In Africa, HIV prevention has been most successful with women, not men. For example, young, South African men aged 18-29 years continue to have a high incidence of HIV, frequent drug use, low HIV testing rates, concurrent sexual partnerships, and low rates of HIV testing and utilization of medical care. Innovations are needed in how, when, and where we engage men in HIV prevention. With R34 funding, we successfully demonstrated the feasibility of engaging young men with soccer and vocational training to reduce drug use.

Based on these results, a randomized controlled trial (RCT) this project aims to test the efficacy of randomizing all young men in a neighborhood to receive: 1) soccer training (8 neighborhoods, 400 men); 2) soccer and vocational training (8 neighborhoods, 400 men); or 3) a control condition (8 neighborhoods, 400 men). The primary outcomes will be decreased substance use (tested with rapid diagnostic tests [RDT]), increased repeat HIV testing (linkage, retention, and adherence to medical care among HIV-infected men), no concurrent partnerships, increased condom use, and no violence/arrests. Stellenbosch University interviewers will conduct assessments at recruitment, 6, 15, and 24 months (using mobile phones). Coaches will implement a Life Skills manual, as well as integrating cognitive-behavioral skills into problem situations that arise at games/practices, and reporting in real time via mobile phones all intervention contacts and content. Qualitative interviews will be conducted with coaches and young men (n=30 at each 6 month interval). If the RCT is successful, global program diffusion is probable by the Fédération Internationale de Football Association (FIFA) with national funding by the South African government NEET (Not in Education, Employment or Training) vocational training program, whose annual funding is typically underspent.