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A Systematic Review of Behavioral Interventions to Prevent HIV Infection and Transmission among Heterosexual, Adult Men in Low-and Middle-Income Countries

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Abstract

Prevention of new HIV infections needs to move to the forefront in the fight against HIV and AIDS. In the current economic crisis, low- and middle-income countries (LMICs) should invest limited resources to amass reliable evidence-based information about behavioral prevention efforts, and on behaviors that are driving the epidemic among people who are engaging in those behaviors. This paper aims to provide a systematic review and synthesis of behavioral interventions among a group of people in high HIV-burden countries: heterosexual men in LMICs. The review includes articles published between January 2001 and May 2010 that evaluated behavioral prevention interventions among heterosexual males aged 18+ years in LMICs. The studies were evaluated using the quality assessment tool for quantitative studies developed by the Effective Public Health Practice Project. The review identified 19 articles that met the review's inclusion criteria. Most studies were conducted in South Africa (n=6); two each in Uganda and Thailand; and one in each of Angola, Brazil, Bulgaria, India, Nigeria, the Philippines, Russia, Ukraine and Zimbabwe. Eight of 19 interventions increased condom use among their respective populations. Those interventions that sought to reduce the number of sexual partners had little effect, and those that addressed alcohol consumption and intimate partner violence had mixed effects. There was no evidence for any specific format of intervention that impacted best on any of the targeted risk behaviors. The paucity of evaluated interventions for heterosexual men in LMICs suggests that adult men in these countries remain underrepresented in HIV prevention efforts.

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References

  • Baliunas, D., Rehm, J., Irving, H., & Shuper, P. (2010). Alcohol consumption and risk of incident human immunodeficiency virus infection: A meta-analysis. International Journal of Public Health, 55, 159–166.

    Google Scholar 

  • Bing, E. G., Cheng, K. G., Ortiz, D. J., Ovalle-Bahamón, R. E., Ernesto, F., Weiss, R. E., et al. (2008). Evaluation of a prevention intervention to reduce HIV risk among Angolan soldiers. AIDS and Behavior, 12, 384–395.

    Article  PubMed  Google Scholar 

  • Booth, R. E., Lehman, W. E. K., Dvoryak, S., Brewster, J. T., & Sinitsyna, L. (2009). Interventions with injecting drug users in Ukraine. Addiction, 104, 1864–1873.

    Article  PubMed  Google Scholar 

  • Centers for Disease Control and Prevention. (2001). Compendium of HIV Prevention Interventions with Evidence of Effectiveness. Retrieved June 3, 2010, from http://www.cdc.gov/hiv/resources/reports/hiv_compendium/

  • Cornman, D. H., Schmiege, S. J., Bryan, A., Benziger, T. J., & Fisher, J. D. (2007). An information-motivation-behavioral skills (IMB) model-based HIV prevention intervention for truck drivers in India. Social Science & Medicine, 64, 1572–1584.

    Article  Google Scholar 

  • Cornman, D. H., Kiene, S. M., Christie, S., Fisher, W. A., Shuper, P. A., Pillay, S., et al. (2008). Clinic-based intervention reduces unprotected sexual behavior among HIV-infected patients in KwaZulu-Natal, South Africa: Results of a pilot study. Journal of Acquired Immune Deficiency Syndromes, 48, 553–560.

    Article  PubMed  Google Scholar 

  • Crepaz, N., Horn, A. K., Rama, S. M., Griffin, T., Deluca, J. B., Mullins, M. M., et al. (2007). The efficacy of behavioral interventions in reducing HHIV 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. Sexually Transmitted Diseases, 34, 319–332.

    PubMed  Google Scholar 

  • Crepaz, N., Lyles, C. M., Wolitski, R. J., Passin, W. F., Rama, S. M., Herbst, J. H., et al. (2006). Do prevention interventions reduce risk behaviours among people living with HIV? A meta-analytic review of controlled trials. AIDS, 20, 143–157.

