A groundbreaking study from the South African Medical Research Council (SAMRC) has illuminated the intricate connections between emotional dysregulation, HIV acquisition risk behaviors, and intimate partner violence (IPV) perpetration among young men in South Africa. Published in early March 2026 in the journal Psychology, Health & Medicine, the research draws from data collected in KwaZulu-Natal (KZN) province, one of the epicenters of South Africa's HIV epidemic. Researchers analyzed responses from 163 young men aged 18 to 30 living in rural areas and urban informal settlements, revealing how difficulties in managing emotions contribute to heightened health risks.

This work underscores the urgent need for integrated mental health strategies within HIV prevention efforts, particularly targeting vulnerable young males who face socioeconomic challenges like unemployment and poverty. By addressing emotional dysregulation, interventions could simultaneously curb new HIV infections and reduce gender-based violence, fostering healthier communities across South Africa.

Defining Emotional Dysregulation in Context

Emotional dysregulation (ED) refers to the challenges individuals face in understanding, accepting, and managing their emotional responses to stressors in adaptive ways. It is a transdiagnostic psychological construct, meaning it appears across various mental health conditions such as depression, anxiety, and post-traumatic stress disorder. The study employed the Difficulties in Emotion Regulation Scale-16 (DERS-16), a validated 16-item tool that assesses six dimensions: non-acceptance of emotions, difficulties engaging in goal-directed behavior, impulse control difficulties, lack of emotional awareness, limited access to emotion regulation strategies, and lack of emotional clarity. Scores range from 16 to 80, with higher values indicating greater dysregulation.

In South Africa, where historical trauma, economic inequality, and daily stressors compound mental health burdens, ED manifests frequently. For instance, baseline mean DERS-16 scores in the study were 30.01 (SD=10.81), suggesting moderate levels among participants. Untreated ED can lead to impulsive actions, poor decision-making, and relational conflicts, amplifying public health risks like HIV transmission and violence.

South Africa's HIV Landscape: Spotlight on Young Men in KZN

South Africa bears the world's largest HIV burden, with approximately 7.8 million people living with HIV as of recent estimates. KwaZulu-Natal province reports a prevalence of around 16% among adults, second only to some other high-burden areas, with young people aged 15-24 accounting for a significant portion of new infections—up to 40% nationally. Young men, particularly those in informal settlements and rural settings, exhibit lower testing rates, inconsistent condom use (48.41% reported no condom at last sex in the study), multiple partners (mean 6.67 in past six months), and substance use—key drivers of acquisition risk.

Alcohol and drug use exacerbate these behaviors; 40% reported drug use and 30% alcohol problems at baseline. Despite progress in antiretroviral therapy coverage, incidence remains high at 14.9 per 100 person-years in KZN for certain groups, highlighting the need for behavioral interventions beyond biomedical approaches.

Intimate Partner Violence: A Dual Threat Intertwined with HIV

Intimate partner violence (IPV)—encompassing physical, emotional, sexual, and economic abuse—is alarmingly prevalent in South Africa, with up to 31% of young adults reporting experiences and men as primary perpetrators in many cases. In KZN, rates among young men hover around 18-30% for perpetration. The study found 57% emotional IPV at baseline, linking it strongly to ED.

IPV and HIV form a vicious cycle: perpetrators engage in risky sex, while victims face coerced unprotected intercourse. WHO data adapted in the research showed dichotomized past-six-months perpetration rates underscoring this overlap. Addressing ED could break this cycle, as emotionally dysregulated men are more prone to all IPV forms.

The SAMRC Pilot Trial: Stepping Stones and Creating Futures Plus

This research stems from a pilot cluster randomized controlled trial (RCT) of Stepping Stones and Creating Futures Plus (SSCF+), co-developed by SAMRC's Gender and Health Research Unit and partners including the University of KwaZulu-Natal's Centre for Rural Health. Delivered in friendship groups over 21 sessions, SSCF+ combines sexual health education (Stepping Stones) with livelihood skills and gender-equitable norms (Creating Futures), aiming to reduce ED, IPV, and HIV risks. Of 163 participants (84 intervention, 79 control), retention was 97% at five-month follow-up.

The trial, ethically approved by SAMRC (EC023-10/2022) and UKZN (BREC/00004912/2022), used audio-assisted self-administered questionnaires via KoboToolbox, ensuring accessibility in isiZulu/English/Xhosa. For more on the intervention, see the full protocol at ClinicalTrials.gov.

Study Methodology: Rigorous Cross-Sectional and Longitudinal Design

Participants were unemployed/out-of-school young men from eThekwini Municipality clusters. Covariates included age, education, relationship status, and gender-equitable attitudes (GEM scale). Analyses used logistic/linear regressions adjusted for clusters in Stata 16, examining baseline associations and baseline ED predicting endline outcomes, controlling for changes and intervention effects.

• ED Measure: DERS-16 (α=0.91)
• HIV Risks: Condom use, partners, AUDIT-C alcohol, drug use
• IPV: WHO-adapted scale for past 6 months
• Subgroup: Elevated depressive symptoms (n=56)

Cross-Sectional Findings: Immediate Links Exposed

Higher ED correlated with more sexual partners (aβ=0.11, p<0.05), drug use (aOR=1.07), and alcohol problems (aOR=1.09). For IPV, ED raised odds of emotional perpetration (aOR=1.05) and combined types (aβ=0.17). These patterns highlight ED as a proximal risk factor in high-prevalence settings.

Longitudinal Results: Persistent Alcohol and IPV Risks

Over five months, ED baseline predicted endline alcohol abuse (aOR=1.06), with ED increases tied to more partners. Critically, ED forecasted all IPV types: physical (aOR=1.07), emotional (1.06), sexual (1.05), combined (aβ=0.16). Control arm saw perpetration rises; intervention mitigated in depressed subgroup. Access the full study here.

Intervention Impact: Hope for Depressed Subgroup

Among 56 with elevated depression, control group's combined IPV rose with ED, while intervention stabilized it. SSCF+ shows promise for emotion-focused programming, reducing ED and stabilizing behaviors.

University Contributions to SAMRC Research

South African universities play pivotal roles; UKZN's Centre for Rural Health led recruitment and analysis, exemplifying interdisciplinary collaboration. Exeter and others provided expertise. Such partnerships advance evidence-based interventions, training future researchers in psychometrics and epidemiology.

Policy and Prevention Implications

Integrate ED screening (e.g., DERS-16) into HIV clinics and community programs. Scale SSCF+-like interventions via universities and SAMRC. Target KZN's informal settlements with livelihood support to address root stressors. UNAIDS data supports prioritizing youth mental health for epidemic control: UNAIDS South Africa.

Photo by Alexas_Fotos on Unsplash

• Screen for ED in HIV testing
• Gender-transformative group interventions
• Livelihood skills training
• Mental health-HIV integration

Future Outlook: Research and Higher Education Pathways

Expand to larger RCTs, women, and other provinces. Universities like UKZN can lead PhD training in behavioral HIV science. Fund emotion regulation modules in health sciences curricula for actionable insights.