Group-format, peer-facilitated mental health promotion interventions for students in higher education settings: a scoping review protocol.

INTRODUCTION: Young people in higher education face various stressors that can make them vulnerable to mental ill-health. Mental health promotion in this group therefore has important potential benefits. Peer-facilitated and group-format interventions may be feasible and sustainable. The scoping review outlined in this protocol aims to map the literature on group-format, peer-facilitated, in-person interventions for mental health promotion for higher education students attending courses on campuses in high and low/middle-income countries. METHODS AND ANALYSIS: Relevant studies will be identified through conducting searches of electronic databases, including Medline, CINAHL, Scopus, ERIC and PsycINFO. Searches will be conducted using Boolean operators (AND, OR, NOT) and truncation functions appropriate for each database. We will include a grey literature search. We will include articles from student participants of any gender, and published in peer-reviewed journals between 2008 and 2023. We will include English-language studies and all study types including randomised controlled trials, pilot studies and descriptive studies of intervention development. A draft charting table has been developed, which includes the fields: author, publication date, country/countries, aims, population and sample size, demographics, methods, intervention type, comparisons, peer training, number of sessions/duration of intervention, outcomes and details of measures. ETHICS AND DISSEMINATION: No primary data will be collected from research participants to produce this review so ethics committee approval is not required. All data will be collated from published peer-reviewed studies already in the public domain. We will publish the review in an open-access, peer-reviewed journal accessible to researchers in low/middle-income countries. This protocol is registered on Open Science Framework (https://osf.io/agbfj/).

Sexual health knowledge acquisition processes among very young adolescent girls in rural Malawi: Implications for sexual and reproductive health programs.

Early adolescence is a period characterized by enormous biological, cognitive, sexual, emotional, and social changes. Sexual curiosity and the desire to acquire sexual health (SH) information are part of these developments. Understanding the SH knowledge acquisition process is critical for designing interventions that can best support very young adolescents (VYAs). This study explored the SH knowledge acquisition processes among VYA girls aged 10 to 14 years who attended the DREAMs Girl Only Clubs (GOCs) and those who did not. The GOCs were a part of a larger comprehensive HIV prevention project called DREAMS (Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe) which provided an evidence-based core package of interventions to VYAs to prevent HIV. In-depth interviews were conducted with 43 VYA girls aged 10-14 years in two rural southern districts of Zomba and Machinga in Malawi. Twenty-three VYA girls were GOC participants and 20 VYAs were not. Guided by the Social Ecological Model, a thematic analysis approach was used to analyze the data with the assistance of Nvivo 12 software. The SH knowledge acquisition processes were the interaction of various factors at the microsystem (self-efficacy, attitudes, trust and the beginning of menstruation), mesosystem (communication of SH issues between VYAs and their immediate family and peers), and exosystem levels (availability of life skills programs and mother-groups in schools and availability of GOCs). Compared to Non-GOC participants, GOC participants demonstrated an in-depth knowledge of SH issues and positive sexual behaviors such as HIV testing. Limitations to SH knowledge acquisition were adult messages' focus on sexual relationship avoidance and on girls who have started menstruation; the perception of adults not being knowledgeable about SH and school teachers hiding some SH information. VYAs' SH interventions that provide VYAs with accurate, consistent, and age-appropriate SH information such as the GOCs have the potential to address the limitations that other sources have in reaching VYAs. Integrating such interventions with programs that empower parents, other adults, and teachers with comprehensive SH information and with skills on how to deliver SH information to VYAs can enhance VYAs' SH knowledge acquisition and influence positive behavior change.

Reflections on the process, challenges, and lessons learned conducting remote qualitative research on Violence against women during COVID-19 pandemic lockdown in South Africa.

