Skip to main content

Advertisement

SpringerLink
Log in

Efficacy of HIV Prevention Interventions in Latin American and Caribbean Nations, 1995–2008: A Meta-Analysis

  • Original Paper
  • Published:
AIDS and Behavior Aims and scope Submit manuscript

Abstract

This meta-analysis synthesized 37 HIV prevention interventions (from 28 studies) that were evaluated in Latin American and Caribbean nations. These studies were obtained through systematic searches of English, Spanish, and Portuguese-language databases available as of January 2009. Overall, interventions significantly increased knowledge (d = 0.40) and condom use (d = 0.25) but the effects varied widely. Interventions produced more condom use when they focused on high-risk individuals, distributed condoms, and explicitly addressed social-cultural components. The best-fitting models utilized factors related to geography, especially indices of a nations’ human development index (HDI) and income inequality (i.e., Gini index). Interventions that provided at least 3 h of content succeeded better when HDI and income inequality were lower, suggesting that intensive HIV prevention activities succeed best where the need is greatest. Implications for HIV intervention development in Latin America and the Caribbean are discussed.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

Asterisks indicate reports with studies included in the meta-analysis

  1. UNAIDS. Report on the global AIDS epidemic. Geneva: Joint United Nations Programme on HIV/AIDS (UNAIDS); 2008.

  2. Fernández MI, Kelly JA, Stevenson LY, et al. HIV prevention programs of nongovernmental organizations in Latin America and the Caribbean: the Global AIDS Intervention Network project. Rev Panam Salud Publica. 2007;17(3):154–62.

    Google Scholar 

  3. Darbes LA, Kennedy GE, Peersman G, Zohrabyan L, Rutherford GW. Systematic review of HIV behavioral prevention research in Latinos. 2002. (http://hivinsite.ucsf.edu/InSite.jsp?page=kb-07-04-11) Accessed 21 Nov 2007.

  4. Levy V, Page-Shafer K, Evans J, et al. HIV-related risk behavior among Hispanic immigrant men in a population-based household survey in low income neighborhoods of northern California. Sex Transm Dis. 2005;32(8):487–90.

    Article  PubMed  Google Scholar 

  5. Galanti GA. The Hispanic family and male-female relationships: an overview. J Transcult Nurs. 2003;14(3):180–5.

    Article  PubMed  Google Scholar 

  6. Goodyear RK, Newcomb MD, Allison RD. Predictors of Latino men’s paternity in teen pregnancy: test of a mediational model of childhood experiences, gender role attitudes, and behaviors. J Couns Psychol. 2000;47(1):116–28.

    Article  Google Scholar 

  7. Marín BV, Gómez CA, Tschann JM, Gregorich SE. Condom use in unmarried Latino men: a test of cultural constructs. J Health Psychol. 1997;16(5):458–67.

    Article  Google Scholar 

  8. Marín BV, Tschann JM, Gómez CA, Kegeles SM. Acculturation and gender differences in sexual attitudes and behaviors: Hispanic vs non-Hispanic white unmarried adults. Am J Public Health. 1993;83(12):1759–61.

    Article  PubMed  Google Scholar 

  9. Parrado EA, Flippen CA, McQuiston C. Use of commercial sex workers among Hispanic migrants in North Carolina: implications for the spread of HIV. Perspect Sex Reprod Health. 2004;36(4):150–6.

    Article  PubMed  Google Scholar 

  10. Amaro H, Raj A. On the margin: power and women’s HIV risk reduction strategies. Sex Roles. 2000;42(7–8):723–49.

    Article  Google Scholar 

  11. Gómez CA, Marín BV. Gender, culture and power: barriers to HIV prevention strategies. J Sex Res. 1996;33(4):355–62.

    Article  Google Scholar 

  12. Marín BV. HIV prevention in the Hispanic community: sex, culture, and empowerment. J Transcult Nurs. 2003;14(3):186–92.

    Article  PubMed  Google Scholar 

  13. Marín BV, Gómez CA. Latino culture and sex: implications for HIV prevention. In: Garcia JG, Zea MC, editors. Psychological interventions and research with Latino populations. Boston, MA: Allyn & Bacon; 1997. p. 73–93.

