Research has shown that young men living in poor communities are at risk of developing habits that compromise their health. Substance abuse and unsafe sex are at the top the list. Getting involved in crime and gangsterism is also a possibility, especially if they are unemployed.
In South Africa, young men are likely to be both the perpetrators and the victims of violence, sustaining serious injuries in fights and accidents.
They are also possibly living with HIV. South Africa has 2.4 million HIV-infected men with close to 70% of men reporting they have unprotected sex with several partners. But these young men avoid health care settings such as clinics, which are the primary sites for the delivery of HIV prevention and other health interventions.
Conventional health interventions to address these concerns are typically strategies such as one-on-one counselling and giving health information through psycho-education. But these kinds of approaches are not always effective in reaching men.
The challenge is to develop new healthcare interventions that encourage men to become more health conscious. Our pilot study has found an intervention to “pull” or engage men, rather than “push” public health strategies and health messages into their lives. By using sport – and specifically soccer – we were able to engage with the men through the pilot study.
The provisional data suggests that, through the soccer programme, men were able to change alcohol and substance abuse habits, learn about HIV and safe sex, develop more socially acceptable habits and learn skills that could help them find jobs.
The value of sport
Research shows that sport can help build people’s identities. It makes them more socially connected because it fosters a sense of belonging and promotes feelings of agency and self-determination. Sport can help men and boys develop strong feelings of masculine identity and provide opportunities for them to assert their masculinity in a positive way.
Sport also boost self-esteem and enhance psychological well-being by reducing anxiety, alleviating the symptoms of depression and regulating emotions.
A study in the US found that sport and physical activity can reduce substance abuse. Research in South Africa, meanwhile, has demonstrated how involvement in sport and other voluntary organisations can reduce HIV risk.
But generally, there is limited empirical evidence to support links between sport and personal and economic development. This is why we set out to run the pilot study in Cape Town.
Engaging men differently
Our pilot study used soccer as the basis for health interventions. It was a joint venture between Stellenbosch University’s Psychology Department and the University of California in Los Angeles and took place in Cape Town. We enrolled young men between the ages of 18 and 25 from Khayelitsha, one of the city’s largest and poorest townships. Each week they had two practice sessions and a game. The programme lasted for six months and we were able to retain about 80% of the young men we recruited.
Young men could only be part of the team if they underwent random rapid diagnostic tests for alcohol and drug use. They also had access to a vocational training programme and life skills training.
Soccer coaches were trained to deliver HIV and substance abuse preventive interventions in a novel fashion. Instead of using a manual, they were taught the fundamentals of behaviour change. They used informal conversations, real world situations and role plays to encourage health promoting behaviours.
The young men were assessed at the beginning of the programme and then six months later.
We found that as the programme continued, there was a significant increase in the percentage of young men who agreed to HIV and drug tests. By the end of the six months more than 70% of them were alcohol and drug free. Close to 30% of the young men were employed. The self-reported rates of HIV testing did not improve as we would have liked.
Next steps
Following the pilot, we have recently launched a larger research project using a randomised controlled trial to see if the intervention is really effective. This project is called the Eyethu Soccer League.
This health intervention will investigate how sport can be used to engage young men, promote their well-being and empower them with the skills they need to gain employment.
The league, which was launched at the start of September 2016, currently consists of six teams of young men aged between 18 and 29. Over the course of the next year more teams will be added to the league as other young men are recruited to join.
The study will establish whether participating in organised sport can be used to teach young men life skills and promote social behaviour such as reducing the use of alcohol and drugs, practising safe sex and not engaging in inter-personal violence.
The thinking is that sport could help young men develop the habits needed to maintain their health and secure a job. These skills include:
developing consistent daily routines,
staying drug and alcohol free,
forming healthy relationships,
being sociable and
being able to solve problems, set goals, resolve conflict and honour commitments.
New options are needed
To promote the health of young men living in resource scarce communities, those who deliver these services will not be able to rely on conventional health interventions delivered in medical settings.
Interventions need to be mounted in settings where they can engage and reach young men. Our research will try to establish if soccer could be one of these settings.