BACKGROUND: Violence against women (VAW) research is a sensitive topic, which has been conducted mainly using face-to-face methods. The COVID-19 pandemic lockdown and restrictions on movement presented an opportunity to conduct VAW research using remote methods. We discuss how we adapted methods, reflect on lessons learned, and make recommendations highlighting key considerations when conducting remote research on a sensitive topic of VAW. METHODS: We designed and conducted an exploratory qualitative study using remote methods with 18 men and 19 women, aged 18 years and older, who lived with their partner or spouse during lockdown in South Africa. The aim of the study was to explore experiences of COVID-19 lockdown, and its link to women and children's experiences of violence in the homes. Data presented in this paper draws from researchers' reflections drawn from debriefing sessions during the research process, and from participants' interview transcripts. FINDINGS: Remote recruitment of participants took longer than anticipated, and we had to re-advertise the study. We could not ensure safety and privacy during interviews. Regardless of all the safety and privacy measures we put in place during the research process, some participants had an adult person present in the room during interviews, and the researchers had no control over interruptions. Rapport was difficult to establish without an in-person connection, which limited disclosure about violence experience (amongst women) and perpetration (amongst men). CONCLUSIONS: Given the methodological and ethical challenges which limited disclosure of VAW remotely, we conclude that telephone interviews used in our study impacted on the quality of study data. Therefore, we do not recommend VAW research to be conducted remotely, unless it is essential and participants are already known to the interviewer and trust has been established.

Ntombi Vimbela! Sexual violence risk reduction intervention: pre and one-year post assessments from a single arm pilot feasibility study among female students in South Africa.

BACKGROUND: The extremely high prevalence of sexual violence victimisation reported among female students in South African public higher education demands urgent action to develop, rigorously evaluate and scale effective prevention interventions. This article details findings from a pilot feasibility study of Ntombi Vimbela! a campus sexual violence risk reduction intervention developed to tackle the high burden of sexual violence in higher education institutions in South Africa. METHODS: Ntombi Vimbela! (NV!) is a sexual violence risk reduction intervention that comprises sexuality empowerment, gender and social norm change, early-risk identification, self-defence, resistance and mental wellbeing components. NV! is comprised of ten workshop sessions running for 3.5 h each. Workshops are co-delivered by two trained peer facilitators per group of at most 20 first-year female students. One-year post-intervention quantitative outcome assessments were remotely completed by 98 participants who participated in the NV! pilot workshops. Qualitative assessments were conducted with 35 participants through in-depth telephone interviews (IDTIs). FINDINGS: One year after attending NV! workshops, most participants reported improved awareness of sexual rights, assertive communication, shifts in gender equitable beliefs, reductions in rape myth acceptance, improved expressed sexual relationship power sexual decision-making, and improved negotiation within their intimate relationships. Participants' depressive symptoms also significantly decreased. Many participants improved awareness of sexual assault risk and vigilance, including using self-protection strategies such as removing themselves from environments where alcohol intoxication posed sexual assault risks. Some participants used assertive communication to withstand peer pressure to engage in risky sexual behaviours. Most participants scored highly on the self-defence efficacy scale. Some participants were exposed to and successful in using verbal and physical resistance strategies in potential sexual assault risky situations. CONCLUSION: These findings indicate the potential beneficial effects of NV! as a campus sexual violence risk reduction intervention at one-year post-intervention, which must be evaluated in a future rigorous randomised control trial. PILOT TRIAL REGISTERED AT: ClinicalTrials.gov NCT04607564 on 29/10/2020.

"I Don't Want to Be Known as a Weak Man": Insights and Rationalizations by Male Students on Men's Sexual Violence Perpetration against Female Students on Campus.

Understanding how men view rape is foundational for rape prevention, but it is not always possible to interview men who rape, especially in a college campus context. We explore male students' insights into and rationalizations for why men on campus perpetrate sexual violence (SV) against female students by analysing qualitative focus group discussion data with male students. Men contended that SV is a demonstration of men's power over women, yet they did not perceive sexual harassment of female students as serious enough to constitute SV and appeared to be tolerant of it. Men perceived "sex for grades" as exploitative and rooted in the power asymmetry between privileged male lecturers and vulnerable female students. They were disdainful of non-partner rape, describing it as acts exclusively perpetrated by men from outside campus. Most men felt entitled to have sex with their girlfriends, although an alternative discourse challenged both this entitlement and the dominant masculinity linked to it. Gender-transformative work with male students is needed to support them to think and do things differently while they are on campus.