    Google Scholar 

  14. Russell LD, Alexander MK, Corbo KF. Developing culture-specific interventions for Latinas to reduce HIV high-risk behaviors. J Assoc Nurses AIDS Care. 2000;11(3):70–6.

    Article  CAS  PubMed  Google Scholar 

  15. Díaz RM, Ayala G, Bein E. Sexual risk as an outcome of social oppression: data from a probability sample of Latino gay men in three U.S. cities. Cultur Divers Ethnic Minor Psychol. 2004;10(3):255–67.

    Article  PubMed  Google Scholar 

  16. Díaz RM, Morales ES, Bein E, Dilán E, Rodríguez RA. Predictors of sexual risk in Latino gay/bisexual men: the role of demographic, developmental, social cognitive and behavioral variables. Hisp J Behav Sci. 1999;21(4):480–501.

    Article  Google Scholar 

  17. Herbst JH, Kay LS, Passin WF, et al. A systematic review and meta-analysis of behavioral interventions to reduce HIV risk behaviors of Hispanics in the United States and Puerto Rico. AIDS Behav. 2007;11(1):25–47.

    Article  PubMed  Google Scholar 

  18. Marín BV, Gómez CA. Latinos, HIV disease, and culture: strategies for HIV prevention. In: Cohen PT, Sande MA, Volberding PA, editors. The AIDS knowledge base. Boston, MA: Little, Brown & Co; 1994. p. 108–13.

    Google Scholar 

  19. Marín G, Marín BV, editors. Research with Hispanic populations. Newbury Park, CA: Sage; 1991.

    Google Scholar 

  20. Zea MC, Reisen CA, Díaz RM. Methodological issues in research on sexual behavior with Latino gay and bisexual men. Am J Community Psychol. 2003;31(3–4):281–91.

    Article  PubMed  Google Scholar 

  21. Albarracín J, Albarracín D, Durantini M. Effects of HIV-prevention interventions for samples with higher and lower percents of Latinos and Latin Americans: a meta-analysis of change in condom use and knowledge. AIDS Behav. 2008;12(4):521–43.

    Article  PubMed  Google Scholar 

  22. Manji A, Peña R, Dubrow R. Sex, condoms, gender roles, and HIV transmission knowledge among adolescents in León, Nicaragua: implications for HIV prevention. AIDS Care. 2007;19(8):989–95.

    Article  CAS  PubMed  Google Scholar 

  23. Prado G, Schwartz SJ, Pattatucci-Aragón A, et al. The prevention of HIV transmission in Hispanic adolescents. Drug Alcohol Depend. 2006;84(Suppl 1):S43–53.

    Article  PubMed  Google Scholar 

  24. Piot P, Greener R, Russell S. Squaring the circle: AIDS, poverty, and human development. PLoS Med. 2007;4(10):1571–5.

    Article  PubMed  Google Scholar 

  25. Baral S, Sifakis F, Cleghorn F, Beyrer C. Elevated risk for HIV infection among men who have sex with men in low- and middle-income countries 2000–2006: a systematic review. PLoS Med. 2007;4(12):1901–11.

    Article  Google Scholar 

  26. United Nations Development Programme. Statistics of the Human Development Report. New York: Oxford University Press; 2008.

  27. World Bank. World Development Indicators 2007. CD-ROM. Washington, DC; 2007.

  28. Johnson BT, Redding CA, Diclemente RJ, et al. A network-individual-resource model for HIV prevention. AIDS Behav (in press).

  29. DiClemente RJ, Salazar LF, Crosby RA. A review of STD/HIV preventive interventions for adolescents: sustaining effects using an ecological approach. J Pediatr Psychol. 2007;32(8):888–906.

    Article  PubMed  Google Scholar 

  30. United Nations Development Programme. Economic growth and human development, Human Development Report 1996. New York: Oxford University Press; 1996.

  31. United Nations Development Programme. Human development to eradicate poverty, Human Development Report 1997. New York: Oxford University Press; 1997.

