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Objective To assess the impact of Stepping Stones, a HIV prevention programme, on incidence of HIV and herpes simplex type 2 (HSV-2) and sexual behaviour.Design Cluster randomised controlled trial.Setting 70 villages (clusters) in the Eastern Cape province of South Africa.Participants 1360 men and 1416 women aged 15-26 years, who were mostly attending schools.Intervention Stepping Stones, a 50 hour programme, aims to improve sexual health by using participatory learning approaches to build knowledge, risk awareness, and communication skills and to stimulate critical reflection. Villages were randomised to receive either this or a three hour intervention on HIV and safer sex. Interviewers administered questionnaires at baseline and 12 and 24 months and blood was tested for HIV and HSV-2.Main outcome measures Primary outcome measure: incidence of HIV. Other outcomes: incidence of HSV-2, unwanted pregnancy, reported sexual practices, depression, and substance misuse.Results There was no evidence that Stepping Stones lowered the incidence of HIV (adjusted incidence rate ratio 0.95, 95% confidence interval 0.67 to 1.35). The programme was associated with a reduction of about 33% in the incidence of HSV-2 (0.67, 0.46 to 0.97; P=0.036)-that is, Stepping Stones reduced the number of new HSV-2 infections over a two year period by 34.9 (1.6 to 68.2) per 1000 people exposed. Stepping Stones significantly improved a number of reported risk behaviours in men, with a lower proportion of men reporting perpetration of intimate partner violence across two years of follow-up and less transactional sex and problem drinking at 12 months. In women desired behaviour changes were not reported and those in the Stepping Stones programme reported more transactional sex at 12 months.

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(2015). From work with men and boys to changes of social norms and reduction of inequities in gender relations: A conceptual shift in prevention of violence against women and girls. The Lancet, 385 (9977), 1580-1589. From work with men and boys to changes of social norms and reduction of inequities in gender relations: A conceptual shift in prevention of violence against women and girls AbstractViolence perpetrated by and against men and boys is a major public health problem. Although individual men's use of violence differs, engagement of all men and boys in action to prevent violence against women and girls is essential. We discuss why this engagement approach is theoretically important and how prevention interventions have developed from treating men simply as perpetrators of violence against women and girls or as allies of women in its prevention, to approaches that seek to transform the relations, social norms, and systems that sustain gender inequality and violence. We review evidence of intervention effectiveness in the reduction of violence or its risk factors, features commonly seen in more effective interventions, and how strong evidence-based interventions can be developed with more robust use of theory. Future interventions should emphasise work with both men and boys and women and girls to change social norms on gender relations, and need to appropriately accommodate the differences between men and women in the design of programmes.Keywords social, changes, boys, men, work, against, violence, girls, prevention, women, shift, conceptual, relations, gender, inequities, reduction, norms AbstractViolence perpetrated by, and against, men and boys is a major public health problem. Whilst individual men's use of violence differs, engaging all men and boys in action against violence against women and girls (VAWG) is essential. We discuss why this is theoretically important and how it has evolved from men as perpetrators or as allies of women in VAWG prevention, to approaches that seek to transform the relations, norms and systems that sustain gender inequality and violence. We review evidence of interventions' effectiveness in reducing violence or its risk factors, features commonly found in more effective interventions, and discuss how stronger evidence-based interventions can be developed with more robust use of theory. Future interventions should emphasise working with men and boys as well as women and girls to change social norms on gender relations, and need to appropriately accommodate the differences among men and women in the design of programmes. VAWG is more common where men themselves experience higher levels of violence.  Interventions to address men's perpetration of VAWG vary greatly in terms of target groups, change objectives and methodology. Evidence on interventions solely with boys and men is limited, and most of it points to some measured attitudinal changes, but not necessarily change in violence perpetration or social norms. Future work should promote more programming with women...