Social support and very young adolescent girl's knowledge on sexual relationships: A comparative qualitative study of Girl Only Clubs' participants and non-participants in rural Malawi.

Early sexual relationships are associated with an increased risk of acquiring sexually transmitted diseases including HIV/AIDs, teenage pregnancies, and unsafe abortions among other negative health outcomes. Understanding sexual relationships among very young adolescents (VYAs) is important to equip them to protect themselves from negative sexual health (SH) outcomes. DREAMS (Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe) is an HIV prevention initiative that provided an evidence-based core package of interventions to VYAs to prevent HIV acquisition in 15 countries in sub-Saharan Africa. The Girl Only Club (GOC) was the primary context for the interventions. Our objective in this study was to explore if there was any difference in social support (SS) received concerning sexual relationships between the VYA girls who attended GOCs and those who did not. In-depth interviews were conducted with 43 VYA girls, aged 10-14 years, in two rural southern districts, Zomba and Machinga, in Malawi. Twenty-three VYA girls were participants in GOCs and 20 VYA girls did not participate. A thematic, descriptive approach that involved a constant comparative analysis guided the data analysis, and Nvivo 12 software was used. In both study sites available SS concerning sexual relationships is informational support including information from parents, older relatives, and friends. However, club participants differed from non-club participants in sexual and reproductive health (SRH) knowledge and use. Club participants reported consulting others on decision-making and information on sexual relationships; receiving detailed SH information from clubs; condom use due to education received from the clubs; quitting sexual relationships; and correcting misinformation with club information. GOC participants received more SS which made them more knowledgeable and better at handling sexual relationship issues than those not in clubs. Interventions that integrate SS including social asset building and safe spaces are critical for VYA SRH programming.

Adaptation and pre-test of a shortened Stepping Stones and Creating Futures intervention focused on HIV for young men in rural South Africa.

Men's engagement in HIV prevention and treatment is suboptimal, including in South Africa. We sought to address this through adapting an evidence-based intervention, Stepping Stones and Creating Futures (SSCF), to strengthen its HIV content and provide a more scalable (shorter) intervention in rural South Africa. We then conducted a mixed methods pre-test of the intervention among young men aged 18-35 years. To adapt SSCF, we reviewed the current evidence base and worked with male Peer Navigators to update the SSCF theory of change (ToC) and manual. The revised intervention was ~45 hours (9 sessions) as opposed to ~63 hours and included a greater focus on HIV prevention and treatment technologies. Overall, 64% (n = 60) of men approached agreed to participate in the intervention, uptake (attending one session) among those who agreed was n = 35(58%) and retention (attending 6 or more sessions) was n = 25(71%). Qualitative data emphasized the intervention was acceptable, with young men describing it as something they liked. The qualitative data also broadly supported the intervention ToC, including the normalization of HIV in men's lives, and the importance of health for men in achieving their life goals. However, it also highlighted the need to focus more on HIV-related stigma and fear, and the importance of HIV self-testing kits in encouraging testing. We revised the ToC and manual in light of this data. The adapted SSCF is acceptable and supports the ToC. Next steps is an evaluation to look at effectiveness of the intervention.

"I Carry the Trauma and Can Vividly Remember": Mental Health Impacts of the COVID-19 Pandemic on Frontline Health Care Workers in South Africa.

We know from research that pandemics and disease outbreaks expose HCWs to an increased risk of short and long-term psychosocial and occupational impacts. We conducted qualitative research among 44 frontline health care workers (FHCWs) practicing in seven South African hospitals and clinics. FHCWs were interviewed on their experiences of working during the first-wave of the COVID-19 pandemic and its perceived impact on their wellness. In this study, FHCWs included the non-medical and medical professionals in direct contact with COVID-19 patients, providing health care and treatment services during the COVID-19 pandemic. Most of the FHCWs reported stressful and traumatic experiences relating to being exposed to a deadly virus and working in an emotionally taxing environment. They reported depression, anxiety, traumatic stress symptoms, demoralization, sleep difficulties, poor functioning, increased irritability and fear of being infected or dying from COVID-19. The mental health impacts of COVID-19 on HCWs were also associated with increased poor physical wellbeing, including fatigue, burnout, headache, and chest-pains. FHCWs reported professional commitment and their faith as critical intrinsic motivators that fostered adaptive coping while working on the frontline during the first-wave of the COVID-19 pandemic. Many alluded to gaps in workplace psychosocial support which they perceived as crucial for coping mentally. The findings point to a need to prioritize interventions to promote mental wellness among FHCWs to ensure the delivery of quality healthcare to patients during pandemics or deadly disease outbreaks.