  32. United Nations Development Programme. Consumption for human development, Human Development Report 1998. New York: Oxford University Press; 1998.

  33. United Nations Development Programme. Globalization with a human face, Human Development Report 1999. New York: Oxford University Press; 1999.

  34. United Nations Development Programme. Human rights and human development, Human Development Report 2000. New York: Oxford University Press; 2000.

  35. United Nations Development Programme. Making new technologies work for human development, Human Development Report 2001. New York: Oxford University Press; 2001.

  36. United Nations Development Programme. Deepening democracy in a fragmented world, Human Development Report 2002. New York: Oxford University Press; 2002.

  37. United Nations Development Programme. Millennium development goals: a compact among nations to end human poverty, Human Development Report 2003. New York: Oxford University Press; 2003.

  38. United Nations Development Programme. Cultural liberty in today’s diverse world, Human Development Report 2004. New York: Oxford University Press; 2004.

  39. United Nations Development Programme. Beyond scarcity: power, poverty and the global water crisis, Human Development Report 2006. New York: Oxford University Press; 2006.

  40. *Magnani RJ, Gaffikin L, Aquino EML, Seiber EE, Almeida MC, Lipovsek V. Impact of an integrated adolescent reproductive health program in Brazil. Stud Fam Plan. 2001;32(3):230–43.

    Google Scholar 

  41. *Barros T, Barreto D, Pérez F, et al. Un Modelo de prevención primaria de las enfermedades de transmisión sexual y del VIH/SIDA en adolescentes. Rev Panam Salud Pública. 2001;10(2):86–94.

    Google Scholar 

  42. *Hearst N, Lacerda R, Gravato N, Hudes ES, Stall R. Reducing AIDS risk among port workers in Santos, Brazil. Am J Public Health. 1999;89(1):76–8.

    Google Scholar 

  43. *Coates TJ, Grinstead OA, Gregorich SE, et al. Efficacy of voluntary HIV-1 counselling and testing in individuals and couples in Kenya, Tanzania, and Trinidad: a randomised trial. Lancet 2000;356(9224):103–12.

    Google Scholar 

  44. *Martinez-Donate AP, Hovell MF, Zellner J, Sipan CL, Blumberg EJ, Carrizosa C. Evaluation of two school-based HIV prevention interventions in the border city of Tijuana, Mexico. J Sex Res. 2004;41(3):267–78.

    Google Scholar 

  45. *Sampaio M, Brites C, Stall R, Hudes ES, Hearst N. Reducing AIDS risk among men who have sex with men in Salvador, Brazil. AIDS Behav. 2002;6(2):173–81.

    Google Scholar 

  46. *Deschamps MM, William J, Hafner A, Johnson WD. Heterosexual transmission of HIV in Haiti. Ann Intern Med. 1996;125(4):324–30.

    Google Scholar 

  47. *Patterson TL, Mausbach B, Lozada R, et al. Efficacy of a brief behavioral intervention to promote condom use among female sex workers in Tijuana and Ciudad Juarez, Mexico. Am J Public Health. 2008;98(11):2051–7.

    Google Scholar 

  48. Becker BJ. Synthesizing standardized mean-change measures. Br J Math Stat Psychol. 1988;41(2):257–78.

    Google Scholar 

  49. Hedges LV. Distribution theory for Glass’s estimator of effect size and related estimators. J Educ Behav Stat. 1981;6(2):107–28.

    Article  Google Scholar 

  50. Sánchez-Meca J, Marín-Martínez F, Chacón-Moscoso S. Effect-size indices for dichotomized outcomes in meta-analysis. Psychol Methods. 2003;8(4):448–67.

    Article  PubMed  Google Scholar 

  51. Johnson BT, Boynton MH. Cumulating evidence about the social animal: meta-analysis in social-personality psychology. Pers Soc Psych Comp. 2008;2(2):817–41.

    Article  Google Scholar 

  52. Lipsey MW, Wilson DB. Practical meta-analysis. Thousand Oaks, CA: Sage Publications Inc; 2001.

    Google Scholar 

  53. Huedo-Medina TB, Sánchez-Meca J, Martín-Martínez F, Botella J. Assessing heterogeneity in meta-analysis: Q statistic or I2 index? Psychol Methods. 2006;11(2):193–206.

