The efficacy of HIV/STI behavioral interventions for African American females in the United States: a meta-analysis.

OBJECTIVES We evaluated the efficacy of HIV behavioral interventions for African American females in the United States, and we identified factors associated with intervention efficacy. METHODS We conducted a comprehensive literature review covering studies published from January 1988 to June 2007, which yielded 37 relevant studies. Data were analyzed using mixed-effects models and meta-regression. RESULTS Overall, behavioral interventions had a significant impact on reductions in HIV-risk sex behaviors (odds ratio [OR] = 0.63; 95% confidence interval [CI] = 0.54, 0.75; n = 11 239; Cochrane Q(32) = 84.73; P < .001) and sexually transmitted infections (STIs; OR = 0.81; 95% CI = 0.67, 0.98; n = 8760; Cochrane Q(16) = 22.77; P = .12). Greater intervention efficacy was observed in studies that specifically targeted African American females used gender- or culture-specific materials, used female deliverers, addressed empowerment issues, provided skills training in condom use and negotiation of safer sex, and used role-playing to teach negotiation skills. CONCLUSIONS Behavioral interventions are efficacious at preventing HIV and STIs among African American females. More research is needed to examine the potential contribution of prevention strategies that attend to community-level and structural-level factors affecting HIV infection and transmission in this population.

[1]  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.

[2]  Cynthia M. Lyles,et al.  Developing a Comprehensive Search Strategy for Evidence Based Systematic Reviews , 2008 .

[3]  M. Hogben,et al.  Expedited partner therapy for sexually transmitted diseases: assessing the legal environment. , 2008, American journal of public health.

[4]  A. O'Leary,et al.  Addressing Poverty as Risk for Disease: Recommendations from CDC's Consultation on Microenterprise as HIV Prevention , 2008, Public health reports.

[5]  A. O'Leary,et al.  Effects on sexual risk behavior and STD rate of brief HIV/STD prevention interventions for African American women in primary care settings. , 2007, American journal of public health.

[6]  T. Ellerbrock,et al.  Social organization of sexual‐economic networks and the persistence of HIV in a rural area in the USA , 2007, Culture, health & sexuality.

[7]  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.

[8]  Nicole Crepaz,et al.  Evidence-based HIV behavioral prevention from the perspective of the CDC's HIV/AIDS Prevention Research Synthesis Team. , 2006, AIDS education and prevention : official publication of the International Society for AIDS Education.

[9]  M. Borenstein,et al.  Publication Bias in Meta-Analysis: Prevention, Assessment and Adjustments , 2006 .

[10]  Irene A. Doherty,et al.  Heterosexually Transmitted HIV Infection Among African Americans in North Carolina , 2006, Journal of acquired immune deficiency syndromes.

[11]  I. Brill,et al.  Do Participant Characteristics Influence the Effectiveness of Behavioral Interventions? Promoting Condom Use to Women , 2005, Sexually transmitted diseases.

[12]  C. Boyer,et al.  Youth united through health education: building capacity through a community collaborative intervention to prevent HIV/STD in adolescents residing in a high STD prevalent neighborhood. , 2005, AIDS education and prevention : official publication of the International Society for AIDS Education.

[13]  G. Fong,et al.  HIV/STD risk reduction interventions for African American and Latino adolescent girls at an adolescent medicine clinic: a randomized controlled trial. , 2005, Archives of pediatrics & adolescent medicine.

[14]  S. Kalichman,et al.  Experimental components analysis of brief theory-based HIV/AIDS risk-reduction counseling for sexually transmitted infection patients. , 2005, Health psychology : official journal of the Division of Health Psychology, American Psychological Association.

[15]  C. Malotte,et al.  Relative Efficacy of Prevention Counseling With Rapid and Standard HIV Testing: A Randomized, Controlled Trial (RESPECT-2) , 2005, Sexually transmitted diseases.

[16]  Adaora A Adimora,et al.  Social context, sexual networks, and racial disparities in rates of sexually transmitted infections. , 2005, The Journal of infectious diseases.

[17]  J. Hardin,et al.  A Randomized Controlled Trial to Reduce HIV Transmission Risk Behaviors and Sexually Transmitted Diseases Among Women Living With HIV: The WiLLOW Program , 2004, Journal of acquired immune deficiency syndromes.

[18]  James W Hardin,et al.  Efficacy of an HIV prevention intervention for African American adolescent girls: a randomized controlled trial. , 2004, JAMA.

[19]  G. Bobashev,et al.  Efficacy of a woman-focused intervention to reduce HIV risk and increase self-sufficiency among African American crack abusers. , 2004, American journal of public health.

[20]  J. Bryce,et al.  Evidence-based public health: moving beyond randomized trials. , 2004, American journal of public health.