    Article  PubMed  Google Scholar 

  • Darbes, L., Crepaz, N., Lyles, C., Kennedy, G., & Rutherford, G. (2008). The efficacy of behavioral interventions in reducing HIV risk behaviors and incident sexually transmitted diseases in heterosexual African Americans. AIDS, 22, 1177–1194.

    Article  PubMed  Google Scholar 

  • Effective Public Health Practice Project. (2009). Quality assessment tool for quantitative studies. Retrieved August 2, 2010, from http://www.ephpp.ca/Tools.html

  • Epstein, H. (2008). The invisible cure. Why we are losing the fight against AIDS in Africa. New York: Picador.

    Google Scholar 

  • Epstein, H. (2010). The mathematics of concurrent partnerships and HIV: A commentary on Lurie and Rosenthal, 2009. AIDS and Behavior, 14, 29–30.

    Article  PubMed  Google Scholar 

  • Exner, T. M., Gardos, P. S., Seal, D. W., & Ehrhardt, A. A. (1999). HIV sexual risk reduction interventions with heterosexual men: The forgotten group. AIDS and Behavior, 3, 347–358.

    Article  Google Scholar 

  • Exner, T. M., Mantell, J. E., Adeokun, L. A., Udoh, I. A., Lapido, O. A., Delano, G. E., et al. (2009). Mobilizing men as partners: The results of an intervention to increase dual protection among Nigerian men. Health Education Research, 846–854. doi:10.1093/her/cyp021.

  • Fisher, J. C., Bang, H., & Kapiga, S. H. (2007). The association between HIV infection and alcohol use: A systematic review and meta-analysis of African studies. Sexually Transmitted Diseases, 34, 856–863.

    Article  PubMed  Google Scholar 

  • Foss, A. M., Hossain, M., Vickerman, P. T., & Watts, C. H. (2007). A systematic review of published evidence on intervention impact on condom use in sub-Saharan Africa and Asia. Sexually Transmitted Infections, 83, 510–516.

    Article  PubMed  CAS  Google Scholar 

  • Global HIV Prevention Working Group (2007). Bringing HIV prevention to scale: An urgent global priority. Retrieved June 10, 2010, from www.globalhivprevention.org/reports.html

  • Green, E. C., Mah, T. L., Ruark, A., & Hearst, N. (2009). A framework of sexual partnerships: Risks and implications for HIV prevention in Africa. Studies in Family Planning, 40, 63–70.

    Google Scholar 

  • Gregson, S., Adamson, S., Papaya, S., Mundondo, J., Nyamukapa, C. A., Mason, P. R., et al. (2007). Impact and process evaluation of integrated community and clinic-based HIV-1 control: A cluster-randomised trial in Eastern Zimbabwe. PLoS Medicine, 4, 545–555.

  • Hallett, T. B., Garnett, G. P., Mupamberiyi, Z., & Gregson, S. (2007). Measuring effectiveness in community randomized trials of HIV prevention. International Journal of Epidemiology, 37, 77–87.

    Article  PubMed  Google Scholar 

  • Halperin, D., & Epstein, H. (2004). Concurrent sexual partnerships help to explain Africa’s high HIV prevalence: Implications for prevention. The Lancet, 364, 4–6.

    Google Scholar 

  • Hearst, N., & Chen, S. (2004). Condom promotion for AIDS prevention in the developing world? Is it working? Studies in Family Planning, 35, 39–47.

    Article  PubMed  Google Scholar 

  • Herbst, J. H., Kay, L. S., Passin, W. F., Lyles, C. M., Crepaz, N., Marín, B. V., et al. (2007). A systematic review and meta-analysis of behavioral interventions to reduce HIV risk behaviors of Hispanics in the United States and Puerto Rico. AIDS and Behavior, 11, 25–47.

    Article  PubMed  Google Scholar 

  • Jewkes, R., Nduna, M., Levin, J., Jama, N., Dunkle, K., Puren, A., et al. (2008). Impact of Stepping Stones on incidence of HIV and HSV-2 and sexual behaviour in rural South Africa: Cluster randomised controlled trial. British Medical Journal, 337, a506. doi:10.1136/bmj.a506.

