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Southern Africa: AIDS prevention through reduced choice-disability: a randomized control trial
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AIDS prevention focused on the choice-disabled: a randomized controlled trial in southern Africa
CIET is currently conducting a pragmatic randomized controlled trial to test the impact of focusing local AIDS prevention on the choice-disabled, especially the victims of gender-based violence, in three countries: Botswana, Namibia and Swaziland. The idea is that reducing gender-based violence and openly questioning the culture of gender-based violence will reduce HIV transmission directly and indirectly.
Almost all current AIDS prevention strategies address the choice-enabled – those who can take preventive measures if they want to. Abstinence, for example, protects only those who can say No. People who are able to give up multiple concurrent partners or to insist on correct condom use can reduce their risks of HIV. But many do not have this freedom of choice, mostly because they are victims of violence or are simply destitute, or for both reasons. These are the choice-disabled. We know little about prevention for choice-disabled people, or how this affects the AIDS epidemic. Choice-disability is a prevention blind spot and quite probably a pivot of the AIDS epidemic in southern Africa.
For the current study we randomly allocated 79 nationally representative clusters in Botswana, Namibia and Swaziland to test four interventions, alone and in combination. One intervention promotes partnerships in existing local AIDS prevention activities in favour of the choice-disabled, looking to increase their effectiveness without additional investment. A second intervention is sexual violence education through schools, youth groups, granny groups, church groups and local radio, geared to generate solutions to reduce sexual violence from within each community. The third intervention focuses on empowerment of the choice-disabled through a structural intervention based on the Organisational Workshop approach. The fourth intervention is promotion of male circumcision, using the standard government approach. All clusters (100-120 households) will continue existing AIDS prevention programmes and all will have the same measurement activities.
The main outcome measure is HIV infection (in the 15 to 29 year age group). We will also measure protective knowledge, attitudes, subjective norms (the relative weight people give to the norms of those close to them), intention to change, agency (do people feel capable of acting as they would wish to?), discussion of prevention (within people's social networks), and practices related to sexual violence. Likely side effects of the intervention include reduced criminal delinquency and substance abuse. All effects will be measured in the trial's fourth year.
The trial is being funded by Canada's International Development Research Centre (IDRC) and has been registered as ISRCTN28557578 - http://www.controlled-trials.com/ISRCTN28557578 .
In Botswana, CIET works in partnership with the Health Ministry's Department of HIV/AIDS Prevention and Care.