A growing body of evidence suggests that programs that change harmful gender norms can have notable HIV-related effects on program participants, including increased condom use, as well as a decrease in sexually transmitted infections and intimate partner violence. Yet there is limited evidence of whether such programs can shift norms in the community, and if so, whether, and how, these changes can improve men’s and women’s uptake of HIV services. There is a particular need to better understand these relationships in South Africa, given its generalized HIV epidemic and high levels of gender-based violence.
SOAR is addressing these knowledge gaps by building on an ongoing National Institute of Mental Health-funded randomized controlled trial being conducted in South Africa, Community Mobilization for Treatment as Prevention (CM for TasP). The existing trial is testing whether a CM program that addresses social barriers—such as HIV-related stigma or fear of disclosure—can increase HIV testing, linkage to care, and retention in care. Under SOAR, we are strengthening and expanding the gender content of the CM for TasP intervention to engage both women and men in critically examining gender norms and power inequalities. We are investigating whether these CM activities shift community support toward more equitable gender norms, and whether and how improved gender norms affect HIV service utilization.
The randomized controlled trial is in 16 villages in Mpumalanga Province, and the SOAR research consists of four data collection activities: (1) analysis of surveys of randomly selected men and women in study communities at baseline and endline to assess relationships between gender dynamics (e.g., gender norms) and HIV service utilization; (2) qualitative data collection among community members and program staff/mobilizers to explore the process of shifting gender norms; (3) collection of programmatic data on HIV-related clinical visits in the study areas to triangulate findings with the surveys and qualitative research; and (4) a costing component to determine the cost per HIV test resulting from the intervention, and the intervention’s cost-effectiveness.
Building the evidence base in this area is vital for improving care outcomes as well as creating more equitable gender norms.