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Community engagement increases community trust of research and improves trial participation. However, there is limited documented appraisal of community engagement practices. Several HIV vaccine efficacy trials have been conducted in South Africa, the country most affected by HIV, predominantly in collaboration with the HIV Vaccine Trials Network (HVTN). We explored stakeholder and researcher perspectives of the HVTN community engagement practices used in the Gauteng province of South Africa. In 2017, we conducted a qualitative study. Using semi-structured interview guides, we facilitated two group discussions with Community Advisory Board (CAB) members (n = 13), and 14 in-depth interviews with HVTN-affiliated employees (n = 8 in South Africa and n = 6 in the USA). Group discussions and in-depth interviews were audio-recorded, transcribed verbatim, translated into English, and coded using NVIVO 12 Plus software for thematic data analysis. Overall, median age of study participants was 22 (interquartile range 32-54) years, and 74% (n = 20) were female. Three main themes about community engagement emerged: (i) community engagement as an ongoing iterative relationship between researchers and community; (ii) methods of community engagement, encompassing community education by linking with external stakeholders and through awareness campaigns by pamphlet distribution and mass events, working with communities to develop recruitment messages, and working with CAB as a link to communities; and (iii) strategies to improve community engagement, for example, using simple language, linking with religious leaders and traditional healers, and communicating via conventional (newspapers, television, and radio) and social (videos and listicles) media. Our data indicate ways for researchers to improve relationships with community by understanding local needs, strengthening collaborations, and tailoring communication strategies. In this regard, CABs signify critical linkages between researchers and communities. CABs can relay relevant health research needs, advise on the creation of suitable materials, and link researchers more effectively with community leaders and media.

Male circumcision has both health benefits and significance to some cultures. We sought to understand perceptions about male circumcision as part of the HIV prevention toolkit among participants enrolled in a preventive HIV vaccine efficacy trial in South Africa. We conducted a qualitative study with 28 people aged 18-35 years old who self-reported that they were not living with HIV, provided informed consent, and who were participating in the HVTN 702 vaccine efficacy trial in Soweto. Using a semi-structured guide, we facilitated four focus group discussions (FGDs) stratified by age, gender, and sexual orientation. FGDs were audio-recorded, transcribed verbatim, translated into English, and thematically analysed. Four main themes emerged. (1) Everyone had accurate knowledge about what male circumcision is, and some participants stated that it partially reduces acquisition of HIV and sexually transmitted infections. (2) There was an emerging distrust of cultural circumcision because of perceived lack of transparency and adverse events. (3) There was a perception that circumcision boosted masculinity. (4) The choice to circumcise was influenced by parents, family, and female partners. In conclusion, the study found that young South African HIV vaccine trial participants accurately understand the HIV prevention benefits of male circumcision, but uptake decisions are embedded within a context that is informed by culture, sexuality and masculinity norms and values.

Background Despite multiple available HIV prevention methods, the HIV epidemic continues to affect South Africa the most. We sought to understand willingness to use actual and hypothetical HIV prevention methods among participants enrolled in a preventative HIV vaccine efficacy trial in Soweto, South Africa. Methods We conducted a qualitative study with 38 self-reporting HIV-uninfected and consenting 18–35 year olds participating in the HVTN 702 vaccine efficacy trial in Soweto. Using a semi-structured interview guide, five focus group discussions (FGDs) were held, stratified by age, gender and sexual orientation. The FGDs were composed of: (i) 10 heterosexual women aged 18–24 years; (ii) 9 heterosexual and bisexual women aged 25–35 years; (iii & iv) heterosexual men aged 25–35 years with 7 in both groups; and (v) 5 men aged 18–35 years who have sex with men. FGDs were audio-recorded, transcribed verbatim, translated into English and analysed using thematic analysis. Results We present five main themes: (i) long-lasting methods are preferable; (ii) condoms are well-known but not preferred for use; (iii) administration route of HIV prevention method is a consideration for the user; (iv) ideal HIV prevention methods should blend into the lifestyle of the user; and the perception that (v) visible prevention methods indicate sexual indiscretion. Conclusions The participants’ candour about barriers to condom and daily oral pre-exposure prophylaxis (PrEP) use, and expressed preferences for long-lasting, discreet, lifestyle-friendly methods reveal a gap in the biomedical prevention market aiming to reduce sexually acquired HIV in South Africa. Product developers should consider long-acting injectable formulations, such as vaccines, passive antibodies and chemoprophylaxis, for HIV prevention technologies. Future innovations in HIV prevention products may need to address the desire for the method to blend easily into lifestyles, such as food-medication formulations.

