Using soccer to build confidence and increase HCT uptake among adolescent girls: a mixed-methods study of an HIV prevention programme in South Africa
Outcomes: Human Immunodeficiency Virus, Sexual and Reproductive Health
View SourceKey Social Norms Take-aways The SKILLZ Street intervention highlights how challenging harmful gender norms in a girls-only, sport-based setting can enhance adolescent girls’ confidence, communication, and health-seeking behavior. By creating a safe space and using female community coaches as role models, the program addressed stigma, gender inequality, and the perception of soccer as male-only, fostering shifts in social norms around HIV prevention and gender roles.
Objectives To assess the effectiveness of SKILLZ Street, a sport-based HIV prevention program, in improving HIV-related knowledge, attitudes, communication, and uptake of HIV counseling and testing (HCT) among adolescent girls in South Africa.
Methods This mixed-methods study combined pre/post surveys (n=514), attendance and HIV testing data, and focus group discussions with participants (n=11 groups) and coaches (n=5 groups). Quantitative analysis used chi-square tests to evaluate changes in knowledge and attitudes; qualitative data were coded using NVivo software.
Intervention Details SKILLZ Street comprised ten bi-weekly afterschool sessions blending soccer, life skills education, and team-based discussions. Topics included body image, HIV and SRHR knowledge, and decision-making. Local female coaches led the sessions, with HIV testing offered during the seventh session by external partners. Coaches received over 80 hours of training.
Results 86.3% of participants attended at least seven sessions. Among the 1,953 girls offered HIV testing, 68.5% chose to test. Survey data showed significant improvements in 14 of 16 indicators, including HIV-related knowledge, gender-equitable attitudes, and self-efficacy to avoid risky behaviors (p<0.001 for most). Focus groups confirmed increased confidence, improved communication with peers and adults, and a shift in perceptions of soccer and gender roles. Conclusions: SKILLZ Street improved HIV-related knowledge, gender attitudes, and HCT uptake among adolescent girls. The program’s use of female coaches and a girls-only space was central to its success in fostering trust, open communication, and social norm change. The integration of soccer provided a powerful platform to disrupt norms that traditionally limit girls’ agency. This model offers a promising approach to gender-sensitive HIV prevention and youth empowerment.
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