Prevention of sexual risk behavior for HIV infection with women

This paper defines the components of gender-specific interventions for HIV infections for women, i.e. negotiation skills with male partners for condom use, integration of strategies against HIV and other STD infections and for contraception, the urgent need for female controlled methods, the importance of the inclusion of heterosexual men and an expansion to couples in prevention programs. This paper also presents a critical update in HIV prevention articles for women since the beginning of the AIDS epidemic through March 1996. All reviewed interventions were conducted in the U.S., Canada or Puerto Rico and described a psychological, behavioral, or educational component that addressed sexual risk reduction and included a behavioral evaluation. Manual and computer searches identified 47 studies that targeted women and provided a female-specific analysis of intervention effects. Overall, the findings demonstrate that HIV prevention programs can be effective in reducing risky sexual behavior among women. Program effectiveness varied by intervention type, session duration, and whether studies included women alone or both men and women. The most efficacious HIV prevention programs were specifically directed toward women, focused on relationship and negotiation skills, and involved multiple, sustained contacts. Evidence also indicated that community-level interventions hold promise. It is recommended that outcomes for women be expanded to include strategies beyond the male condom, such as refusing or avoiding unsafe sex or using the female condom.     

Alcohol and HIV in India: A Review of Current Research and Intervention

HIV is frequently transmitted in the context of partners in a committed relationship, thus couples-focused HIV prevention interventions are a potentially promising modality for reducing infection. We conducted a systematic review of studies testing whether couples-focused behavioral prevention interventions reduce HIV transmission and risk behavior. We included studies using randomized controlled trial designs, quasi-randomized controlled trials, and nonrandomized controlled studies. We searched five electronic databases and screened 7,628 records. Six studies enrolling 1,084 index couples met inclusion criteria and were included in this review. Results across studies consistently indicated that couples-focused programs reduced unprotected sexual intercourse and increased condom use compared with control groups. However, studies were heterogeneous in population, type of intervention, comparison groups, and outcomes measures, and so meta-analysis to calculate pooled effects was inappropriate. Although couples-focused approaches to HIV prevention appear initially promising, additional research is necessary to build a stronger theoretical and methodological basis for couples-focused HIV prevention, and future interventions must pay closer attention to same-sex couples, adolescents, and young people in relationships.     

Synthesizing Gender Based HIV Interventions in Sub-Sahara Africa: A Systematic Review of the Evidence

Gender is a critical component of HIV and sexual risk interventions. Examining the range, effectiveness and methodological rigor of studies that include a gender based component can inform current interventions and future directions for intervention research. This review investigated gender informed intervention studies conducted in sub-Saharan Africa that measured an outcome related to HIV. We reviewed 311 articles, 41 of which met our inclusion criteria, resulting in 11 articles that described eight different studies used in the analyses. The findings demonstrated wide variations in the types of interventions from low intensity educational content to multi-component interventions. Study outcomes were categorized into biological outcomes, HIV risk, behavioral, violence and risk reduction. Most interventions showed positive effects, and although research methodologies varied considerably, longer interventions appeared to be more effective. More research, however, is needed to build the evidence base for effectiveness of gender-based programs in reducing HIV infections in sub-Saharan Africa.     

Behavioral interventions to reduce HIV risk behavior for MSM and transwomen in Southeast Asia: a systematic review

This systematic review aims to gain insights from existing literature from Southeast Asian countries to improve future HIV prevention programs for men who have sex with men (MSM) and transgender women (transwomen). We conducted a systematic search in six international databases for literature published prior to 1 January 2015. We included studies describing behavioral interventions targeting MSM and/or transwomen, and conducted in at least one Southeast Asian country. Five out of 575 screened studies met the inclusion criteria and reported a significant intervention effect on at least one outcome measure, that is, condom use (with casual or commercial partner), water-based lubricant use, number of sex partners, HIV prevention knowledge, or willingness to use pre-exposure prophylaxis. Peer education/outreach was the most commonly employed type of intervention in the five included studies and was usually delivered as an element of a larger intervention package, together with condom distribution and the provision of drop-in centers. Motivational interviewing was effective, while internet-based interventions appeared to be a viable platform for intervention delivery. Nevertheless, research on behavioral interventions among MSM and transwomen in Southeast Asia is limited. Future interventions should be culturally appropriate, theoretically grounded, and rigorously evaluated. Only then can we best address the HIV epidemic among MSM and transwomen in this region.     