    Article  PubMed  Google Scholar 

  • Jewkes, R. & Morrell, R. (2010). Gender and sexuality: Emerging perspectives from the heterosexual epidemic in South Africa and implications for HIV risk and prevention. Journal of the International AIDS Society, (p. 6). Retrieved July 13, 2010, from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2828994/

  • Jewkes, R., Dunkle, K., Nduna, M., & Shai, N. (2010). Intimate partner violence, relationship power inequity, and incidence of HIV infection in young women in South Africa: A cohort study. The Lancet, 376, 41–48.

    Google Scholar 

  • Kajubi, P., Kamya, M. R., Kamya, S., Chen, S., McFarland, W., & Hearst, N. (2005). Increasing condom use without reducing HIV risk. Journal of Acquired Immune Deficiency Syndromes, 40, 77–82.

    Article  PubMed  Google Scholar 

  • Kalichman, S. C., Simbayi, L. C., Vermaak, R., Cain, D., Jooste, S., & Peltzer, K. (2007a). HIV/AIDS risk reduction counseling for alcohol using sexually transmitted infections clinic patients in Cape Town, South Africa. Journal of Acquired Immune Deficiency Syndromes, 44, 594–600.

    Article  PubMed  Google Scholar 

  • Kalichman, S. C., Simbayi, L. C., Kaufman, M., Cain, D., & Jooste, S. (2007b). Alcohol use and sexual risks for HIV/AIDS in sub-Saharan Africa: Systematic review of empirical findings. Prevention Science, 8, 141–151.

    Article  PubMed  Google Scholar 

  • Kalichman, S. C., Simbayi, L. C., Vermaak, R., Cain, D., Smith, G., Mthebu, J., et al. (2008). Randomized trial of a community-based alcohol-related HIV risk-reduction intervention for men and women in Cape Town South Africa. Annuls of Behavioral Medicine, 36, 270–279.

    Article  Google Scholar 

  • Kalichman, S. C., Simbayi, L. C., Cloete, A., Clayford, M., Arnolds, W., Mxoli, M., et al. (2009). Integrated gender-based violence and HIV risk reduction intervention for South African men: Results of a quasi-experimental field trial. Prevention Science, 10, 260–269.

    Article  PubMed  Google Scholar 

  • Kamali, A., Quigley, M., Nakiyingi, J., Kinsman, J., Kengeya-Kayondo, J., Gopal, R., et al. (2003). Syndromic management of sexually-transmitted infections and behaviour change interventions on transmission of HIV-1 in rural Uganda: A community randomised trial. The Lancet, 361, 645–652.

    Google Scholar 

  • Kelly, J. A., Amirkhanian, Y. A., Kabakchieva, E., Vassileva, S., McAuliffe, T. L., DiFranceisco, W. J., et al. (2006). Prevention of HIV and sexually transmitted diseases in high risk social networks of young Roma (Gypsy) men in Bulgaria: Randomised controlled trial. British Medical Journal, 333, 1098–1101.

    Google Scholar 

  • Latkin, C. A., Donnell, D., Metzger, D., Sherman, S., Aramrattna, A., Davis-Vogel, A., et al. (2009). The efficacy of a network intervention to reduce HIV risk behaviors among drug users and risk partners in Chiang Mai, Thailand and Philadelphia, USA. Social Science & Medicine, 68, 740–748.

    Article  Google Scholar 

  • Leclerc-Madlala, S. (2008). Age-disparate and intergenerational sex in southern Africa: Dynamics of hypervulnerability. AIDS, 22, S17–S25.

  • Lurie, M. N., & Rosenthal, S. (2010). Concurrent partnerships as a driver of the HIV epidemic in sub-Saharan Africa? The evidence is limited. AIDS & Behaviour, 14, 17–24.

    Google Scholar 

  • Lyles, C. M., Kay, L. S., Crepaz, N., Herbst, J. H., Passin, W. F., Kim, A. S., et al. (2007). Best-evidence interventions: Findings from a systematic review of HIV behavioral interventions for US populations at high risk, 2000–2004. American Journal of Public Health, 97, 133–143.

