Utilizing Soccer for Delivery of HIV and Substance Use Prevention for Young South African Men: 6-Month Outcomes of a Cluster Randomized Controlled Trial

Abstract

Young men in South Africa face the intersecting epidemics of HIV, substance use and endemic poverty. We tested the effectiveness of a behavioral intervention using soccer training to reduce the cluster of risks associated with HIV and substance use. This cluster randomized controlled trial was conducted with men aged 18–29 years old in 27 neighborhoods in the townships of Cape Town, South Africa. Neighborhoods were randomized to receive for 6 months either: (1) Soccer League (SL; n = 18 neighborhoods, n = 778 men) who attended soccer three times weekly (72 sessions; 94% uptake, 45.5% weekly attendance rate), combined with an HIV/substance use, cognitive-behavioral intervention; or (2) a Control Condition (CC; n = 9; 415 men) who received educational materials and referrals at 3 month intervals. The primary outcome was the number of significant changes in a cluster of outcomes including HIV-related risks, substance abuse, employment/income, mental health, violence, and community engagement. There was only one significant difference on the rapid diagnostic tests for mandrax at 6 months, an insufficient number of changes to indicate a successful intervention. A group-based behavioral intervention was ineffective in addressing multiple risk behaviors among at-risk young men, similar to the findings of several recent soccer-related interventions. Early adulthood may be too late to alter well-established patterns of risk behaviors.Clinical Trial Registration This trial was prospectively registered on 24 November 2014 with ClinicalTrials.gov NCT02358226.

Men's mental health and interventions tailored to masculinity: a scoping review

“…This is similar to previous scoping reviews that highlighted the diversity of approaches used to address men's mental health [1,33]. One intervention used physical activities such as soccer [26], four used online interventions [16,21,29,31], six corresponded to therapeutic counseling interventions including interview and cognitive behavior group treatment [8,15,27,[30][31][32], and one intervention used expert networks [5]. Thus, the majority corresponded to online and therapeutic counseling interventions.…”

“…Therefore, it is necessary to confirm the effectiveness of the interventions applied to improve the mental health outcomes of men. Results of the study that applied soccer to the experimental group thrice a week, reported after six months that it was not effective in addressing various risk behaviors in young people, suggesting that early adulthood may be too late to change established risk-behavior [26]. Therefore, it is evident that the age of the participants must be considered when employing interventions such as sports that involve physical activities, though this needs to be confirmed through further research.…”

“…The study tested the effectiveness of behavioral interventions using soccer training to reduce the risks associated with HIV and drug use. The experimental group attended soccer three times a week and its effectiveness were evaluated six months later [26]. Two online interventions allowed visitors to navigate the website and alerted them to immediate risks.…”

“Emotional stress is more detrimental than the virus itself”: Towards an understanding of HIV testing and pre-exposure prophylaxis (PrEP) use among internal migrant men in South Africa

“…60 Efforts to address alcohol use and HIV risk have had mixed success, with evidence showing that social barriers (e.g., social norms around substance use) and structural level barriers (e.g., unemployment, poverty, violence, limited clinic resources) constrain long-lasting behavior change. 61,62 Building on these barriers for men, our data uncovered challenges that are exacerbated for and/or unique to South African migrants. Migrants may have a higher likelihood of life stressors, given the conditions that prompted their move as well as their near-universal need to find employment.…”

“Emotional stress is more detrimental than the virus itself”: A qualitative study to understand HIV testing and pre‐exposure prophylaxis (PrEP) use among internal migrant men in South Africa

“…social norms around substance use) and structural‐level barriers (e.g. unemployment, poverty, violence, limited clinic resources) constrain long‐lasting behaviour change [ 61 , 62 ].…”