Substance Use, Sexual Risk, and Violence: HIV Prevention Intervention with Sex Workers in Pretoria

This paper describes an HIV prevention intervention designed in the US that was adapted and implemented in South Africa. Using an experimental design, 93 women who reported recent substance use and sex trading were randomly assigned to a modified Standard HIV intervention or to a Woman-Focused HIV prevention intervention. Eighty women completed the one-month follow-up interview. Participants reported high rates of sexual risk and violence at baseline. At follow-up, findings showed decreases in the proportion of women reporting unprotected sex and the daily use of alcohol and cocaine. Daily alcohol and cocaine use decreased more for women receiving the Woman-Focused intervention. Although violence continued to be a problem, at follow-up Woman-Focused participants reported being victimized less often than women receiving the Standard intervention. This study demonstrates the feasibility of implementing cross-cultural behavioral HIV prevention interventions, and supports the need for future studies of women's contextual issues and the effectiveness of targeted interventions.     

HIV Sexual Risk Reduction Interventions With Heterosexual Men: The Forgotten Group

This paper reviews published evaluations (through fall 1998) of HIV sexual risk reduction programs conducted in the United States that have targeted adult heterosexual men. The review was limited to studies that provided a male-specific analysis of intervention effects on sexual risk behavior. Fifteen of 20 peer-reviewed studies meeting inclusion criteria demonstrated that HIV sexual risk reduction programs can be effective in reducing men's heterosexual risk behavior, although effect sizes were usually modest. Outcomes varied and included biological markers and self-reported behavior. No clear pattern distinguished effective from ineffective interventions. All intervention types (information-only; condom skills/distribution; behavioral skills–focused; HIV counseling and testing; individual risk counseling; street outreach) showed some efficacy, and there were no discernable differences by targeted population. Both group and individual delivery formats were effective. The review includes a methodologic critique, identifies research gaps, and provides recommendations for future research efforts with heterosexually active men.     

Efficacy of HIV/STI Behavioral Interventions for Heterosexual African American Men in the United States: A Meta-Analysis

This meta-analysis estimates the overall efficacy of HIV prevention interventions to reduce HIV sexual risk behaviors and sexually transmitted infections (STIs) among heterosexual African American men. A comprehensive search of the literature published during 1988-2008 yielded 44 relevant studies. Interventions significantly reduced HIV sexual risk behaviors and STIs. The stratified analysis for HIV sexual risk behaviors indicated that interventions were efficacious for studies specifically targeting African American men and men with incarceration history. In addition, interventions that had provision/referral of medical services, male facilitators, shorter follow-up periods, or emphasized the importance of protecting family and significant others were associated with reductions in HIV sexual risk behaviors. Meta-regression analyses indicated that the most robust intervention component is the provision/referral of medical services. Findings indicate that HIV interventions for heterosexual African American men might be more efficacious if they incorporated a range of health care services rather than HIV/STI-related services alone.     

Effectiveness of interventions for the prevention of HIV and other sexually transmitted infections in female sex workers in resource poor setting: a systematic review

Objective To systematically review the evidence for effectiveness of HIV and sexually transmitted infection (STI) prevention interventions in female sex workers in resource poor settings. Method Published and unpublished studies were identified through electronic databases (Cochrane database, Medline, Embase, and Web of Science), hand searching and contacting experts. Randomized‐controlled‐trials and quasi‐experimental studies were included if they were conducted in female sex workers from low and middle income settings; if the exposure was described; if the outcome was externally measurable, it was after the discovery of HIV, and if follow‐up was longer than 6 months. A priori criteria were used to extract data. Meta‐analysis was not performed due to the heterogeneity of studies. Results Twenty‐eight interventions were included. Despite methodological limitations, the evidence suggested that combining sexual risk reduction, condom promotion and improved access to STI treatment reduces HIV and STI acquisition in sex workers receiving the intervention. Strong evidence that regular STI screening or periodic treatment of STIs confers additional protection against HIV was lacking. It appears that structural interventions, policy change or empowerment of sex workers, reduce the prevalence of STIs and HIV. Conclusion Rigorous evaluation of HIV/STI prevention interventions in sex workers is challenging. There is some evidence for the efficacy of multi‐component interventions, and/or structural interventions. The effect of these interventions on the wider population has rarely been evaluated.     

