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A Systematic Review of the Effects of Behavioral Counseling on Sexual Risk Behaviors and HIV/STI Prevalence in Low- and Middle-Income Countries

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Abstract

The purpose of this study was to assess the effectiveness of behavioral counseling interventions in reducing sexual risk behaviors and HIV/STI prevalence in low- and middle-income countries. A systematic review of papers published between 1990 and 2011 was conducted, identifying studies that utilized either a multi-arm or pre-post design and presented post-intervention data. Standardized methods of searching and data abstraction were used, and 30 studies met inclusion criteria. Results are summarized by intervention groups: (a) people living with HIV; (b) people who use drugs and alcohol; (c) serodiscordant couples; (d) key populations for HIV prevention; and (e) people at low to moderate HIV risk. Evidence for the effectiveness of behavioral counseling was mixed, with more rigorously designed studies often showing modest or no effects. Recommendations about the use of behavioral counseling in developing countries are made based on study results and in light of the field’s movement towards combination prevention programs.

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References

  1. UNAIDS. 2010. UNAIDS report on the global HIV epidemic: 2010. Retrieved June 24, 2013 from http://www.unaids.org/GlobalReport/.

  2. King R. Sexual behavioural change for HIV: Where have theories taken us? UNAIDs; 1999. Retrieved August 7, 2013 from http://www.who.int/hiv/strategic/surveillance/en/unaids_99_27.pdf.

  3. Cornman DH, Kiene SM, Christie S, et al. Clinic-based intervention reduces unprotected sexual behavior among HIV-infected patients in KwaZulu-Natal, South Africa: results of a pilot study. J Acquir Immune Defic Syndr. 2008;48:553–60.

    Article  PubMed Central  PubMed  Google Scholar 

  4. Kalichman SC, Simbayi LC, Vermaak R, et al. HIV/AIDS risk reduction counseling for alcohol using sexually transmitted infections clinic patients in Cape Town, South Africa. J Acquir Immune Defic Syndr. 2007;44:594–600.

    Article  PubMed  Google Scholar 

  5. Xu F, Kilmarx PH, Supawitkul S, et al. Incidence of HIV-1 infection and effects of clinic-based counseling on HIV preventive behaviors among married women in northern Thailand. J Acquir Immune Defic Syndr. 2002;29:284–8.

    Article  PubMed  Google Scholar 

  6. U.S. Preventive Services Task Force. Behavioral counseling to prevent sexually transmitted infections: U.S. Preventive Services Task Force Recommendation Statement. AHRQ Publication 08-05123-EF-2; 2008.  Retrieved June 24, 2013 from http://www.uspreventiveservicestaskforce.org/uspstf08/sti/stirs.htm.

  7. Tan JY, Huedo-Medina TB, Warren MR, Carey MP, Johnson BT. A meta-analysis of the efficacy of HIV/AIDS prevention interventions in Asia, 1995–2009. Soc Sci Med. 2012;75(4):676–87.

    Article  PubMed Central  PubMed  Google Scholar 

  8. Huedo-Medina TB, Boynton MH, Warren MR, LaCroix JM, Carey MP, Johnson BT. Efficacy of HIV prevention interventions in Latin American and Caribbean nations, 1995–2008: a meta-analysis. AIDS Behav. 2010;14(6):1237–51.

    Article  PubMed Central  PubMed  Google Scholar 

  9. Weinhardt LS, Carey MP, Johnson BT, Bickham NL. Effects of HIV counseling and testing on sexual risk behavior: a meta-analytic review of published research, 1985–1997. Am J Public Health. 1999;89(9):1397–405.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  10. Kennedy CE, Fonner VA, Sweat MD, Okero FA, Baggaley R, O’Reilly KR. Provider-initiated HIV testing and counseling in low- and middle-income countries: a systematic review. AIDS Behav. 2013;17:1571–90.