    Article  PubMed  Google Scholar 

  • Mah, T. (2008). Concurrent sexual partnerships and HIV transmission in Khayelitsha, South Africa. for Social Science Research, University of Cape Town Working Paper No. 225. Retrieved July 8, 2010, from http://www.cssr.uct.ac.za/sites/cssr.uct.ac.za/files/pubs/WP225.pdf

  • Mah, T. L., & Halperin, D. T. (2010a). Concurrent sexual partnerships and the HIV epidemics in Africa: Evidence to move forward. AIDS and Behavior, 14, 11–16.

    Article  PubMed  Google Scholar 

  • Mah, T., & Halperin, D. T. (2010b). The evidence for the role of concurrent partnerships in Africa’s HIV epidemics: A response to Lurie and Rosenthal. AIDS and Behavior, 14, 25–28.

    Article  Google Scholar 

  • Mah, T., Maughan-Brown, B. (2009). Social and cultural contexts of concurrency in Khayelitsha. Centre for Social Science Research, University of Cape Town Working Paper No. 251.

  • McCoy, S. I., Kangwende, R. A., & Padian, N. S. (2010). Behavior change interventions to prevent HIV infection among women living in low and middle income countries: A systematic review. AIDS and Behavior, 14, 469–482.

    Article  PubMed  Google Scholar 

  • McPhail, C., & Campbell, C. (2001). “I think condoms are good, but, aai, I hate those things”: Condom use among adolescents and young people in a southern African township, South Africa. Social Science & Medicine, 52, 1613–1627.

  • Merson, M., Padian, N., Coates, T. J., Rao Gupta, G., Bertozzi, S. M., Piot, P., et al. (2008). Combination HIV prevention. The Lancet, 372, 1805–1806.

    Article  Google Scholar 

  • Morisky, D. E., Ang, A., Coly, A., & Tiglao, T. V. (2004). A model HIV/AIDS risk reduction program in the Philippines: A comprehensive community-based approach through participatory action research. Health Promotion International, 19, 69–76.

    Google Scholar 

  • Morris, M. (2010). Barking up the wrong evidence tree. Commentary on Lurie & Rosenthal, “Concurrent partnerships as a driver of the HIV epidemic in sub-Saharan Africa? The evidence is limited.” AIDS and Behavior, 14, 31–33.

    Article  PubMed  Google Scholar 

  • Noguchi, K., Albarracín, D., Durantini, M. R., & Glasman, L. R. (2007). Who participates in which health promotion programs? A meta-analysis of motivations underlying enrollment and retention in HIV-prevention interventions. Psychological Bulletin, 133, 955–975.

    Article  PubMed  Google Scholar 

  • Nelson, S. J., Manhart, L. E., Gorbach, P. M., Martin, D. H., Stoner, B. P., Aral, S. O., et al. (2007). Measuring sex partner concurrency: It’s what’s missing that counts. Sexually Transmitted Diseases, 34, 801.807.

    Google Scholar 

  • Neumann, M. S., Johnson, W. D., Semaan, S., Flores, S. A., Peersman, G., Hedges, L. V., et al. (2002). Review and meta-analysis of HIV prevention intervention research for heterosexual adult populations in the United States. Journal of Acquired Immune Deficiency Syndromes, 30, S106–S117.

    PubMed  Google Scholar 

  • Padian, N. S., McCoy, Sandra, I., Balkus, J. E., & Wasserheit, J. N. (2010). Weighing the gold in the gold standard: Challenges in HIV prevention research. AIDS, 24, 621–635.

  • Pechansky, F., Bassani, D. G., Von Diemen, L., Kessler, F., Leikefeld, C. G., Surratt, H. L., et al. (2007). Using thought mapping and structured stories to decrease HIV risk behaviors among cocaine injectors and crack smokers in the South of Brazil. Revista Brasileira de Psiquiatria, 29, 233–240.

    Article  PubMed  Google Scholar 

  • Richards, J. E., Risser, J. M., Padgett, P. M., Rehma, H. U., Wolverton, M. I., & Arafat, R. R. (2008). Condom use among high-risk heterosexual women with concurrent sexual partners. International Journal of STD & AIDS, 19, 76–771.