Soccer clubs as avenues for gender transformative socialization of adolescent boys in Cape Town and Mthatha, South Africa: A qualitative study.

In this paper, we explore the gender socialization of adolescent boys in soccer clubs, and ask whether there are opportunities for integrating gender transformative elements into that socialization. This qualitative study involved 11 in-depth interviews and informal conversations with male soccer coaches from Gugulethu township and Mthatha town in the Western Cape and Eastern Cape provinces of South Africa, respectively. Data were analyzed using a thematic analysis approach. We found that the coaches felt that the adolescent boys in their soccer clubs faced serious social and emotional challenges, with the boys' poor socio-economic backgrounds and fragmented family structures being major contributors to these challenges. Most coaches also gave themselves the responsibility to try to address some of the challenges faced by their club members. To do this, they employed specific strategies, including creating an alliance with parents and professionals. In the process, the coaches engaged the boys on topics around respect, sexual and reproductive health, and avoiding alcohol, drugs, and involvement in criminal gangs. Some coaches also played a social fathering role to club members as a way of helping them to think differently about their lives, redirect risky practices, and reduce the chance for poor health outcomes. These findings highlight the role of soccer clubs and coaches as potential avenues for health- and equity-promoting gender socialization of adolescent boys.

Factors associated with TB screening among agricultural workers in Limpopo Province, South Africa.

BACKGROUND: Tuberculosis (TB) continues to be a public health issue of concern in South Africa. Workers in the agricultural sector are generally at increased risk of TB due to multiple interacting factors such as exposure to silica dust, co-worker infection, and occupations falling within the lower socio-economic sectors. OBJECTIVE: This study investigates factors associated with TB screening uptake for agricultural workers in Limpopo Province, South Africa. METHOD: This cross-sectional study targeted a study population of 16,787 agricultural workers across 96 agricultural worksites in South Africa. A two-stage cluster random sampling design identified 24 agricultural worksites and a potential 2500 participants. The outcome variable was self-reported TB screening. Descriptive statistics and unadjusted and adjusted logistic regression analyses were performed to determine factors associated with TB screening. A literature review informed the selection of covariates as possible confounders. RESULTS: The final study sample comprised 2144 workers across 24 sites, with 55% being women. TB screening uptake was 1155 (56.3%). Factors such as living with human immunodeficiency virus (HIV) (AOR 3.16, 95% CI: 2.44-4.09), accessing health services in the workplace (AOR 1.94, 95% CI: 1.09-3.46), and having prior TB knowledge (AOR 18.45, 95% CI: 9.8-34.74) were positively associated with TB screening. Participants in the age group 36-49 years had significantly higher odds of self-reporting TB screening, compared with those aged 18-25 years (AOR 1.37, 95% CI 1.07-1.77). Migrant workers from Mozambique (OR 0.52, 95% CI: 0.34-0.79) and Zimbabwe (OR 0.71, 95% CI 0.57-0.89) were significantly less likely to self-report TB screening compared to their South African counterparts. CONCLUSION: The findings underscore the importance of workplace health services in achieving end-TB targets. We recommend programs and interventions for preventing TB in South Africa that target the agricultural sector in general, and in particular migrant workers.

Adolescent sexual health interventions that include very young adolescents in sub-Saharan Africa: a scoping review protocol.