Bringing it home: design and implementation of an HIV/STD intervention for women visiting incarcerated men

Incarceration has been identified as a key variable to be addressed in halting the HIV epidemic among African Americans. Our research team has been conducting and evaluating HIV prevention interventions for prisoners and their families since the early 1990s, including interventions specifically tailored to the needs of women with incarcerated partners. This article describes the development and implementation of a multicomponent HIV prevention intervention for women with incarcerated partners, and presents qualitative data from women who participated as peer educators in this intervention. Women with incarcerated partners reported low rates of condom use and HIV testing combined with a lack of information about prison-related HIV risks. We found that peer education is a feasible intervention to reach women with incarcerated partners and that flexibility and inclusiveness are important factors in designing intervention programs for this population.     

Condom availability for HIV/STD prevention

Condom availability is a structural intervention that increases access to condoms. It is the most important strategy for the prevention of the sexual transmission of HIV/STDs in developing countries. While it is an integral component of many prevention programs, it is considered controversial in high school settings and its role in a variety of HIV/STD prevention interventions has been understudied, understated, and/or unacknowledged. Condom availability as an HIV/STD prevention strategy needs to be reprioritized and should be considered a critical foundation of all programs to prevent the sexual transmission of HIV.     

Microenterprise Development Interventions for Sexual Risk Reduction: A Systematic Review

Comprehensive interventions that address both individual and structural determinants associated with HIV/STI risk are gaining increasing attention over the past decade. Microenterprise development offers an appealing model for HIV prevention by addressing poverty and gender equality. This study systematically reviewed the effects of microenterprise development interventions on HIV/STI incidence and sexual risk behaviors. Microenterprise development was defined as developing small business capacity among individuals to alleviate poverty. Seven eligible research studies representing five interventions were identified and included in this review. All of the studies targeted women, and three focused on sex workers. None measured biomarker outcomes. All three sex worker studies showed significant reduction in sexual risk behaviors when compared to the control group. Non-sex worker studies showed limited changes in sexual risk behavior. This review indicates the potential utility of microenterprise development in HIV risk reduction programs. More research is needed to determine how microenterprise development can be effectively incorporated in comprehensive HIV control strategies.     

Behavior Change Interventions to Prevent HIV Infection among Women Living in Low and Middle Income Countries: A Systematic Review

We conducted a systematic review of behavioral change interventions to prevent the sexual transmission of HIV among women and girls living in low- and middle-income countries. PubMed/MEDLINE, Web of Science, the Cochrane Library, and other databases and bibliographies were systematically searched for trials using randomized or quasi-experimental designs to evaluate behavioral interventions with HIV infection as an outcome. We identified 11 analyses for inclusion reporting on eight unique interventions. Interventions varied widely in intensity, duration, and delivery as well as by target population. Only two analyses showed a significant protective effect on HIV incidence among women and only three of ten analyses that measured behavioral outcomes reduced any measure of HIV-related risk behavior. Ongoing research is needed to determine whether behavior change interventions can be incorporated as independent efficacious components in HIV prevention packages for women or simply as complements to biomedical prevention strategies.     