    Google Scholar 

  • Samet, J. H., Krupitsky, E. M., Cheng, D. M., Raj, A., Egorova, V. Y., Levenson, S., et al. (2008). Mitigating risky sexual behaviors among Russian narcology hospital patients: The PREVENT (Partnership to Reduce the Epidemic Via Engagement in Narcology Treatment) randomized controlled trial. Addiction, 103, 1474–1483.

    Google Scholar 

  • Sherman, S. G., Sutcliffe, C., Srirojn, B., Latkin, C. A., Aramratanna, A., & Celentano, D. D. (2009). Evaluation of a peer network intervention trial among young methamphetamine users in Chiang Mai, Thailand. Social Science & Medicine, 68, 69–79.

    Article  Google Scholar 

  • Shelton, J. D. (2006). Confessions of a condom lover. The Lancet, 368, 1947–1948.

    Article  Google Scholar 

  • Shuper, P. A., Joharchi, N., Irving, H., & Rehm, J. (2009). Alcohol as a correlate of unprotected sexual behavior among people living with HIV/AIDS: Review and meta-analysis. AIDS and Behavior, 13, 1021–1036.

    Article  PubMed  Google Scholar 

  • Simbayi, L. C., Kalichman, S. C., Skinner, D., Jooste, S., Cain, D., Cherry, C., et al. (2004). Theory-based HIV risk reduction counseling for sexually transmitted infection clinic patients in Cape Town, South Africa. Sexually Transmitted Diseases, 31, 727–733.

    Article  PubMed  Google Scholar 

  • Talbot, M. (1999). Monetary incentives in research and participation in HIV/STD risk reduction programmes. Sexually Transmitted Infections, 75, 1–2.

    Google Scholar 

  • Townsend, L., Johnson, L. G., Flisher, A. J., Mathews, C., & Zembe, Y. (2010). Effectiveness of respondent-driven sampling to recruit high risk heterosexual men who have multiple female sexual partners: Differences in HIV prevalence and sexual risk behaviours measured at two time points. AIDS and Behavior, 14, 1330–1339.

    Google Scholar 

  • UNAIDS. (2009a). AIDS epidemic update. Geneva, Switzerland: Joint United Nations Programme on HIV/AIDS.

    Google Scholar 

  • UNAIDS. (2009b). Impact of the global financial and economic crisis on the AIDS response. Geneva, Switzerland: Joint United Nations Programme on HIV/AIDS.

    Google Scholar 

  • UNAIDS. (2009c). Ambitious project brings key countries in eastern and southern Africa closer to ‘knowing their epidemics’. Retrieved July 13, 2010, from http://www.unaids.org/en/KnowledgeCentre/Resources/FeatureStories/archive/2009/20090512_UNAIDS_WB_epi.asp

  • UNAIDS. (2009d). Joint action for results: Outcome framework 2009-2011. Retrieved July 12, 2010, from http://data.unaids.org/pub/BaseDocument/2010/jc1713_joint_action_en.pdf

  • Ward, D. J., Rowe, B., Pattison, H., Taylor, R. S., & Radcliffe, K. W. (2005). Reducing the risk of sexually transmitted infections in genitourinary medicine clinic patients: A systematic review and meta-analysis of behavioral interventions. Sexually Transmitted Infections, 81, 386–393.

    Google Scholar 

  • World Bank. (2010). Country classifications. Retrieved June 12, 2010, from http://data.worldbank.org/about/country-classifications

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Acknowledgements

Loraine Townsend and Yanga Zembe were supported by the Columbia University-Southern African Fogarty AIDS International Training and Research Program (AITRP) funded by the Fogarty International Center, National Institutes of Health (grant X D43TW00231) (May to July 2010).

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Townsend, L., Mathews, C. & Zembe, Y. A Systematic Review of Behavioral Interventions to Prevent HIV Infection and Transmission among Heterosexual, Adult Men in Low-and Middle-Income Countries. Prev Sci 14, 88–105 (2013). https://doi.org/10.1007/s11121-012-0300-7

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