INTRODUCTION: Targeting very young adolescents (VYAs) with sexual health (SH) interventions is increasingly being recognised as one of the strategies for addressing SH challenges in late adolescence. However, there is a dearth of literature regarding SH interventions implemented specifically for VYAs in sub-Saharan Africa (SSA). This scoping review aims to provide a summary of documented evidence on SH interventions that include VYAs in SSA, identify gaps in existing interventions and provide recommendations for further programmatic work on SH for VYAs. METHODS AND ANALYSIS: The methods for this scoping review will be guided by the framework proposed by Arksey and O'Malley and further enhanced by Levac et al and the Joanna Briggs Institute. We will search electronic databases: Popline, EMBASE, PubMed, CINAHL, Dimensions, African Journals Online (AJOL) and specific summon country-specific search. We will include published studies from SSA and only adolescent SH interventions published from the year 2003-2022. Furthermore, we will include programmatic and intervention literature that has not been published in peer-reviewed articles. The data will be charted using the Preferred Reporting Items for Systematic Review and Meta-Analysis Extension for Scoping Review. The data will then be collated and summarised. ETHICS AND DISSEMINATION: The scoping review methodology involves putting together information from articles or grey literature that is either publicly available or shared by the authors, this study does not require ethical approval. Findings of this scoping review will be published in a scientific journal and presented at relevant scientific fora and conferences. This scoping review will provide a comprehensive overview of the evidence base of adolescent SH interventions for VYAs in SSA and will highlight critical gaps in the existing interventions and areas where further programmatic work is needed for VYAs in SSA. REGISTRATION: https://archive.org/details/osf-registrations-gn538-v1.

Suicidal Thoughts, Depression, Post-Traumatic Stress, and Harmful Alcohol Use Associated with Intimate Partner Violence and Rape Exposures among Female Students in South Africa.

While ample evidence from high-income country settings indicates the prevalence and risk factors for multiple mental ill-health symptoms in student populations, evidence from low- and middle-income higher education settings remains limited. We determined the frequency, associations, and structural pathways between mental health outcomes and possible risk factors among a sample of 1292 predominantly Black African and female students ages 18-30 years, enrolled at nine purposefully selected public universities and Technical Vocational Education and Training (TVET) campuses. We measured and created a mental ill-health latent outcome consisting of depressive symptoms, post-traumatic stress disorder (PTSD), and suicidal thoughts. We also measured traumatic exposures including childhood trauma, recent intimate partner violence (IPV), non-partner rape, and other life traumatic events. We used structural equation modelling to analyse data. We found that 50% of the surveyed students binge drank, 43% reported depressive symptoms, 9% reported PTSD symptoms, and 21% had suicidal thoughts. Students' experiences of childhood trauma, food insecurity, other traumatic events, non-partner rape, and IPV impacted the mental ill-health latent. IPV experiences mediated the relationships between experiences of childhood trauma or other trauma and the mental ill-health latent, and the relationship between binge drinking and other life traumatic events. Non-partner rape mediated the relationship between food insecurity and the mental ill-health latent. Binge drinking directly impacted non-partner rape experience. The findings substantiate the need for campus-based mental health promotion, psychosocial services and treatments, and implementation of combined interventions that address the intersections of violence against women and mental health among students in South Africa.

"You see this thing is hard ey, this thing is painful": The burden of the provider role and construction of masculinities amongst Black male mineworkers in Marikana, South Africa.

In this paper we examine men's insights on how migration and minework affect their perceptions and performances of masculinity in the settings of minework and in their "real home" communities and explore the potential consequences of masculinity constructions for their own and their family's health. This study used qualitative methodology. Findings are based on 13 in-depth interviews conducted over two phases of data collection with adult men who were either working or seeking work in the mines in North-West province, South Africa. Data suggest that for these men, migration to and working in the mines meant they must straddle the temporal space of work and the rural home space. For these men, the role of provider was an inescapable demand and, resulting from migration for work, their experience of fatherhood was solely centred on material provision with little or no emotional involvement with their children. Findings further illustrate the impact of minework on men's health and livelihoods-resulting in some men reimagining and seeking to create alternative career paths for their children. There is pressing need for labour reforms on the employment conditions of low-paid mine workers to enable them to reinforce their livelihoods and secure better futures for their families. Gender-transformative interventions which aim to transform ideas of masculinity that emphasize providing rather than emotional involvement with children are also needed.