Background In the last ten years, the South African Personality Inventory (SAPI) has been developed as an indigenous measurement of personality for the multi-cultural environment of South Africa. The aim of the SAPI is to assess personality in an unbiased and equivalent way. For the purpose of this study, we used an 82-item version of the SAPI which measures nine factors (Conscientiousness, Emotional Stability, Extraversion, Facilitating, Integrity, Intellect, Openness, Relationship Harmony and Soft-heartedness). Participants and procedure A cross-sectional survey was conducted using the SAPI, the General Health Questionnaire and the Brief Multidimensional Student Life Satisfaction Scale. A purposive sample was drawn from Black and White emerging adults (N = 990). We assessed the relationship between personality aspects and well-being across groups in a multiple group structural equation model (SEM) using the SPSS and AMOS programs. Results Black emerging adults showed evidence of more individualistic-inclined personality features, while the White emerging adults seem to demonstrate more collectivistic features. In terms of health, the White emerging adults experience more life satisfaction than their Black counterparts. Conscientiousness, emotional stability, extraversion, facilitating and openness predict well-being among emerging adults. Conclusions This study contributes to expanding the nomological network of the SAPI, and it enhances knowledge pertaining to the link between personality and well-being of emerging adults in South Africa. Understanding which factors contribute to poor mental health and lack of life satisfaction may lead to innovation programmes for emerging adults to assist them in dealing with negative health outcomes possibly associated with living in multicultural contexts.

Background In South Africa, the Church has historically played an important role in the lives of the Black population. In light of the high number of Black persons living with HIV/AIDS (PLWHA) in the country, it is important to explore religious leaders' perceptions of HIV/AIDS and PLWHA to inform the development and implementation of faith-based interventions. # Aims This article explores Christian religious leaders' perceptions of people living with HIV/AIDS (PLWHA) in Soweto and the role of religious institutions in the lives of PLWHA. # Methods We conducted a mixed-methods cross-sectional study of religious leaders serving in Soweto. A questionnaire was administered to 45 religious leaders who self-identified as Black, Christian, and serving congregations in Soweto. The questionnaire included general demographic information about the religious leaders and their Churches, perceptions of the role of the Church in the lives of PLWHA, and HIV-related stigma. Of the questionnaire respondents, 26 participated in qualitative interviews. Survey and interview results were analysed separately, then compiled for additional analysis. # Results Leaders reported HIV/AIDS is a concern (40%) or great concern (49%) to the Church and 84% believed the Church should support PLWHA, yet 80% reported persisting HIV-related stigma. Expectations of PLWHA depended primarily on the mode of infection: if as a result of 'sinful' behaviour (pre/extra-marital sex), spiritual reconciliation is needed; when as a result of another's behaviour (spouse, rape, mother-to-child), making peace and forgiving is important. Leaders saw themselves as 'restorers' of the faith of PLWHA. Despite the overwhelming compassion and willingness to be of assistance, religious leaders (71%) admit to having inadequate skills to address HIV/AIDS-related stigma and resources needed to support people living with HIV/AIDS. # Conclusions Religious leaders are willing to tackle HIV/AIDS-related issues in their congregations but need the appropriate support and training to address HIV stigma and to provide support to PLWHA.

Pre-exposure prophylaxis (PrEP) is an important HIV prevention method for adolescent girls and young women (AGYW) in Africa, who are at heightened risk of HIV infection. HIV risk perception is generally a powerful motivator for adoption of HIV prevention behaviours, including PrEP use. While HIV risk perceptions have been evaluated using quantitative measures, these seldom capture how individuals conceptualize and understand risk within local frameworks of meaning. More nuanced understanding may come from qualitative approaches that map these perceptions across the trajectory of sexual histories. Between 2016 and 2018, we implemented a novel participatory method to investigate risk perceptions in interviews with 32 participants in HPTN 082, a study of AGYW's use of PrEP in South Africa and Zimbabwe. Timelines were used to record narrative sexual histories and perceived HIV risk for each relationship. We found that women assessed HIV risk primarily based on their partners' personal qualities and behaviour (especially relating to infidelity); their subjective experience of being treated respectfully; and the practice of perceived 'risk reduction', including younger partners and condoms, even if used inconsistently. A narrative timeline approach grounded in an understanding of young women's sexual histories may increase critical reflection about HIV risks and facilitate risk-reduction counselling with this group.