[21]  K. Theall,et al.  HIV Risk Reduction Among African-American Women Who Inject Drugs: A Randomized Controlled Trial , 2003, AIDS and Behavior.

[22]  Anke A. Ehrhardt,et al.  A Review of HIV Interventions for At-Risk Women , 1997, AIDS and Behavior.

[23]  N. El-Bassel,et al.  The efficacy of a relationship-based HIV/STD prevention program for heterosexual couples. , 2003, American journal of public health.

[24]  C. Leukefeld,et al.  Women, sex, and HIV: social and contextual factors, meta-analysis of published interventions, and implications for practice and research. , 2002, Psychological bulletin.

[25]  L. Hedges,et al.  A Protocol for the Analytical Aspects of a Systematic Review of HIV Prevention Research , 2002, Journal of acquired immune deficiency syndromes.

[26]  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.

[27]  Larry V. Hedges,et al.  Review and Meta‐analysis of HIV Prevention Intervention Research for Heterosexual Adult Populations in the United States , 2002, Journal of acquired immune deficiency syndromes.

[28]  B. Westover,et al.  Evaluation of a sexual health approach to prevent HIV among low income, urban, primarily African American women: results of a randomized controlled trial. , 2002, AIDS education and prevention : official publication of the International Society for AIDS Education.

[29]  C. Leu,et al.  A gender-specific HIV/STD risk reduction intervention for women in a health care setting: Short- and long-term results of a randomized clinical trial , 2002, AIDS care.

[30]  S. Mize,et al.  Meta-analysis of the effectiveness of HIV prevention interventions for women , 2002, AIDS care.

[31]  S. Hobfoll,et al.  Effects and generalizability of communally oriented HIV-AIDS prevention versus general health promotion groups for single, inner-city women in urban clinics. , 2002, Journal of consulting and clinical psychology.

[32]  A. Nyamathi,et al.  Evaluating the impact of peer, nurse case-managed, and standard HIV risk-reduction programs on psychosocial and health-promoting behavioral outcomes among homeless women. , 2001, Research in nursing & health.

[33]  Mark W. Lipsey,et al.  Practical Meta-Analysis , 2000 .

[34]  L. Tiedje,et al.  A community-level HIV prevention intervention for inner-city women: results of the women and infants demonstration projects. , 2000, American journal of public health.

[35]  A. Loundou,et al.  A randomized trial of hierarchical counseling in a short, clinic-based intervention to reduce the risk of sexually transmitted diseases in women , 2000, AIDS.

[36]  B. Dancy,et al.  The long-term effectiveness of an HIV prevention intervention for low-income African American women. , 2000, AIDS education and prevention : official publication of the International Society for AIDS Education.

[37]  S A Maisto,et al.  Using information, motivational enhancement, and skills training to reduce the risk of HIV infection for low-income urban women: a second randomized clinical trial. , 2000, Health psychology : official journal of the Division of Health Psychology, American Psychological Association.

[38]  R. Winett,et al.  Outcomes of a randomized community-level HIV prevention intervention for women living in 18 low-income housing developments. , 2000, American journal of public health.

[39]  S. Kalichman,et al.  Brief behavioural skills building intervention for female controlled methods of STD-HIV prevention: outcomes of a randomized clinical field trial , 1999, International journal of STD & AIDS.

[40]  D. Fleming,et al.  From epidemiological synergy to public health policy and practice: the contribution of other sexually transmitted diseases to sexual transmission of HIV infection. , 1999, Sexually transmitted infections.

[41]  J. Piper,et al.  A randomized, controlled trial of a behavioral intervention to prevent sexually transmitted disease among minority women. , 1999, The New England journal of medicine.

[42]  B. Branson,et al.  Group Counseling to Prevent Sexually Transmitted Disease and HIV: A Randomized Controlled Trial , 1998, Sexually transmitted diseases.

[43]  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.

[44]  A. Nyamathi,et al.  Effectiveness of a specialized vs. traditional AIDS education program attended by homeless and drug-addicted women alone or with supportive persons. , 1998, AIDS education and prevention : official publication of the International Society for AIDS Education.

[45]  F. Norris,et al.  A randomized trial of a brief HIV risk reduction counseling intervention for women. , 1998, Journal of consulting and clinical psychology.

[46]  Nancy F. Hansen,et al.  The NIMH Multisite HIV Prevention Trial: reducing HIV sexual risk behavior. The National Institute of Mental Health (NIMH) Multisite HIV Prevention Trial Group. , 1998, Science.

[47]  S. Lai,et al.  Effectiveness of HIV interventions among women drug users. , 1998, Women & health.

