Reducing Young Men's HIV Risk and Violence Against Women by Promoting Gender-equitable Norms and Behavior in India
Population Council researchers explored whether social norms can be changed to foster support for gender-equitable relationships among young men in India and, if so, to what extent doing so will prevent HIV infection.
Although there is increasing awareness of the role norms that encourage gender inequality play in fostering HIV risk behaviors and partner violence, few studies have attempted to influence these norms and measure changes in support for them among young men exposed to an intervention. In response to this gap, the Horizons program; CORO for Literacy, an India-based nongovernmental organization (NGO); and Promundo, a Brazilian NGO, conducted operations research to examine the impact on young men of promoting gender equity as part of an HIV prevention program.
The research began with a qualitative investigation into how young men construct their gender identities. This information guided the development of a group-based intervention that was piloted in three large slum communities in Mumbai. Using exercises and materials that were adapted from Promundo’s Program H in Brazil, the India program aimed to change negative aspects of masculinity and reduce risky sexual behavior among young men.
Based on the experiences generated during the pilot intervention, a larger evaluation of the group education intervention was conducted with over 1,000 young men in urban Mumbai and rural settings in the state of Uttar Pradesh. In some sites, group education activities were combined with a community-based and gender-focused “lifestyle” social marketing campaign to reinforce the gender equitable and HIV prevention messages from the group education sessions. The campaign promoted a gender-sensitive and violence-free lifestyle for young men in the community and consisted of street plays, posters, pamphlets, banners, and a service and information booth.
Key findings include:
- At baseline, the majority of young men supported inequitable gender norms.
- Young men reported substantial HIV/STI risk practices at baseline.
- Support for inequitable gender norms was associated with HIV risk.
- Intervention participants reported less support for inequitable gender norms after the intervention.
- Partner communication significantly improved in the intervention sites.
- There was a significant increase in condom use at last sex with all partner types in the intervention areas.
- Self-reported violence against a partner declined in the intervention sites.
- There was a positive trend toward improvements in Gender Equitable Men scale scores being associated with decreases in HIV/STI risk behaviors.
- Young men in the intervention sites reported more positive attitudes toward people living with HIV (PLHIV).
- Young men participated actively in the group education sessions.
Study results suggest that young men became less supportive of inequitable gender norms after participating in the interventions, whereas in the comparison groups, there tended to be little or no positive change, or the changes were in the wrong direction. Similarly, there were significant improvements among intervention participants in key outcome indicators, including condom use, partner communication, partner violence, and attitudes toward PLHIV. The study also found that the impact of the group education intervention alone was comparable with the impact of the combined intervention that included the lifestyle social marketing campaign. The intervention activities were also considered culturally appropriate for both rural and urban settings in India, based on qualitative findings. Given this study’s successful results, project collaborators are now proceeding to scale up the Yaari-Dosti program in India’s public education sector.
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Project Stats
Location: India (Mumbai)
Program(s):
HIV and AIDS
Topic(s):
Behavior change
Sexual and gender-based violence
Duration: 12/2003 - 7/2007
Non-Council collaborators:
Anita Noora (DAUD Center for Rural Development, Gorakhpur, India)
Asha Bhende
Gary Barker (Promundo, Brazil)
Hermant Apte (University of Pune, India)
Mahindra Rokade (CORO for Literacy, India)
Prakash Fulpagare (International Institute for Population Sciences, Mumbai)
Shri Kant Singh (International Institute for Population Sciences, Mumbai)
Stephen Schensul (Center for International Community Health Studies, University of Connecticut)
Subha Das (MAMTA Health Institute for Mother and Child, New Delhi, India)
Sujata Khandekar (CORO for Literacy, India)
Vilas Sarmarkar (CORO for Literacy, India)
Donors:
Promundo/SSL International
The William and Flora Hewlett Foundation
US Agency for International Development
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