Impact of Stepping Stones on incidence of HIV and HSV-2 and sexual behaviour in rural South Africa: cluster randomised controlled trial

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. This article in the British Medical Journal details the results of a randomized trial to measure the impact of the Stepping Stones programme on HIV and herpes simplex type 2 (HSV2) rates in rural South Africa. The trial also measured unwanted pregnancy, reported sexual practices, depression, and substance misuse.

The article shows how there was no evidence that Stepping Stones lowered the incidence of HIV. The programme was associated with a reduction of about 33% in the incidence of HSV-2 that is, Stepping Stones reduced the number of new HSV-2 infections over a two year period by 34.9 per 1000 people exposed. The article shows how 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. The article argues that whilst some might view that Stepping Stones did not work because it failed to affect the incidence of HIV, both HSV-2 and intimate partner violence are established risk factors for HIV and so the observation that Stepping Stones had an effect is of some interest.