title: Randomized community-level HIV prevention intervention trial for men who drink in South African alcohol-serving venues.
abstract: BACKGROUND
  South African alcohol-serving establishments (i.e., shebeens) offer unique opportunities to reduce HIV risks among men who drink.
  
  
  OBJECTIVE
  To test an individual- and a social structural-level HIV prevention intervention for men who drink in shebeens.
  
  
  METHODS
  Twelve matched pairs of township neighbourhoods were randomized to receive either (i) an HIV prevention intervention (guided by Social Action Theory) to reduce sexual risk and increase risk reduction communication in social networks, or (ii) an attention-matched control intervention that focused on the prevention of relationship violence. At the individual level, the interventions delivered skills building workshops focused on sexual risk reduction. At the social structural level, the intervention aimed to increase conversations about safer sex among men in the shebeens, distributed small media and implemented community educational events. Individual-level outcomes were assessed by following the workshop cohorts for 1 year (N = 984), and community-level outcomes were examined through cross-sectional community surveys conducted for 1 year in the shebeens (N = 9,678).
  
  
  RESULTS
  Men in the HIV prevention workshops demonstrated greater condom use, more HIV prevention-oriented conversations and greater perceptions of safer sex norms than men in the comparison workshops. Changes at the community level demonstrated significant differences in condom use, although the pattern was not consistent over time.
  
  
  CONCLUSIONS
  Multi-level interventions that target men who drink in South African shebeens may help reduce risks for HIV and other sexually transmitted infections.
authors.affiliation: 1 University of Connecticut seth.k@uconn.edu.
authors.forename: Seth C
authors.initials: SC
authors.lastname: Kalichman
authors.affiliation: 2 Human Sciences Research Council, Cape Town, South Africa & University of Cape Town.
authors.forename: Leickness C
authors.initials: LC
authors.lastname: Simbayi
authors.affiliation: 1 University of Connecticut.
authors.forename: Demetria
authors.initials: D
authors.lastname: Cain
authors.affiliation: 3 Brown University.
authors.forename: Kate B
authors.initials: KB
authors.lastname: Carey
authors.affiliation: 3 Brown University 4 The Miriam Hospital, Providence, RI.
authors.forename: Michael P
authors.initials: MP
authors.lastname: Carey
authors.affiliation: 1 University of Connecticut.
authors.forename: Lisa
authors.initials: L
authors.lastname: Eaton
authors.affiliation: 1 University of Connecticut.
authors.forename: Ofer
authors.initials: O
authors.lastname: Harel
authors.affiliation: 2 Human Sciences Research Council, Cape Town, South Africa & University of Cape Town.
authors.forename: Vuyelwa
authors.initials: V
authors.lastname: Mehlomakhulu
authors.affiliation: 5 University of the Western Cape, Cape Town, South Africa.
authors.forename: Kelvin
authors.initials: K
authors.lastname: Mwaba
mesh_terms: D000328:Adult; D000428:Alcohol Drinking / Q000453:epidemiology*; D016000:Cluster Analysis; D003132:Commerce; D003153:Community Health Services / Q000379:methods*; D015897:Comorbidity; D005500:Follow-Up Studies; D015658:HIV Infections / Q000453:epidemiology* / Q000517:prevention & control*; D006266:Health Education / Q000379:methods* / Q000706:statistics & numerical data; D018451:Homosexuality, Male / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D015397:Program Evaluation / Q000379:methods* / Q000706:statistics & numerical data; D012307:Risk Factors; D040242:Risk Reduction Behavior; D012725:Sexual Behavior / Q000706:statistics & numerical data; D013019:South Africa / Q000453:epidemiology