A systematic review of income generation interventions,including microfinance and vocational skills training,for HIV prevention

Income generation interventions, such as microfinance or vocational skills training, address structural factors associated with HIV risk. However, the effectiveness of these interventions on HIV-related outcomes in low- and middle-income countries has not been synthesized. The authors conducted a systematic review by searching electronic databases from 1990 to 2012, examining secondary references, and hand-searching key journals. Peer-reviewed studies were included in the analysis if they evaluated income generation interventions in low- or middle-income countries and provided pre-post or multi-arm measures on behavioral, psychological, social, care, or biological outcomes related to HIV prevention. Standardized forms were used to abstract study data in duplicate and study rigor was assessed. Of the 5218 unique citations identified, 12 studies met criteria for inclusion. Studies were geographically diverse, with six conducted in sub-Saharan Africa, three in South or Southeast Asia, and three in Latin America and the Caribbean. Target populations included adult women (N = 6), female sex workers/bar workers (N = 3), and youth/orphans (N = 3). All studies targeted females except two among youth/orphans. Study rigor was moderate, with two group-randomized trials and two individual-randomized trials. All interventions except three included some form of microfinance. Only a minority of studies found significant intervention effects on condom use, number of sexual partners, or other HIV-related behavioral outcomes; most studies showed no significant change, although some may have had inadequate statistical power. One trial showed a 55% reduction in intimate partner violence (adjusted risk ratio 0.45, 95% confidence interval 0.23–0.91). No studies measured incidence/prevalence of HIV or sexually transmitted infections among intervention recipients. The evidence that income generation interventions influence HIV-related behaviors and outcomes is inconclusive. However, these interventions may have important effects on outcomes beyond HIV prevention. Further studies examining not only HIV-related outcomes but also causal pathways and intermediate variables, are needed. Additional studies among men are also needed.     

Meta-analysis of the effectiveness of HIV prevention interventions for women

The present study is a meta-analysis of the effectiveness of HIV prevention interventions for women in the USA. Twenty-four articles from 1989-1997 were included. We evaluated five ethnic groupings (All Ethnicities Combined, African-American, White, Hispanic and a Mixed Ethnicity group) over four time periods (post-test, less than two months after the intervention, 2-3 months after the intervention and 6-24 months after the intervention) on three HIV-related sexuality outcome variables (HIV/AIDS knowledge, self-efficacy and sexual risk reduction behaviour). The HIV interventions appear effective at improving knowledge about HIV/AIDS and increasing sexual risk reduction behaviours for all ethnicities examined at all follow-up periods, with one exception. The findings for self-efficacy are less consistent. The interventions were less consistently effective for African-American women, for whom significant improvements in feelings of self-efficacy were only seen six months or longer after the intervention. The present analysis elucidates ethnic differences which may have previously been obscured while demonstrating convincingly that HIV interventions are generally effective for women of many different ethnicities.     

Science,Surveillance and the Epidemiology of HIV

Abstract

As HIV prevention has become more focused on evidencebased interventions and service provision for people living with HIV (PLH), providers are faced with challenges engaging and retaining PLH in prevention programs. Lessons learned by intervention facilitators may assist service providers address these challenges. To this end, 12 facilitators of a randomized behavioral intervention, designed to reduce sexual risk among PLH, participated in qualitative feedback groups regarding the challenges engaging and retaining participants and strategies used to overcome barriers. Qualitative methods revealed key components to tailoring prevention programs to successfully engage PLH: making interventions personally relevant, teaching skills that can be applied to participants' life contexts, providing support and consistency, and challenging resistance to sexual behavior change.     

Girlfriends: evaluation of an HIV-risk reduction intervention for adult transgender women

This study evaluated Girlfriends, a behavioral HIV intervention, developed for male-to-female transgender persons, for whom there are few scientifically evaluated prevention programs. The Girlfriends intervention included four group-level sessions. We used a single group, pre-post test design to assess changes in sexual risk behaviors at 3-month follow-up. We enrolled 63 transgender women into the study. Forty-six percent were Hispanic and 35% were African American. Three months after the intervention, participants had fewer sexual partners (p = .043) and were less likely to have any unprotected anal intercourse (UAI) with male exchange partners (p = .013) and unprotected sex at last vaginal or anal sex episode with female and male partners (p = .039). The findings of this study are promising. We observed behavioral effects among a largely ethnic minority sample of transgender women. Replication with a larger sample and a control group is needed.     

