Pulerwitz, Horizons/PATH Program and Barker, Segundo, and Nascimento, Instituto Promundo

In this 49-page document Horizons and Instituto Promundo examine the effectiveness of interventions designed to improve young men’s attitudes toward gender norms and to reduce HIV/sexually transmitted infection (STI) risk. Set in Rio de Janeiro, Brazil, this study measures the results of two interventions: interactive group education sessions for young men led by adult male facilitators, and a community-wide “lifestyle” social marketing campaign to promote condom use, using gender-equitable messages. One measurement is of the education component alone, the other is of the combined interventions.

The intervention, Program H, focuses on helping young men question traditional norms related to manhood and on promoting the abilities of young men to discuss and reflect on the “costs” of inequitable gender-related views and the advantages of more gender equitable behaviours. Intervention activities include two main components: 1) a field-tested curriculum that includes a manual and an educational video for promoting attitude and behaviour change among men, and 2) a lifestyle social marketing campaign for promoting changes in community or social norms about what it means to be a man. "The curriculum includes an overview and framework for thinking about these issues, a 20-minute cartoon video, and 70 activities that were developed and pre-tested with groups of young men aged 15 to 24 years. The activities are organized under five themes: Sexuality and Reproductive Health, Fatherhood and Caregiving, From Violence to Peaceful Coexistence, Reasons and Emotions including communication skills, substance abuse, and mental health), and Preventing and Living with HIV/AIDS. The activities in the manual were designed to be carried out in a same-sex group setting. They consist of role plays, brainstorming exercises, discussion sessions, and individual reflection...Five adult men were selected to facilitate the group activities....It was fundamental that the facilitators had prior experience in leading group discussions, particularly in terms of how to be attuned to group dynamics, manage conflicts, deal with participant apathy, and encourage young men not accustomed to talking about emotions and values to open up."

Recruitment was done through meetings with local groups, radio station announcements, and informal meetings. "At each workshop, the facilitators took attendance. Those young men who did not attend were contacted and reminded of the next sessions. The team used various strategies to contact the young men: cell phone calls, leaving messages for the young men with the resident associations, with their schools, or with other young men in the group sessions; and as a last resort, the interviewers would visit the young men at their homes. The young men participating in the study were paid a small stipend to reimburse them for transportation expenses and for their time."

The behaviour change communication campaign - also referred to as a lifestyle social marketing campaign - promoted a more gender-equitable lifestyle and HIV/STI/violence prevention at the community level, and reinforced the messages learned in the group education sessions. "Program staff worked with ‘peer promoters’ - young men recruited from the community to help develop and implement the campaign. The peer promoters identified preferred sources of information and cultural outlets in the community. They also crafted intervention messages - in the form of radio spots, billboards, posters, postcards, and dances - about how “cool and hip” it was to be a more “gender-equitable” man."

To assess programme impact, the researchers developed and used the Gender-equitable Men (GEM) Scale, which measures attitudes toward gender norms related to topics such as HIV/AIDS prevention, partner violence, and sexual relationships. Measurements were made prior to the intervention activities, six months after the interventions, and one year after. The following are the findings:

• "At baseline, young men in the study reported substantial HIV/STI risk.
• Agreement with inequitable gender norms was associated with more risk.
• More equitable gender norms and related behaviors can be successfully promoted.
• Significant improvements were found in key HIV/STI outcomes, with greater changes often found in the combined intervention site.
• Increased agreement with more equitable gender norms was associated with reduced HIV/STI risk.
• Communication between couples about HIV/AIDS remained relatively high."

Horizons website [9] accessed on May 20 2008.