Intersections between disability, masculinities, and violence: experiences and insights from men with physical disabilities from three African countries.

BACKGROUND: Gender-transformative work in the Global South often focuses on transforming 'toxic masculinities' to prevent intimate partner violence (IPV), but there has been little research on whether and how constructions of masculinities by men with disabilities shape their experiences and perpetration of violence. METHODS: We used repeated in-depth interviews and content analysis to understand whether and how physical disability intersects with the construction of masculinities and experience/perpetration of violence among 15 adult men with physical disabilities participating in interventions to prevent IPV in Ghana, Rwanda, and South Africa. RESULTS: Societal expectations and participants' aspirations around masculinity impacted their vulnerability to violence mainly by men without disabilities. Participants reported experiences of disrespect and social exclusion in their communities and felt incapable of protecting themselves when being violated. Most participants felt they were not providing for their families and perceived themselves as having lost decision-making and positions of power in their homes. They expressed their disappointment with having reduced stamina, virility, and sexual prowess in intimate partnerships as a result of their disability. While participants reported that they could not attain key markers of idealized masculinity, placed upon and often internalized by themselves, they longed to achieve these markers to facilitate their inclusion and acceptance in their communities. CONCLUSIONS: Programmers addressing violence need to engage with men with physical disabilities and consider the intersectionality of masculinities and disability, how these reinforce patriarchal norms and how men with disabilities can be included and enabled to overcome their conflict between disability and masculinities.

Research Site Anonymity in Context.

This paper utilizes critical theory to interrogate and problematize the practice of anonymising research sites as an ethical imperative. The contributing authors conduct research in and with various communities in southern Africa, position themselves and work from and within diverse areas and specialities of the social sciences. This article is developed from their rich and wide spectrum of field experience with a great diversity of communities, but mainly the poorer, under-resourced, socially and economically marginalized. The authors strongly identify with these communities whose anonymity in published research is seen as marginalizing. Such research sites are places and communities where these researchers grew up and live in, and thus not just as peripheral or 'out there' entities. Therefore, the naming of research sites in this context is deemed as being ethical, out of respect for participants, for a contextually embedded understanding, and for well-targeted interventions and policy influence.

Opportunities for technologically driven dialogical health communication for participatory interventions: Perspectives from male peer navigators in rural South Africa.

There is increasing interest in the potential to deliver participatory dialogical HIV and intimate partner violence (IPV) prevention interventions via digital platforms, though the majority of mHealth interventions have been didactic in approach. We undertook 10 in-depth interviews with male Peer Navigators (PNs) who had been extensively trained and working on a larger intervention promoting young people's sexual and reproductive rights, in rural KwaZulu-Natal. Interviews focused on their, and their peers', use of technology in their everyday lives. Data were transcribed and translated, and subjected to thematic analysis. PNs described structural barriers to the use of technology, including poor connectivity, high data costs, and erratic electricity. They primarily used Facebook and WhatsApp for communication and highlighted how reading messages asynchronously was important to overcome connectivity challenges. PNs shared how groups were primarily for information sharing, they also discussed 'sensitive' issues online. Privacy was a concern, especially for conversations, and there was recognition of how confidentiality could be breached. It was also felt that WhatsApp could potentially support greater openness in discussions. We reflect on the potential for online interventions to support dialogical health communication, highlighting how dialogical health communication may be enabled through information provision, the asynchronous communication enhancing the potential for reflection, and greater participation in discussion by those who are shyer. Despite this potential there remain important risks around privacy of discussions and how to implement these approaches online.

Conceptualisations of masculinity and sexual development among boys and young men in Korogocho slum in Kenya.

Youth and adolescence are times when young men negotiate their identity in relation to social and cultural expectations of being a man, with enduring implications for sexual health and wellbeing. This study explored how boys aged 10-14 years living in Korogocho slum in Nairobi, Kenya conceptualised masculinity, their perceptions of how masculinities are performed, and the linkage between conceptualisations of masculinity and sexual development. Three bases of gender socialisation were identified: (1) verbal messaging (mainly from parents and teachers); (2) observing the behaviours of older men in the community; and (3) information received from mainstream and social media. Masculinity conceptualisations focussed on financial stability, family life and responsibility, physical attributes, character and religion. Two contrasting portrayals of masculinity emerged in the form of idealised and dominant masculinities. A close linkage was found between masculinity conceptualisations and sexual development. Findings are important for programmes that aim to transform harmful gender norms and signal the need for longitudinal research exploring how gender beliefs may change over time.