    Article  PubMed  Google Scholar 

  54. Stram DO. Meta-analysis of published data using linear mixed-effects model. Biometrics. 1996;52(2):536–44.

    Article  CAS  PubMed  Google Scholar 

  55. *Bronfman M, Leyva R, Negroni MJ. HIV prevention among truck drivers on Mexico’s southern border. Cult Health Sex. 2002;4(4):475–88.

    Google Scholar 

  56. *Givaudan M, Van de Vijver FJR, Poortinga YH, Leenen I, Pick S. Effects of a school-based life skills and HIV-prevention program for adolescents in Mexican high schools. J Appl Soc Psychol. 2007;37(6):1141–62.

    Google Scholar 

  57. Givaudan M, Pick S. Evaluación del programa escolarizado para adolescentes: “UN equipo contral el VIH/SIDA”. Interam J Psychol. 2005;39(3):339–46.

    Google Scholar 

  58. Givaudan M, Leenen I, Van de Vijver FJR, Poortinga YH, Pick S. Longitudinal study of a school based HIV/AIDS early prevention program for Mexican adolescents. Psychol Health Med. 2008;13(1):98–110.

    Article  PubMed  Google Scholar 

  59. Givaudan M, Van de Vijver FJR, Poortinga YH. Identifying precursors or safer-sex practices in Mexican adolescents with and without sexual experience: an exploratory model. J Appl Soc Psychol. 2005;35(5):1089–109.

    Article  Google Scholar 

  60. *Patterson TL, Semple SJ, Fraga M, Bucardo J, Davila-Fraga W, Strathdee SA. An HIV-prevention intervention for sex workers in Tijuana, Mexico: a pilot study. Hisp J Behav Sci. 2005;27(1):82–100.

    Google Scholar 

  61. *Pick de Weiss S, Andrade-Palos P, Townsend J, Givaudan M. Evaluación de un programa de educación sexual sobre conocimientos, conducta sexual y anticoncepción en adolescentes. Salud Mental V. 1994;17(1):25–31.

  62. *Walker D, Gutierrez JP, Torres P, Bertozzi SM. HIV prevention in Mexican schools: prospective randomized evaluation of intervention. Br Med J. 2006;332:1189–94.

    Google Scholar 

  63. *Ferreira-Pinto JB, Ramos R. HIV/AIDS prevention among female sexual partners of injection-drug users in Ciudad-Juarez, Mexico. AIDS Care. 1995;7(4):477–88.

    Google Scholar 

  64. *Antunes M, Stall R, Paiva V, et al. Evaluating an AIDS sexual risk reduction program for young adults in public night schools in Sao Paulo, Brazil. AIDS. 1997;11(Suppl 1):S121–7.

  65. *McBride DC, Inciardi JA, Surratt HL, Terry YV, Van Buren H. The impact of an HIV risk-reduction program among street drug users in Rio de Janeiro, Brazil. Am Behav Sci. 1998;41(8):1171–84.

    Google Scholar 

  66. *Egger M, Pauw J, Lopatatzidis A, Medrano D, Paccaud F, Smith GD. Promotion of condom use in a high-risk setting in Nicaragua: a randomised controlled trial. Lancet. 2000; 355(9221):2101–2105.

    Google Scholar 

  67. *Pauw J, Ferrie J, Villegas RR, Martínez JM, Gorter A, Egger M. A controlled HIV/AIDS-related health education programme in Managua, Nicaragua. AIDS. 1996;10(5):537–44.

    Google Scholar 

  68. *Calderón E, López M, Bonilla N. Prevención de la transmisión sexual del SIDA mediante un trabajo grupal de cambio de actitudes. Rev Latinoam Sexol. 1991;2:123–36.

    Google Scholar 

  69. *Garcia-Bernal R, Castro JA, Caamano JM, Klaskala WI. Casual sex and condom use: an impact evaluation study in Bogota, Colombia. In: The XII International AIDS Conference, Geneva, Switzerland, 1998.

