South Africa has the highest number of HIV-infected persons of any nation, including 2.4
million men, and from 2002-2011 young men have had a 3% incidence HIV rate that has remained
stable. New infections occur later in men than in women, making men in their 20s a target for
intervention. Decreasing sexual risk and concurrent partnerships is a key outcome in
interventions to reduce HIV incidence. Most men (68%) report unprotected sex, typically with
three partners in the last three months,and more than half of young men do not use condoms
with casual partners.
In South Africa, the amount of alcohol consumed per adult is among the highest in the world.
'Heavy episodic drinking', which most strongly correlates with risky sexual behaviors and HIV
infection, is reported by 60% of men. Alcohol, tik (methamphetamine) and marijuana are common
among young men in South Africa. Among alcohol abusers, men are highly likely to be poly
substance users. Among HIV seropositive young men, drug use is common. Drug and alcohol use
is associated with risky sexual behaviors and an increase in the number of sexual partners.
In townships, alcohol is involved in or responsible for 60% of automobile accidents, 75% of
homicides, 50% of non-natural deaths, 67% of domestic violence, 30% of hospital admissions,
and costs South Africa about R9 billion annually. Violence also characterizes the lives of
young men in the Xhosa townships. Intimate partner violence is frequent in alcohol-using
partnerships and is correlated with increased HIV incidence. Substance use and unemployment
often lead to violence in a township. Jobs, by contrast, provide income and create a strong
and respected community role.
HIV prevention efforts for young people in Sub-Saharan Africa have largely been unsuccessful:
novel, structural, community level programs that address the social determinants of HIV are
needed. Unemployment and a culture of alcohol and violence are major social determinants of
HIV among young men. Yet, men are often excluded from economic development programs. Young,
South African men need new pathways for prosocial roles and behaviors and our interventions
need to be attractive and consistent with men's styles. The social determinants of HIV
(unemployment, alcohol, and violence) are critical to creating opportunities for prosocial
roles for young men. One of the most common comments by both the men and their families in
our previous pilot qualitative study on soccer and vocational training was men's lack of
"things to do." Given these needs, the investigators focus on soccer and vocational training
in this randomized controlled trial as opportunities for young men to acquire the habits of
daily living that are most likely to result in jobs, health, and positive relationships.