Discussion
adolescence, AIDS-related deaths, HIV-related behaviors, HIV among at-risk young men in South Africa., health-risking sexual behavior, deaths, substance abuse
In a cluster randomized controlled trial targeting at-risk young men, our results indicate that the intervention was ineffective in reducing HIV-related behaviors and substance abuse, as well as a cluster or related outcomes. There was only one potential significant result—a lower rate of mandrax use at 6 month in the SL compared to the CC. However, there were no other reductions in other drugs or alcohol. Also, in general, the self-reports of alcohol and drug use were similar to results of the RDT. In the case of mandrax, the self-reports were not lower at 6 months and we did not have a baseline RDT for mandrax. Both of these problems suggest this finding be interpreted with caution. Given an effective pilot study [First, there may be a cultural encouragement for men to use alcohol and drugs, which may be difficult to overcome. Alcohol consumption in South Africa is among the highest globally [Second, there is substantial evidence that putting young men who have problem behaviors together can exacerbate these risk behaviors [There is one very disturbing finding that could reflect that the intervention was harmful—there were nine deaths observed in the SL compared to none in the CC. While these do not reflect a significant result, this finding is concerning. We hypothesize that our far more limited contact with the participants in the CC led us not to discover the number of deaths among the CC. It was common for young men to leave Cape Town to “escape” to the rural Eastern Cape. For example, one young man died when caught burglarizing a neighborhood home. When young men expected a negative interaction with peers or law enforcement, they reported going to the Eastern Cape to wait for any stress to die down. We would have had less knowledge, nor reports from peers or coaches, when deaths occurred in the CC.Third, for many of the young men in this study, the cluster of risky behaviors that this intervention addressed are entrenched in their daily routines and lifestyles. Our intervention may, therefore, be ineffective in addressing these determinants of risk, as it may be “too late” for these men to alter their risky behaviors into prosocial and healthy lifestyles. The results of this study suggest that in order to target the cluster of risk behaviors associated with HIV, early intervention is key. In fact, there is mounting evidence that interventions targeting risk behavior during childhood and adolescence is effective in preventing health-risking sexual behavior later in life [Adolescents are the only age group in which AIDS-related deaths are stable or increasing [Fourth, our intervention strategy was not traditional—we did not write a manual and train coaches to implement a set of sequenced scripts and activities [Fifth, our control condition provided educational materials that were highly interesting and based on previous evidence-based strategies in previous research [Finally, the results of this study are not unique. Sports has often been linked to lower rates of substance abuse and sexual risks placing persons at risk for HIV [There are several limitations to this study. There were a few significant baseline differences between the SL and CC groups in terms of income and lifetime sexual assault. Results associated with these outcomes should be interpreted with caution.This trial aimed to evaluate the effectiveness of a soccer intervention program to reduce multiple risk behavior associated with HIV among at-risk young men in South Africa. We found that the intervention was ineffective in reducing alcohol, dagga, or methamphetamine use. The effect of the intervention on mandrax use was inconclusive. There were no intervention effects for sexual health, mental health, or violence. We argue that it may be “too late” to address multiple risk behavior using a group-based behavioral intervention among these young men. Rather, early intervention during adolescence may be crucial to address the cluster of risk behaviors that are associated with HIV.