Changing sex risk behaviors, gender norms, and relationship dynamics among couples in Cape Town, South Africa: Efficacy of an intervention on the dyad
Outcomes: Gender‑Based Violence, Human Immunodeficiency Virus, Sexual and Reproductive Health
View SourceKey Social Norms Take-aways This study approaches gender norms through the lens of individual attitudes, measuring participants’ agreement with statements reflecting equitable or inequitable beliefs about gender roles and relationship dynamics. While not direct measures of collective social norms (such as perceived community expectations or reference group behaviors), these attitudinal indicators reflect how deeply internalized gender expectations shape behavior within couples. At baseline, a high proportion of participants endorsed inequitable beliefs—for example, 58% agreed that a woman should tolerate violence to keep her family together. By six-month follow-up, couples in the intervention arms—especially those in joint sessions—were significantly more likely to report gender-equitable attitudes. The study demonstrates that couple-based interventions can effectively shift personal attitudes that align with harmful gender norms, particularly when both partners engage together. These findings suggest that addressing individual beliefs within the relational context of a couple can serve as an entry point for broader gender norm change, even if wider social expectations are not directly measured.
Objectives To evaluate the effectiveness of three different strategies for engaging heterosexual couples in a high-HIV-prevalence community in South Africa to reduce sexual risk behaviors and improve gender norms and relationship dynamics.
Methods The study used a cluster-randomized, three-arm design targeting men who consumed alcohol and their main female partners. A total of 299 couples completed the baseline and were included in the study. Couples were randomly assigned to one of three groups: (1) a joint couple-based intervention, (2) separate gender-focused sessions for each partner, or (3) a comparison group where only women received sessions and men were offered voluntary HIV testing and counseling. A six-month follow-up was completed with 267 couples. Outcomes included self-reported condom use, communication, conflict, and gender norms.
Intervention Details Each intervention included two structured sessions. The joint arm brought couples together for communication and goal-setting exercises. The separate arm offered the same content to men and women individually. The comparison group delivered sessions only to women, with referrals for male partners. All sessions were peer-led and focused on gender roles, relationship power, risk reduction, and behavior change.
Results Couples in the joint and separate arms were more likely than those in the comparison group to report improved gender norms and consistent condom use. Men in these groups more frequently initiated conversations about sexual health. Improvements in relationship conflict were observed across all groups but did not differ significantly.
Conclusions Engaging couples—especially through joint sessions—can improve gender norms and reduce sexual risk behaviors. Couple-based approaches are a promising strategy for advancing gender equity and HIV prevention in high-risk communities.
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