Intimate partner violence among rural South African men: alcohol use, sexual decision-making, and partner communication.

Nearly one-third of South African men report enacting intimate partner violence. Beyond the direct health consequences for women, intimate partner violence is also linked to varied risk behaviours among men who enact it, including alcohol abuse, risky sex, and poor healthcare uptake. Little is known about how to reduce violence perpetration among men. We conducted retrospective, in-depth interviews with men (n = 53) who participated in a rural South African programme that targeted masculinities, HIV risk, and intimate partner violence. We conducted computer-assisted thematic qualitative coding alongside a simple rubric to understand how the programme may lead to changes in men's use of intimate partner violence. Many men described new patterns of reduced alcohol intake and improved partner communication, allowing them to respond in ways that did not lead to the escalation of violence. Sexual decision-making changed via reduced sexual entitlement and increased mutuality about whether to have sex. Men articulated the intertwined nature of each of these topics, suggesting that a syndemic lens may be useful for understanding intimate partner violence. These data suggest that alcohol and sexual relationship skills may be useful levers for future violence prevention efforts, and that intimate partner violence may be a tractable issue as men learn new skills for enacting masculinities in their household and in intimate relationships.