Background: Despite calls to engage men in HIV and intimate partner violence (IPV) prevention efforts, effective approaches to reach and engage men in low-resource, high-HIV prevalence settings are limited. We identified and engaged social networks of mostly young men, locally referred to as “camps,” in Vijana Vijiweni II, a cluster-randomized trial to evaluate the efficacy of a combined microfinance and peer health leadership intervention for HIV and IPV prevention among 59 camps in Dar es Salaam, Tanzania.
Methods: Thirty camps (n=621 men) were randomly assigned to the two-year intervention condition and 29 camps (n=628 men) were randomized to the control. Behavioral assessments were conducted at baseline and 30-months post-intervention launch, with biological samples drawn at 30-months to test for sexually-transmitted infections (STIs). Primary outcomes included prevalence of STIs and past-year IPV perpetration. Secondary outcomes included STI sexual risk behaviors and past-year HIV testing. Proximal intervention targets included inequitable gender norm attitudes and hope. We compared outcomes among intervention vs. control participants by computing covariate-adjusted risk ratios (aRR) with robust confidence intervals (CI) using an intention-to-treat approach.
Results: Of 1,249 men enrolled in the trial, 1,029 (82.4%) completed the 30-month follow-up. There was no evidence that the intervention reduced STI prevalence (aRR 1.05, 95% CI 0.86-1.29), IPV perpetration (aRR 1.15, 95% CI 0.91-1.44), or STI risk behaviors. Men in the intervention condition reported greater levels of past-year HIV testing, controlling for HIV testing status at baseline, (aRR 1.13, 95% CI 1.00-1.28, p=.04) as well as significantly lower levels of inequitable gender norm attitudes at the 30-month follow-up (adjusted effect -0.11, 95% CI -0.21-0.00, p=.04), while there was no significant difference in hope across condition.
Conclusions: We successfully engaged and retained social networks of men in this multilevel HIV and IPV prevention study. The combined microfinance and peer health leadership intervention successfully improved HIV testing and reduced inequitable gender norm attitudes. We did not see an effect on the primary outcomes or STI sexual risk behaviors. Additional analyses will examine whether there were effects for particular subgroups and whether there were differential effects as a function of intervention exposure.