[48]  R. Harris,et al.  An intervention for changing high-risk HIV behaviors of African American drug-dependent women. , 1998, Research in nursing & health.

[49]  W. Compton,et al.  Peer-delivered interventions reduce HIV risk behaviors among out-of-treatment drug abusers. , 1998, Public health reports.

[50]  D. Hoover,et al.  Trends of HIV‐1 and sexually transmitted diseases among pregnant and postpartum women in urban Malawi , 1998, AIDS.

[51]  Sj Senn,et al.  Odds ratios revisited , 1998 .

[52]  J. Ickovics,et al.  Preventive interventions to reduce heterosexual HIV risk for women: current perspectives, future directions. , 1998, AIDS.

[53]  G. Smith,et al.  Bias in meta-analysis detected by a simple, graphical test , 1997, BMJ.

[54]  L. Hedges,et al.  The Handbook of Research Synthesis , 1995 .

[55]  M. Weinman,et al.  The role of condom motivation education in the reduction of new and reinfection rates of sexually transmitted diseases among inner-city female adolescents. , 1997, Patient education and counseling.

[56]  R. DiClemente,et al.  HIV sexual risk reduction interventions for women: a review. , 1996, American journal of preventive medicine.

[57]  C. Langefeld,et al.  Behavioral intervention to increase condom use among high-risk female adolescents. , 1996, The Journal of pediatrics.

[58]  S. Kalichman,et al.  Experimental component analysis of a behavioral HIV-AIDS prevention intervention for inner-city women. , 1996, Journal of consulting and clinical psychology.

[59]  R. DiClemente,et al.  A randomized controlled trial of an HIV sexual risk-reduction intervention for young African-American women. , 1995, JAMA.

[60]  N. El-Bassel,et al.  Preventing HIV/AIDS in drug-abusing incarcerated women through skills building and social support enhancement: preliminary outcomes. , 1995, Social work research.

[61]  J. Santelli,et al.  Interim outcomes for a community-based program to prevent perinatal HIV transmission. , 1995, AIDS Education and Prevention.

[62]  A Shirley,et al.  Cognitive-behavioral intervention to reduce African American adolescents' risk for HIV infection. , 1995, Journal of consulting and clinical psychology.

[63]  J. Kelly,et al.  The effects of HIV/AIDS intervention groups for high-risk women in urban clinics. , 1994, American journal of public health.

[64]  S. Hobfoll,et al.  Reducing inner-city women's AIDS risk activities: a study of single, pregnant women. , 1994, Health psychology : official journal of the Division of Health Psychology, American Psychological Association.

[65]  W A Fisher,et al.  Empirical tests of an information-motivation-behavioral skills model of AIDS-preventive behavior with gay men and heterosexual university students. , 1994, Health psychology : official journal of the Division of Health Psychology, American Psychological Association.

[66]  Joseph L. Fleiss,et al.  Measures of effect size for categorical data. , 1994 .

[67]  R. DiClemente,et al.  A Pilot Study of Sexual Communication and Negotiation among Young African American Women: Implications for HIV Prevention , 1993 .

[68]  S. Kegeles,et al.  Factors Associated With Condom Use in a High‐Risk Heterosexual Population , 1993, Sexually transmitted diseases.

[69]  D. Mackinnon,et al.  Group counseling at STD clinics to promote use of condoms. , 1992, Public health reports.

[70]  C. Dent,et al.  Condoms for Men, Not Women: Results of Brief Promotion Programs , 1992, Sexually transmitted diseases.

[71]  J. Wasserheit,et al.  Epidemiological Synergy: Interrelationships between Human Immunodeficiency Virus Infection and Other Sexually Transmitted Diseases , 1992, Sexually transmitted diseases.

[72]  Raewyn Connell,et al.  Gender and Power: Society, the Person and Sexual Politics. , 1991 .

[73]  Thomas J. Coates,et al.  Towards an Understanding of Risk Behavior: An AIDS Risk Reduction Model (ARRM) , 1990, Health education quarterly.

[74]  M. Fullilove,et al.  Black women and aids prevention: A view towards understanding the gender rules , 1990 .

[75]  A. Bandura,et al.  Social foundation of thoughts and actions: A social cognitive theory , 1986 .

[76]  A. Bandura.  Social Foundations of Thought and Action: A Social Cognitive Theory , 1985 .

[77]  J. Rappaport,et al.  In praise of paradox: A social policy of empowerment over prevention , 1981, American journal of community psychology.

[78]  I. Ajzen,et al.  Belief, Attitude, Intention, and Behavior: An Introduction to Theory and Research , 1977 .

[79]  I. Rosenstock.  Why people use health services. , 1966, The Milbank Memorial Fund quarterly.