Using cost-effectiveness league tables to compare interventions to prevent sexual transmission of HIV

Cost-effectiveness information is needed to help public health decision makers choose between competing HIV prevention programs. One way to organize this information is in a 'league table' that lists cost-effectiveness ratios for different interventions and which facilitates comparisons across interventions. Herein we propose a common outcome measure for use in HIV prevention league tables and present a preliminary league table of interventions to reduce sexual transmission of HIV in the US. Fifteen studies encompassing 29 intervention for different population groups are included in the table. Approximately half of the interventions are cost-saving (i.e. save society money, in the long run), and three-quarters are cost-effective by conventional standards. We discuss the utility of such a table for informing the HIV prevention resource allocation process and delineate some of the difficulties associated with the league table approach, especially as applied to HIV prevention cost-effectiveness analysis.     

Achievement of interventions on HIV infection prevention among migrants in China: A meta-analysis

In China, migrants with acquired immunodeficiency syndrome (AIDS) have become a serious problem in the field of AIDS prevention. This study aimed to evaluate the efficacy of interventions for human immunodeficiency virus (HIV) infection prevention for migrants in China and to identify factors associated with intervention efficacy. A computerized literature search of the Chinese National Knowledge Infrastructure, Wan Fang, and PubMed databases was conducted to collect related articles published in China. Only self-control intervention studies or studies containing sections regarding self-control interventions wherein the method of intervention was health education were included. Rev Manager 5.3 software was used to analyze the intervention effects in terms of knowledge, attitude, and behavior indexes. Relative to pre-intervention, the HIV interventions showed statistically significant efficacy in terms of sexual transmission of HIV, condom use for HIV prevention, change in attitude towards HIV/AIDS patients, incidence of commercial sex behavior, and recent condoms use during sex (P?相似文献   

Structural interventions to encourage primary HIV prevention among people living with HIV

This analysis focuses on primary prevention for people living with HIV and the importance of actively involving HIV-infected people in developing prevention strategies. Structural-level or policy interventions--as opposed to behavioral or psychological interventions--help shape the world in which HIV-infected people live. Thus, we assess potential policy-level interventions that may serve either as a barrier to or a facilitator of primary HIV prevention from the perspective of the people living with HIV. Among potential barriers, we discuss criminalization of nondisclosure in specific sexual situations, laws limiting travel and immigration, name-based HIV reporting and mandatory partner notification. Under potential facilitators, we discuss confidentiality laws, antidiscrimination protections, expansion of HIV primary care, and primary prevention programs designed to actively involve infected people. Ultimately, whether any given policy is a 'barrier' or 'facilitator' of primary HIV prevention is an empirical question, dependent on the acceptability of an intervention to those already infected and those at risk, thus policy research evaluating the impact of structural factors on people living with HIV is encouraged.     

HIV risk reduction behavioral interventions with heterosexual adolescents

This article provides a comprehensive review of research on the effects of behavioral interventions on heterosexual adolescents' HIV sexual-risk behavior. It details adolescents' risk of sexually transmitted HIV infection and describes challenges associated with adolescent intervention research, including obtaining school and parent approval and the validity of self-reported measures. It describes central characteristics of 36 controlled intervention studies assessing the HIV sexual-risk behavior of over 30,000 male and female adolescents 11-21 years of age. It summarizes the participants' race/ethnicity and age, the theoretical framework, and the intervention setting, duration and outcome. This review reveals that the most commonly assessed behavioral outcomes were condom use and abstinence, and the largest effects sized were on condom use and condom acquisition. Effect sizes for abstinence and number of sexual partners were the smallest. Perceived self-efficacy and behavioral interventions were the most commonly assessed theoretical mediators. Key questions this research engaged in included whether behavioral skills can be increased, whether intervention-induced behavior change can be sustained, whether matching the race/ethnicity and gender of facilitators and participants enhances the effectiveness of culturally sensitive interventions, whether classroom teachers can effectively facilitate interventions, whether the behavior of high-risk populations can be changed, and which kinds of interventions are most effective. This review concludes that carefully designed theory-based interventions that take into account the characteristics of the particular population or culture can cause positive changes in adolescents' HIV sexual-risk behavior, but boundary conditions for their effectiveness still need to be identified. Several suggestions for additional research are proffered.