  70. *Colón HM, Robles RR, Freeman D, Matos T. Effects of a HIV risk reduction education program among injection drug users in Puerto Rico. P R Health Sci J. 1993;12(1):27–34.

  71. Colón HM, Sahai H, Robles RR, Matos TD. Effects of a community outreach program in HIV risk behaviors among injection drug users in San Juan, Puerto Rico: an analysis of trends. AIDS Educ Prev. 1995;7(3):195–209.

    PubMed  Google Scholar 

  72. *Robles RR, Marrero CA, Matos TD, et al. Factors associated with changes in sex behaviour among drug users in Puerto Rico. AIDS Care. 1998;10(3):329–38.

    Google Scholar 

  73. *Cáceres CF, Rosasco AM, Mandel JS, Hearst N. Evaluating a school-based intervention for STD/AIDS prevention in Peru. J Adolesc Health. 1994;15(7):582–91.

    Google Scholar 

  74. *Welsh JM, Puello E, Meade M, Kome S, Nutley T. Evidence of diffusion from a targeted HIV/AIDS intervention in the Dominican Republic. J Biosoc Sci. 2001;33(1):107–19.

    Google Scholar 

  75. *Iurcovich M, Lourie KJ, Brown LK. The AIDS prevention training program for high school students in Buenos Aires, Argentina. J HIV/AIDS Prev Educ Adolesc Child. 1998;2(3–4):91–105.

  76. *Kinsler J, Sneed CD, Morisky DE, Ang A. Evaluation of a school-based intervention for HIV/AIDS prevention among Belizean adolescents. Health Educ Res. 2004;19(6):730–8.

    Google Scholar 

  77. *Fox LJ, Bailey PE, Clarke-Matínez KL, et al. Condom use among high-risk women in Honduras: evaluation of an AIDS prevention program. AIDS Educ Prev. 1993;5(1):1–10.

    Google Scholar 

  78. *Levine WC, Revollo R, Kaune V, et al. Decline in sexually transmitted disease prevalence in female Bolivian sex workers: impact of an HIV prevention project. AIDS. 1998;12(14):1899–906.

    Google Scholar 

  79. Levine WC, Higueras G, Revollo R, et al. Rapid decline in sexually transmitted disease prevalence among brothel-based sex workers in La Paz, Bolivia: the experience of Proyecto Contra SIDA, 1992–1995. In: The XI International AIDS Conference, Vancouver, Canada, 1996.

  80. Duval S, Tweedie R. Trim and fill: a simple funnel-plot-based method of testing and adjusting for publication bias in meta-analysis. Biometrics. 2000;56(2):455–63.

    Article  CAS  PubMed  Google Scholar 

  81. Begg CB, Mazumdar M. Operating characteristics of a rank correlation test for publication bias. Biometrics. 1994;50(4):1088–101.

    Article  CAS  PubMed  Google Scholar 

  82. Egger M, Davey G, Schneider M, Minder C. Bias in meta-analysis detected by a simple graphical test. Br Med J. 1997;315:629–34.

    CAS  Google Scholar 

  83. Shahmanesh M, Patel V, Mabey D, Cowan F. Effectiveness of interventions for the prevention of HIV and other sexually transmitted infections in female sex workers in resource poor setting: a systematic review. Trop Med Int Health. 2008;13(5):659–79.

    Article  PubMed  Google Scholar 

  84. Hoffman K, Centeno MA. The lopsided continent: inequality in Latin America. Annu Rev Sociol. 2003;29:363–90.

    Article  Google Scholar 

  85. MkNelly B, Dunford C. Impact of credit with education on mothers and their young children’s nutrition: CRECER credit with education program in Bolivia, Freedom from Hunger Research Paper No. 5, Freedom from Hunger, Davis, California, 1999.

  86. Mitchell SH, Schoel C, Stevens AA. Mechanisms underlying heightened risk taking in adolescents as compared with adults. Psychol Bull. 2008;15(2):272–7.

