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.

[1]  L. Hedges,et al.  Meta‐analysis of the Effects of Behavioral HIV Prevention Interventions on the Sexual Risk Behavior of Sexually Experienced Adolescents in Controlled Studies in the United States , 2002, Journal of acquired immune deficiency syndromes.

[2]  J. Kinsman,et al.  The impact of attending a behavioural intervention on HIV incidence in Masaka, Uganda , 2004, AIDS.

[3]  R. Anderson,et al.  Impact and Process Evaluation of Integrated Community and Clinic-Based HIV-1 Control: A Cluster-Randomised Trial in Eastern Zimbabwe , 2007, PLoS medicine.

[4]  R. Wolitski,et al.  Do prevention interventions reduce HIV risk behaviours among people living with HIV? A meta-analytic review of controlled trials , 2006, AIDS.

[5]  S. Kalichman,et al.  Risk compensation in HIV prevention: Implications for vaccines, microbicides, and other biomedical HIV prevention technologies , 2007, Current HIV/AIDS reports.

[6]  B. Koblin.  Effects of a behavioural intervention to reduce acquisition of HIV infection among men who have sex with men: the EXPLORE randomised controlled study , 2004, The Lancet.

[7]  I. Kleinschmidt,et al.  Young people's sexual health in South Africa: HIV prevalence and sexual behaviors from a nationally representative household survey , 2005, AIDS.

[8]  Wei Liu,et al.  A meta-analytic review of HIV behavioral interventions for reducing sexual risk behavior of men who have sex with men. , 2005 .

[9]  N. Crepaz,et al.  The Efficacy of Behavioral Interventions in Reducing HIV Risk Sex Behaviors and Incident Sexually Transmitted Disease in Black and Hispanic Sexually Transmitted Disease Clinic Patients in the United States: A Meta-Analytic Review , 2006, Sexually transmitted diseases.

[10]  C. Watts,et al.  Effect of a structural intervention for the prevention of intimate-partner violence and HIV in rural South Africa: a cluster randomised trial , 2006, The Lancet.

[11]  chin-hua wang,et al.  Effectiveness of Cellulose Sulfate Vaginal Gel for the Prevention of HIV Infection: Results of a Phase III Trial in Nigeria , 2008, PloS one.

[12]  E. Hudes,et al.  Impact of an intervention on HIV, sexually transmitted diseases, and condom use among sex workers in Bombay, India. , 1995, AIDS.

[13]  M. Pittler.  Systematic Reviews in Health Care: Meta‐analysis in Context , 2010 .

[14]  R. Hayes,et al.  Biological and behavioural impact of an adolescent sexual health intervention in Tanzania: a community-randomized trial , 2007, AIDS.

[15]  Raj Ram Gopal,et al.  Syndromic management of sexually-transmitted infections and behaviour change interventions on transmission of HIV-1 in rural Uganda: a community randomised trial , 2003, The Lancet.

[16]  F Rhodes,et al.  Efficacy of risk-reduction counseling to prevent human immunodeficiency virus and sexually transmitted diseases: a randomized controlled trial. Project RESPECT Study Group. , 1998, JAMA.

[17]  K. Rothman.  Epidemiology: An Introduction , 2002 .

[18]  R. Jewkes,et al.  A cluster randomized‐controlled trial to determine the effectiveness of Stepping Stones in preventing HIV infections and promoting safer sexual behaviour amongst youth in the rural Eastern Cape, South Africa: trial design, methods and baseline findings , 2006, Tropical medicine & international health : TM & IH.

[19]  B. Friedland,et al.  Efficacy of Carraguard for prevention of HIV infection in women in South Africa: a randomised, double-blind, placebo-controlled trial , 2008, The Lancet.

[20]  N. Jewell,et al.  Diaphragm and lubricant gel for prevention of HIV acquisition in southern African women: a randomised controlled trial , 2007, The Lancet.

[21]  Anne M Johnson,et al.  School based HIV prevention in Zimbabwe: feasibility and acceptability of evaluation trials using biological outcomes , 2002, AIDS.

[22]  E. Lagarde,et al.  Condom use and its association with HIV/sexually transmitted diseases in four urban communities of sub-Saharan Africa , 2001, AIDS.

[23]  R. Hayes,et al.  “A bit more truthful”: the validity of adolescent sexual behaviour data collected in rural northern Tanzania using five methods , 2004, Sexually Transmitted Infections.

[24]  Linda Richter,et al.  Behavioural strategies to reduce HIV transmission: how to make them work better , 2008, The Lancet.

[25]  T. Coates,et al.  Project Accept (HPTN 043): A Community-Based Intervention to Reduce HIV Incidence in Populations at Risk for HIV in Sub-Saharan Africa and Thailand , 2008, Journal of acquired immune deficiency syndromes.

[26]  S. Aral.  Just one more day: the gap as population level determinant and risk factor for STI spread. , 2008, Sexually transmitted diseases.

[27]  B. Mausbach,et al.  Efficacy of a brief behavioral intervention to promote condom use among female sex workers in Tijuana and Ciudad Juarez, Mexico. , 2008, American journal of public health.