Stepping Stones and Creating Futures: A group-based approach to addressing violence against women through working with men.

In low- and middle-income countries, group-based interventions to address intimate partner violence (IPV) working with men, whether or not they are violent themselves, are increasingly common. Stepping Stones and Creating Futures (SSCF) is one intervention demonstrating reductions in men's perpetration of IPV through working with men around gender inequalities and livelihoods. Using a case study of Thembani, a young man living in an urban informal settlement in South Africa who was a participant within a large randomized controlled trial evaluating SSCF, we discuss how his use of violence changed. This reduction occurred through recognition that his situation was not a personal failing, but similar to others, thus reducing the shame he felt, learning to control his anger, and starting to understand how others felt when he used his power over others. This case study provides some initial evidence about how group-based interventions working with men may start to transform men's practices.

Preliminary evidence of promise of a sexual violence risk reduction intervention for female students in South African tertiary education institutions.

Campus sexual violence risk reduction and resistance interventions have been developed and tested among female students in the global North and proven effective. Evidence-based interventions to prevent sexual violence tested amongst female students in the global South and in South African campuses are lacking. We present preliminary evidence of promise of Ntombi Vimbela! (NV!), a sexual violence prevention intervention piloted amongst first year female students in eight purposively selected campuses in South Africa. Focus group discussions were conducted with 118 female students who participated in NV! workshops. Most students found the content of NV! relevant and reported having experienced its positive effects. They perceived that NV! empowered them with skills to assess and deal with sexual assault risky situations. NV! changed their attitudes and beliefs about gender, shifted their acceptance of rape myths and beliefs, improved communication skills, enhanced self-esteem, and confidence to defend oneself in risky sexual assault situations. Few participants were unsure whether they will be able to use the skill in real life. These findings indicate a range of short-term positive outcomes which we anticipate would reduce the risk of sexual assault among first year female students. This suggests that NV! should be subject to further evaluation.

Factors associated with female students' past year experience of sexual violence in South African public higher education settings: A cross-sectional study.

BACKGROUND: Intimate partner sexual violence and non-partner rape experiences are widely reported by female students in South African higher education institutions, as they are globally. However, limited research has focused on investigating vulnerability factors, which is vital for informing interventions. OBJECTIVE: To describe the factors and inter-relationships associated with female students' increased vulnerability to past year experience of partner sexual violence and non-partner rape in South African higher education settings. METHODS: We interviewed 1293 female students, i.e., 519 students in six Technical Vocational Education and Training (TVET) college campuses and 774 students at three university campuses. Participants were volunteers aged 18-30. The measured vulnerability factors included childhood sexual abuse, other trauma, mental ill-health, risky sexual behaviours, food insecurity, partner violence, and controlling behaviours. We used bivariate analysis, logistic regression, and structural equation modelling methods. RESULTS: Twenty percent of participants experienced past-year sexual violence (17% partner sexual violence and 7.5% non-partner rape). Childhood sexual abuse had direct effects on experiencing past year sexual violence and physical, emotional partner violence or controlling behaviours. Risky sexual behaviours mediated the relationships of childhood sexual abuse or harmful alcohol use and past-year sexual violence experience. Mental ill-health mediated the relationships between childhood sexual abuse, other traumatic exposures, food insecurity, physical, emotional partner violence or controlling behaviours, and past-year partner sexual violence or non-partner rape experience. CONCLUSIONS: Risky sexual behaviours, gender inequitable relationship dynamics, mental ill-health, and food insecurity are related and amenable vulnerability factors associated with female students' sexual violence experiences. Therefore, addressing these through comprehensive campus interventions, which are implemented when students first enrol in higher education and are most vulnerable to sexual violence, is critical. Society-wide sexual violence prevention is also imperative.