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. We randomized two neighborhoods to either: an intervention (soccer and vocational training contingent on behaviors at soccer); or a delayed-delivery control neighborhood. Almost all eligible neighborhood men were recruited (95%; N=142) and 90% reassessed at 6 months. In the intervention condition, 80% of young men regularly attended soccer and 55% earned entry to vocational training. Intervention men completed drug tests at soccer (with uptake rising over time and drug use decreasing), and increased employment over six months, compared to control men. HIV testing did not increase, based only on self-reports. Qualitative interviews of men, coaches, and family members demonstrated the program’s benefits in shifting men’s role in their homes and communities, although attitudinal shifts towards women were minor.
Based on these results, a randomized controlled trial (RCT) is proposed 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.
Raphael Landovitz’s clinical research career focuses on optimizing the use of HIV antiretroviral therapy for both HIV treatment and HIV prevention. Dr. Landovitz was trained at Princeton University and Harvard Medical School. He completed post-graduate training in internal medicine at Brigham and Women’s Hospital (1996-1999) and Infectious Diseases and HIV Medicine at Brigham and Women’s Hospital and Massachusetts General Hospital (1999-2001). He works in the DAIDS-funded AIDS Clinical Trials Group (ACTG), HIV Prevention Trials Network (HPTN) and the NICHD-funded Adolescent Trials Network (ATN), and serves as the Clinical Research Site leader of the UCLA CARE Center Clinical Research Site for the DAIDS-funded networks. He is the principal investigator of a multisite PrEP demonstration project in Los Angeles County, and the protocol chair of Phase 2a and Phase 2b/3 studies of long-acting injectable PrEP using GSK1265744 (cabotegravir).
infusion for HIV prevention; HPTN 083 compares daily oral Truvada to a long acting injectable antiretroviral (cabotegravir) for HIV prevention. Both studies will contribute critically important information to move the field of biomedical HIV prevention forward, and in the process bring new HIV prevention strategies to the most at-risk populations of Los Angeles County.
