Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA.
Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
J Int AIDS Soc. 2018 Jul;21(7):e25134. doi: 10.1002/jia2.25134.
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.
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.
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).
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.
ClinicalTrials.gov NCT02129530.
社区动员（CM）越来越被认为对于产生实现 HIV 减少所需的社会规范和行为改变至关重要。我们进行了 CM 干预，以改变负面的性别规范，尤其是男性的性别规范，以降低相关的 HIV 风险。
在南非姆普马兰加省农村的 Agincourt 健康和社会人口监测点的 22 个村庄中，将其随机分为基于理论的、具有性别变革性的 CM 干预组或无干预组。在 2012 年（干预前，n=600 名女性；n=581 名男性）和 2014 年（干预后，n=600 名女性；n=575 名男性），对年龄在 18 至 35 岁的成年人进行了两次基于人群的横断面调查。我们采用意向治疗（ITT）方法，使用调查回归聚类调整标准误差，根据试验臂确定干预对使用性别公平男性量表（GEMS）衡量的性别规范和次要行为结果的影响。
在男性中，与对照组相比，干预组的 GEMS 评分显著增加了 2.7 分（贝塔系数 95%可信区间：0.62，4.78，p=0.01）。我们没有观察到女性的 GEMS 评分因试验臂而有显著差异。在干预组和对照组中，男性和女性的亲密伴侣暴力（IPV）发生率、上次性行为时使用避孕套或危险饮酒均无显著差异。与对照组相比，在过去 12 个月中，干预组女性的性伴侣数量显著减少（OR 0.29，95%可信区间 0.11 至 0.77），干预组女性的 IPV 受害率也较低，但减少幅度没有统计学意义（OR 0.53，95%可信区间 0.24 至 1.16）。
社区动员可以减少男性的负面性别规范，并有潜力创造更支持预防 IPV 和减少 HIV 风险行为的环境。然而，我们没有观察到态度的改变导致期望的风险行为的改变，这表明可能需要更多的时间来改变行为，或者干预可能需要更直接地解决行为问题。
ClinicalTrials.gov NCT02129530。
