John B. Jemmott III, G. Anita Heeren, and Craig Carty are with the Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia. John B. Jemmott III is also with the Annenberg School for Communication, University of Pennsylvania. Loretta S. Jemmott is with the School of Nursing, University of Pennsylvania. Ann O'Leary is with the Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA. Zolani Ngwane is with the Department of Anthropology, Haverford College, Haverford, PA. Larry D. Icard is with the College of Health Professionals and Social Work, Temple University, Philadelphia, PA. Xoliswa Mtose is with the Faculty of Education, University of Fort Hare, East London, South Africa.
Am J Public Health. 2014 Mar;104(3):467-73. doi: 10.2105/AJPH.2013.301578. Epub 2014 Jan 16.
OBJECTIVES: We tested the efficacy of a sexual risk-reduction intervention for men in South Africa, where heterosexual exposure is the main mode of HIV transmission. METHODS: Matched-pairs of neighborhoods in Eastern Cape Province, South Africa, were randomly selected and within pairs randomized to 1 of 2 interventions based on social cognitive theory and qualitative research: HIV/sexually transmitted infection (STI) risk-reduction, targeting condom use, or attention-matched control, targeting health issues unrelated to sexual risks. Sexually active men aged 18 to 45 years were eligible. The primary outcome was consistent condom use in the past 3 months. RESULTS: Of 1181 participants, 1106 (93.6%) completed the 12-month follow-up. HIV and STI risk-reduction participants had higher odds of reporting consistent condom use (odds ratio [OR] = 1.32; 95% confidence interval [CI] = 1.03, 1.71) and condom use at last vaginal intercourse (OR = 1.40; 95% CI = 1.08, 1.82) than did attention-control participants, adjusting for baseline prevalence. No differences were observed on unprotected intercourse or multiple partnerships. Findings did not differ for sex with steady as opposed to casual partners. CONCLUSIONS: Behavioral interventions specifically targeting men can contribute to efforts to reduce sexual risk behaviors in South Africa.
目的：我们检验了一种在南非针对男性的性行为风险降低干预的效果，因为异性间性接触是 HIV 传播的主要途径。
方法：在南非东开普省，我们随机选择了配对的街区，在每对街区内，再根据社会认知理论和定性研究将参与者随机分配到 2 种干预措施之一：HIV/性传播感染（STI）风险降低干预，以避孕套使用为目标；或匹配对照组，以与性行为风险无关的健康问题为目标。年龄在 18 至 45 岁之间的活跃男性有资格参与。主要结局是在过去 3 个月中坚持使用避孕套。
结果：在 1181 名参与者中，有 1106 名（93.6%）完成了 12 个月的随访。HIV/STI 风险降低组报告坚持使用避孕套的可能性更高（比值比 [OR] = 1.32；95%置信区间 [CI] = 1.03，1.71）和最近一次性交时使用避孕套（OR = 1.40；95% CI = 1.08，1.82），而与对照组相比，调整基线流行率后，差异具有统计学意义。在无保护性行为或多个性伴侣方面，两组没有差异。与稳定伴侣相比，这种效果在与偶然伴侣发生性行为时没有差异。
结论：专门针对男性的行为干预措施可以有助于南非减少性行为风险行为的努力。
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