title: Effects of a community intervention on HIV prevention behaviors among men who experienced childhood sexual or physical abuse in four African settings: findings from NIMH Project Accept (HPTN 043).
abstract: BACKGROUND
  There is increased focus on HIV prevention with African men who report experiencing childhood sexual (CSA) or physical abuse (CPA).
  
  
  OBJECTIVE
  To better understand the effects of a community-based intervention (Project Accept HPTN 043) on HIV prevention behaviors among men who report CSA or CPA experiences.
  
  
  METHODS
  Project Accept compared a community-based voluntary mobile counseling and testing (CBVCT) intervention with standard VCT. The intervention employed individual HIV risk reduction planning with motivational interviewing in 34 African communities (16 communities at 2 sites in South Africa, 10 in Tanzania, and 8 in Zimbabwe). Communities were randomized unblinded in matched pairs to CBVCT or SVCT, delivered over 36 months. The post-intervention assessment was conducted using a single, cross-sectional random survey of 18-32 year-old community members (total N = 43,292). We analyzed the effect of the intervention on men with reported CSA or CPA across the African sites. Men were identified with a survey question asking about having experienced CSA or CPA across the lifespan. The effect of intervention on considered outcomes of the preventive behavior was statistically evaluated using the logistic regression models.
  
  
  RESULTS
  Across the sites, the rates of CSA or CPA among men indicated that African men reflected the global prevalence (20%) with a range of 13-24%. The statistically significant effect of the intervention among these men was seen in their increased effort to receive their HIV test results (OR 2.71; CI: (1.08, 6.82); P: 0.034). The intervention effect on the other designated HIV prevention behaviors was less pronounced.
  
  
  CONCLUSIONS
  The effect of the intervention on these men showed increased motivation to receive their HIV test results. However, more research is needed to understand the effects of community-based interventions on this group, and such interventions need to integrate other keys predictors of HIV including trauma, coping strategies, and intimate partner violence.
authors.affiliation: University of California Los Angeles, UCLA Center for World Health, Los Angeles, California, United States of America.
authors.forename: Joseph
authors.initials: J
authors.lastname: Daniels
authors.affiliation: Faculty of Mathematics and Physics, Charles University, Prague, Czech Republic.
authors.forename: Arnošt
authors.initials: A
authors.lastname: Komárek
authors.affiliation: Human Sciences Research Council, Durban, South Africa.
authors.forename: Tawanda
authors.initials: T
authors.lastname: Makusha
authors.affiliation: Human Sciences Research Council, Durban, South Africa.
authors.forename: Alastair
authors.initials: A
authors.lastname: Van Heerden
authors.affiliation: University of the Witwatersrand/Chris Hani Baragwanath Hospital, Faculty of Health Sciences, Perinatal HIV Research Unit, Soweto, South Africa.
authors.forename: Glenda
authors.initials: G
authors.lastname: Gray
authors.affiliation: University of Zimbabwe, College of Health Sciences, Harare, Zimbabwe.
authors.forename: Alfred
authors.initials: A
authors.lastname: Chingono
authors.affiliation: Muhimbili University of Health and Allied Sciences, Muhimbili University Teaching Hospital, Dar es Salaam, Tanzania.
authors.forename: Jessie K K
authors.initials: JK
authors.lastname: Mbwambo
authors.affiliation: University of California Los Angeles, UCLA Center for World Health, Los Angeles, California, United States of America.
authors.forename: Thomas
authors.initials: T
authors.lastname: Coates
authors.affiliation: Human Sciences Research Council, Durban, South Africa; Developmental Pathways to Health Research Unit, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: Linda
authors.initials: L
authors.lastname: Richter
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002650:Child Abuse, Sexual / Q000523:psychology* / Q000706:statistics & numerical data; D019058:Community Networks; D003430:Cross-Sectional Studies; D037001:Directive Counseling; D015658:HIV Infections / Q000453:epidemiology / Q000517:prevention & control* / Q000523:psychology; D006801:Humans; D008297:Male; D009315:National Institute of Mental Health (U.S.); D015995:Prevalence; D011897:Random Allocation; D013019:South Africa / Q000453:epidemiology; D013636:Tanzania / Q000453:epidemiology; D014481:United States; D055815:Young Adult; D015030:Zimbabwe / Q000453:epidemiology