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In most villages the chief (or his representative) called a monthly community meeting.Typically the staff member attended and made a brief presentation and then took questions from the community, including from parents of potential participants.The incidence of herpes simplex type 2 virus (HSV-2) was lower in the group that had only a behavioural intervention but not in the group that had both this and treatment for sexually transmitted infections, and so the authors do not attribute the effect in the behavioural arm to success of their intervention.4 The failure to show a biological impact is a particularly important weakness as there are known limitations to the validity of self reported change in sexual behaviour, with a potential for interventions to bias reporting towards socially desirable behaviours, and because an effect on sexually transmitted infections is the ultimate objective of these interventions.5 7 8None of the intervention programmes previously evaluated was established and widely used before the research was conducted.This is potentially an important weakness as development of interventions is an iterative process, and interventions are generally strengthened by being more extensively tested and adapted.9 In this respect Stepping Stones is a quite different intervention as it has been widely used for many years.10 It was originally developed for use in Uganda in 1995 and has been used in over 40 countries, adapted for 17 settings (including South Africa in 199811), translated into 13 languages, and used with hundreds of thousands of individuals.12 It is almost certainly the most widely used intervention of its kind in the world.There was a difference between the actual and intended age of participants, which is discussed in detail elsewhere.13 Most were recruited from schools.
The setting was historically a subsistence farming region within a radius of 1.5 hours’ drive from the town of Mthatha, where contemporary households are primarily supported by contributions from family working elsewhere, grants, and pensions.
Eligible locations were about 10 km from the nearest cluster (to minimise contamination of study arms), had a senior or junior secondary school, and a community willing to participate (established through a process of community mobilisation13).
Clusters were grouped into seven strata, with one stratum comprising the townships and six having the villages grouped according to proximity to particular roads.
After the community meeting project staff went to the school to raise interest in the study and invited possible participants to a meeting.
Here they explained the study to a group of about 60 young men and women in the targeted age group.
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The unit of randomisation was a geographically defined area in which we recruited one pair of single sex groups.