, making men in their 20s a target for
      intervention. Decreasing sexual risk and concurrent partnerships is a key outcome in
      interventions to reduce HIV incidence. Most men (68%) report unprotected sex, typically with
      three partners in the last three months,and more than half of young men do not use condoms
      with casual partners.

      In South Africa, the amount of alcohol consumed per adult is among the highest in the world.
      'Heavy episodic drinking', which most strongly correlates with risky sexual behaviors and HIV
      infection, is reported by 60% of men. Alcohol, tik (methamphetamine) and marijuana are common
      among young men in South Africa. Among alcohol abusers, men are highly likely to be poly
      substance users. Among HIV seropositive young men, drug use is common. Drug and alcohol use
      is associated with risky sexual behaviors and an increase in the number of sexual partners.

      In townships, alcohol is involved in or responsible for 60% of automobile accidents, 75% of
      homicides, 50% of non-natural deaths, 67% of domestic violence, 30% of hospital admissions,
      and costs South Africa about R9 billion annually. Violence also characterizes the lives of
      young men in the Xhosa townships. Intimate partner violence is frequent in alcohol-using
      partnerships and is correlated with increased HIV incidence. Substance use and unemployment
      often lead to violence in a township. Jobs, by contrast, provide income and create a strong
      and respected community role.

      HIV prevention efforts for young people in Sub-Saharan Africa have largely been unsuccessful:
      novel, structural, community level programs that address the social determinants of HIV are
      needed. Unemployment and a culture of alcohol and violence are major social determinants of
      HIV among young men. Yet, men are often excluded from economic development programs. Young,
      South African men need new pathways for prosocial roles and behaviors and our interventions
      need to be attractive and consistent with men's styles. The social determinants of HIV
      (unemployment, alcohol, and violence) are critical to creating opportunities for prosocial
      roles for young men. One of the most common comments by both the men and their families in
      our previous pilot qualitative study on soccer and vocational training was men's lack of
      "things to do." Given these needs, the investigators focus on soccer and vocational training
      in this randomized controlled trial as opportunities for young men to acquire the habits of
      daily living that are most likely to result in jobs, health, and positive relationships.
    

Intervention name(s): Soccer League (SL); Soccer League/Vocational Training (SL-V)
Intervention type(s): Behavioral; Behavioral
Intervention description(s): Participants will be invited to attend soccer practice in the late afternoons, roughly 2-3 times per week. Competitive games will be held on Saturdays so that friends and family may attend. Using a mobile phone application, coaches will regularly record information on participants' arrival and departure times, sportsmanship, volunteering in the community, the results of saliva tests for drugs and alcohol. The SL intervention arm will last for one year.; In addition to the SL intervention, participants will gain access to vocational training. The Vocational Training will take place through the Silulo or Zenzele programs based in Khayelitsha for a period of 6 months. These programs offer practical and market-related training in computer skills, woodwork, or welding. The SL-V intervention arm will last for one year; with six months dedicated to soccer and six months dedicated to vocational training.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Prevention
Keywords: Substance-Related Disorders; Human Immunodeficiency Virus; Alcoholism; South Africa; Men; Soccer; Vocational Training