Engaging men outside the HIV prevention paradigm in rural South Africa

PROJECT SUMMARY This project addresses critical gaps in the uptake of HIV prevention services among men in South Africa, particularly men with alcohol and substance use who are at increased risk for HIV acquisition. Despite advances in HIV care availability, there are disparities in service utilization among this demographic, attributed to factors like traditional masculinity norms, migratory work patterns, and perceptions that healthcare facilities are primarily for women. The project aims to design and evaluate a community-based intervention to be more accessible and aligned with the needs and preferences of men using substances. As an HIV clinician scientist with experience in both South Africa and the United States, my long-term goal is to lead the development and implementation of interventions that better engage men in HIV prevention efforts in South Africa. The NIH K23 Mentored Research Career Development Award will provide me the opportunity to further develop skills in 1) the fundamentals of qualitative data collection and analysis for populations with substance use, 2) intervention design informed by preference elicitation methods and behavioral theory, and 3) implementation and evaluation of community-based interventions. I have designed a training plan to address each of these aims and assembled a multidisciplinary mentorship team. My primary mentor is Dr. Mark Siedner, an expert in HIV cohort studies and implementation research in South Africa. My mentorship team also includes Dr. Christina Psaros, an expert in qualitative research and behavioral intervention design; Dr. Susanne Hoeppner, an expert in biostatistics; Dr. Maryam Shahmanesh, an expert in community-based interventions for HIV prevention in South Africa; Dr. Jeremiah Chikovore, an expert in masculinities in South Africa; Dr. Judith Hahn, an expert in the intersectionality of substance use and HIV. Under their guidance, I plan to 1) explore the lived experiences, perceptions, and preferences for HIV prevention and health services among men who visit shebeens (local bars) using qualitative methods; 2) develop an HIV prevention and health promotion intervention for men attending shebeens using preference elicitation methods and behavioral theory; and 3) evaluate the implementation of a community-based intervention aimed at improving HIV pre-exposure prophylaxis use and health engagement among men who frequent shebeens in rural South Africa. The completion of these training and research aims will directly align with NIH's priorities to reduce HIV incidence in high-risk populations. Accomplishing these aims will also provide me with the foundation to become an independent investigator focused on community-based interventions designed to engage and retain men in HIV prevention services.