    Article  Google Scholar 

  87. Reyna VF, Farley F. Risk and rationality in adolescent decision making: implications for theory, practice, and public policy. Psychol Sci Public Interest. 2006;7(1):1–44.

    Google Scholar 

  88. Johnson BT, Carey MP, Marsh KL, Levin KD, Scott-Sheldon LAJ. Interventions to reduce sexual risk for the human immunodeficiency virus in adolescents, 1985–2000: a research synthesis. Arch Pediatr Adolesc Med. 2003;157(4):381–8.

    Article  PubMed  Google Scholar 

  89. Johnson BT, Scott-Sheldon LAJ, Huedo-Medina TB, Cary MP. Interventions to reduce sexual risk for HIV in adolescents: a meta-analysis of trials, 1985–2008. Arch Pediatr Adolesc Med (in press).

  90. Earl A, Albarracín D. Nature, decay, and spiraling of the effects of fear-inducing arguments and HIV counseling and testing: a meta-analysis of the short- and long-term outcomes of HIV-prevention interventions. J Health Psychol. 2007;26(4):496–506.

    Article  Google Scholar 

  91. Johnson BT, Scott-Sheldon LAJ, Smoak ND, LaCroix JM, Anderson JR, Carey MP. Behavioral interventions for African Americans to reduce sexual risk of HIV: a meta-analysis of randomized controlled trials. J Acquir Immune Defic Syndr. 2009;51(4):492–501.

    Article  PubMed  Google Scholar 

  92. Kalichman SC, Rompa D, Coley B. Experimental component analysis of a behavioral HIV-AIDS prevention intervention for inner-city women. J Consult Clin Psychol. 1996;64(4):687–93.

    Article  CAS  PubMed  Google Scholar 

  93. Albarracín D, Gillette JC, Earl AN, Glasman LR, Durantini MR, Ho MH. Test of major assumptions about behaviour change: a comprehensive look at the effects of passive and active HIV-prevention interventions since the beginning of the epidemic. Psychol Bull. 2005;131(6):356–97.

    Article  Google Scholar 

  94. Bastos FI, Cáceres C, Galvão J, Veras MA, Castilho EA. AIDS in Latin America: assessing the current status of the epidemic and the ongoing response. Int J Epidemiol. 2008;37(4):729–37.

    PubMed  Google Scholar 

  95. Nunn AS, da Fonseca EM, Bastos FI, Gruskin S. AIDS treatment in Brazil: impacts and challenges. Health Aff. 2009;28(4):1103–13.

    Article  Google Scholar 

Download references

Acknowledgements

We thank study authors who made their data available for this study and Jennifer Ortiz, Natalie D. Smoak, and Amanda Northcutt who assisted in coding the meta-analyses and preparing the database of references. The work also benefited from Marijn de Bruin’s comments. This research was supported by National Institutes of Health Grant R01-MH58563 to B. T. Johnson.

Conflict of interest statement

The authors indicate no conflicts of interest.

Author information

Authors and Affiliations

  1. Center for Health, Intervention, and Prevention, University of Connecticut, 2006 Hillside Rd., Unit 1248, Storrs, CT, 06269-1248, USA

    Tania B. Huedo-Medina, Michelle R. Warren, Jessica M. LaCroix & Blair T. Johnson

  2. Transdisciplinary Prevention Research Center, Duke University, Erwin Square Mill Bldg, Bay B, Box 90420, Durham, NC, 27708-0420, USA

    Marcy H. Boynton

  3. Center for Health and Behavior, Syracuse University, Syracuse, NY, USA

    Michael P. Carey

Authors
  1. Tania B. Huedo-Medina
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Marcy H. Boynton
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Michelle R. Warren
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jessica M. LaCroix
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Michael P. Carey
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Blair T. Johnson
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Tania B. Huedo-Medina.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Huedo-Medina, T.B., Boynton, M.H., Warren, M.R. et al. Efficacy of HIV Prevention Interventions in Latin American and Caribbean Nations, 1995–2008: A Meta-Analysis. AIDS Behav 14, 1237–1251 (2010). https://doi.org/10.1007/s10461-010-9763-3

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10461-010-9763-3

Keywords

Search

Navigation