Randomized Controlled Trial

. 2018 Jul;21(7):e25134.

doi: 10.1002/jia2.25134.

Community mobilization to modify harmful gender norms and reduce HIV risk: results from a community cluster randomized trial in South Africa

Audrey Pettifor^{1

2

3}, Sheri A Lippman^{3

4}, Ann Gottert⁵, Chirayath M Suchindran^{2

6}, Amanda Selin², Dean Peacock^{7

8}, Suzanne Maman⁹, Dumisani Rebombo⁷, Rhian Twine³, Francesc Xavier Gómez-Olivé³, Stephen Tollman^{3

10}, Kathleen Kahn^{3

10}, Catherine MacPhail^{3

11

12}

Affiliations

¹ Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA.
² Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
³ MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.
⁴ Center for AIDS Prevention Studies (CAPS), Department of Medicine, University of California at San Francisco, San Francisco, CA, USA.
⁵ Population Council, HIV and AIDS program, Washington, DC, USA.
⁶ Department of Biostatistics, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA.
⁷ Sonke Gender Justice, Cape Town, South Africa.
⁸ School of Public Health, Division of Social and Behavioural Science, University of Cape Town, Cape Town, South Africa.
⁹ Department of Health Behavior, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC.
¹⁰ Epidemiology and Global Health Unit, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
¹¹ School of Health, University of New England, Armidale, NSW, Australia.
¹² Wits RHI, University of the Witwatersrand, Johannesburg, South Africa.

PMID: 29972287
PMCID: PMC6058206
DOI: 10.1002/jia2.25134

Randomized Controlled Trial

Community mobilization to modify harmful gender norms and reduce HIV risk: results from a community cluster randomized trial in South Africa

Audrey Pettifor et al. J Int AIDS Soc. 2018 Jul.

. 2018 Jul;21(7):e25134.

doi: 10.1002/jia2.25134.

Authors

Affiliations

¹ Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA.
² Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
³ MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.
⁴ Center for AIDS Prevention Studies (CAPS), Department of Medicine, University of California at San Francisco, San Francisco, CA, USA.
⁵ Population Council, HIV and AIDS program, Washington, DC, USA.
⁶ Department of Biostatistics, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA.
⁷ Sonke Gender Justice, Cape Town, South Africa.
⁸ School of Public Health, Division of Social and Behavioural Science, University of Cape Town, Cape Town, South Africa.
⁹ Department of Health Behavior, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC.
¹⁰ Epidemiology and Global Health Unit, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
¹¹ School of Health, University of New England, Armidale, NSW, Australia.
¹² Wits RHI, University of the Witwatersrand, Johannesburg, South Africa.

PMID: 29972287
PMCID: PMC6058206
DOI: 10.1002/jia2.25134

Abstract

Introduction: Community mobilization (CM) is increasingly recognized as critical to generating changes in social norms and behaviours needed to achieve reductions in HIV. We conducted a CM intervention to modify negative gender norms, particularly among men, in order to reduce associated HIV risk.

Methods: Twenty two villages in the Agincourt Health and Socio-Demographic Surveillance Site in rural Mpumalanga, South Africa were randomized to either a theory-based, gender transformative, CM intervention or no intervention. Two cross-sectional, population-based surveys were conducted in 2012 (pre-intervention, n = 600 women; n = 581 men) and 2014 (post-intervention, n = 600 women; n = 575 men) among adults ages 18 to 35 years. We used an intent-to-treat (ITT) approach using survey regression cluster-adjusted standard errors to determine the intervention effect by trial arm on gender norms, measured using the Gender Equitable Mens Scale (GEMS), and secondary behavioural outcomes.

Results: Among men, there was a significant 2.7 point increase (Beta Coefficient 95% CI: 0.62, 4.78, p = 0.01) in GEMS between those in intervention compared to control communities. We did not observe a significant difference in GEMS scores for women by trial arm. Among men and women in intervention communities, we did not observe significant differences in perpetration of intimate partner violence (IPV), condom use at last sex or hazardous drinking compared to control communities. The number of sex partners in the past 12 months (AOR 0.29, 95% CI 0.11 to 0.77) were significantly lower in women in intervention communities compared to control communities and IPV victimization was lower among women in intervention communities, but the reduction was not statistically significant (AOR 0.53, 95% CI 0.24 to 1.16).

Conclusion: Community mobilization can reduce negative gender norms among men and has the potential to create environments that are more supportive of preventing IPV and reducing HIV risk behaviour. Nevertheless, we did not observe that changes in attitudes towards gender norms resulted in desired changes in risk behaviours suggesting that more time may be necessary to change behaviour or that the intervention may need to address behaviours more directly.

Clinical trials number: ClinicalTrials.gov NCT02129530.

Keywords: HIV; South Africa; community mobilization; gender norms; gender-based violence.

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Figures

**Figure 1**
Conceptual Framework for Community Mobilization Intervention.

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Community mobilization to modify harmful gender norms and reduce HIV risk: results from a community cluster randomized trial in South Africa

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Community mobilization to modify harmful gender norms and reduce HIV risk: results from a community cluster randomized trial in South Africa

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