[28]  A. Minnis,et al.  Poverty, Gender Inequities, and Women's Risk of Human Immunodeficiency Virus/AIDS , 2008, Annals of the New York Academy of Sciences.

[29]  S. Noar.  Behavioral Interventions to Reduce HIV-related Sexual Risk Behavior: Review and Synthesis of Meta-Analytic Evidence , 2008, AIDS and Behavior.

[30]  N. Crepaz,et al.  A Meta-Analytic Review of HIV Behavioral Interventions for Reducing Sexual Risk Behavior of Men Who Have Sex With Men , 2005, Journal of acquired immune deficiency syndromes.

[31]  Gail Kennedy,et al.  The efficacy of behavioral interventions in reducing HIV risk behaviors and incident sexually transmitted diseases in heterosexual African Americans , 2008, AIDS.

[32]  C. Watts,et al.  Explaining continued high HIV prevalence in South Africa: socioeconomic factors, HIV incidence and sexual behaviour change among a rural cohort, 2001–2004 , 2007, AIDS.

[33]  M. Wong,et al.  Evaluation of a Safe-Sex Intervention Programme among Sex Workers in Singapore , 1994, International journal of STD & AIDS.

[34]  P. Piot,et al.  Combination HIV prevention , 2008, The Lancet.

[35]  R. Jewkes,et al.  Impact of Stepping Stones on incidence of HIV and HSV-2 and sexual behaviour in rural South Africa: cluster randomised controlled trial , 2008, BMJ : British Medical Journal.

[36]  P. Piot,et al.  Coming to terms with complexity: a call to action for HIV prevention , 2008, The Lancet.

[37]  J. Hargreaves,et al.  Social Interventions for HIV/AIDS Intervention with Microfinance for AIDS and Gender Equity IMAGE Study Monograph No 2: Intervention , 2002 .

[38]  C. Morrison,et al.  Men's circumcision status and women's risk of HIV acquisition in Zimbabwe and Uganda , 2007, AIDS.

[39]  I. Kleinschmidt,et al.  A community‐based study to examine the effect of a youth HIV prevention intervention on young people aged 15–24 in South Africa: results of the baseline survey , 2005, Tropical medicine & international health : TM & IH.

[40]  T. Patterson,et al.  A Sexual Risk Reduction Intervention for Female Sex Workers in Mexico , 2006 .

[41]  Martina Morris,et al.  Concurrent Partnerships and Trans-mission Dynamics in Networks , 1995 .

[42]  Anne M Johnson,et al.  The Regai Dzive Shiri Project: a cluster randomised controlled trial to determine the effectiveness of a multi‐component community‐based HIV prevention intervention for rural youth in Zimbabwe – study design and baseline results , 2008, Tropical medicine & international health : TM & IH.

[43]  S. Kiwanuka,et al.  Access to and utilisation of health services for the poor in Uganda: a systematic review of available evidence. , 2008, Transactions of the Royal Society of Tropical Medicine and Hygiene.

[44]  Charles Poole,et al.  Rethinking the heterosexual infectivity of HIV-1: a systematic review and meta-analysis. , 2008, The Lancet. Infectious diseases.

[45]  R. Hayes,et al.  Rationale and design of the MEMA kwa Vijana adolescent sexual and reproductive health intervention in Mwanza Region, Tanzania , 2006, AIDS care.

[46]  R. Roddy,et al.  SAVVY® (C31G) Gel for Prevention of HIV infection in Women: A Phase 3, Double-Blind, Randomized, Placebo-Controlled Trial in Ghana , 2007, PloS one.

[47]  A. Hinman,et al.  AIDS and absolutism--the demand for perfection in prevention. , 1992, The New England journal of medicine.

[48]  D. Hoover,et al.  Use-Effectiveness of the Female Versus Male Condom in Preventing Sexually Transmitted Disease in Women , 2003, Sexually transmitted diseases.

[49]  S. Kalichman.  Time to Take Stock in HIV/AIDS Prevention , 2008, AIDS and Behavior.

[50]  S. Gregorich,et al.  Efficacy of voluntary HIV-1 counselling and testing in individuals and couples in Kenya, Tanzania, and Trinidad: a randomised trial , 2000, The Lancet.

[51]  Azra C Ghani,et al.  Mind the Gap: The Role of Time Between Sex With Two Consecutive Partners on the Transmission Dynamics of Gonorrhea , 2008, Sexually transmitted diseases.

[52]  N. Sewankambo,et al.  Voluntary HIV counseling and testing acceptance, sexual risk behavior and HIV incidence in Rakai, Uganda , 2005, AIDS.

[53]  P. Layde,et al.  All STDs are not created equal: an analysis of the differential effects of sexual behaviour changes on different STDs , 2003, International journal of STD & AIDS.

[54]  R. Hayes,et al.  The Regai Dzive Shiri Project: the results of a cluster randomised trial of a multi-component HIV prevention intervention for Zimbabwean youth , 2010 .

[55]  M. Graffar.  [Modern epidemiology]. , 1971, Bruxelles medical.

[56]  J. Todd,et al.  Impact of improved treatment of sexually transmitted diseases on HIV infection in rural Tanzania: ra , 1995 .