    Article  PubMed Central  PubMed  Google Scholar 

  11. Denison JA, O’Reilly KR, Schmid GP, Kennedy CE, Sweat MD. HIV voluntary counseling and testing and behavioral risk reduction in developing countries: a meta-analysis, 1990–2005. AIDS Behav. 2008;12:363–73.

    Article  PubMed  Google Scholar 

  12. Fonner VA, Denison J, Kennedy CE, O’Reilly K, Sweat M. Voluntary counseling and testing (VCT) for changing HIV-related risk behavior in developing countries. Cochrane Library. 2012. doi:10.1002/14651858.CD001224.pub4.

  13. Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med. 2009;151:264–9.

    Article  PubMed  Google Scholar 

  14. World Bank. Country and lending groups; 2013. Retrieved September 16, 2013 from http://data.worldbank.org/about/country-classifications/country-and-lending-groups#Lower_middle_income.

  15. Kalichman SC, Simbayi LC, Vermaak R, et al. Randomized trial of a community-based alcohol-related HIV risk-reduction intervention for men and women in Cape Town South Africa. Ann Behav Med. 2008;36:270–9.

    Article  PubMed  Google Scholar 

  16. Kalichman SC, Simbayi LC, Cloete A, et al. Integrated gender-based violence and HIV Risk reduction intervention for South African men: results of a quasi-experimental field trial. Prev Sci. 2009;10:260–9.

    Article  PubMed Central  PubMed  Google Scholar 

  17. 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;98:2051–7.

    Article  PubMed Central  PubMed  Google Scholar 

  18. Wang D, Operario D, Hong Q, Zhang H, Coates TJ. Intervention to train physicians in rural China on HIV/STI knowledge and risk reduction counseling: preliminary findings. AIDS Care. 2009;21:468–72.

    Article  PubMed Central  PubMed  Google Scholar 

  19. Levine WC, Revollo R, Kaune V, Vega J, Tinajeros F, Garnica M, Kuritsky JN. Decline in sexually transmitted disease prevalence in female Bolivian sex workers: impact of an HIV prevention project. AIDS. 1998;12:1899–906.

    Article  CAS  PubMed  Google Scholar 

  20. Peltzer K, Tabane C, Matseke G, Simbayi L. Lay counsellor-based risk reduction intervention with HIV positive diagnosed patients at public HIV counselling and testing sites in Mpumalanga, South Africa. Eval Program Plan. 2010;33:379–85.

    Article  Google Scholar 

  21. Jones DL, Weiss SM, Bhat GJ, Bwalya V. Influencing sexual practices among HIV-positive Zambian women. AIDS Care. 2006;18:629–34.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  22. Jones DL, Weiss SM, Bhat GJ, et al. A sexual barrier intervention for HIV ± Zambian women: acceptability and use of vaginal chemical barriers. J Multicult Nurs Health. 2004;10:24–31.

    PubMed Central  PubMed  Google Scholar 

  23. Futterman D, Shea J, Besser M, et al. Mamekhaya: a pilot study combining a cognitive-behavioral intervention and mentor mothers with PMTCT services in South Africa. AIDS Care. 2010;22:1093–100.

    Article  PubMed Central  PubMed  Google Scholar 

  24. MacNeil JM, Mberesero F, Kilonzo G. Is care and support associated with preventive behaviour among people with HIV? AIDS Care. 1999;11:537–46.

    Article  CAS  PubMed  Google Scholar 

  25. Olley BO. Improving well-being through psycho-education among voluntary counseling and testing seekers in Nigeria: a controlled outcome study. AIDS Care. 2006;18:1025–31.

    Article  CAS  PubMed  Google Scholar 

  26. Chen HT, Liao Q. A pilot study of the NGO-based relational intervention model for HIV prevention among drug users in China. AIDS Educ Prev. 2005;17:503–14.

    Article  PubMed  Google Scholar 

  27. Chawarski MC, Mazlan M, Schottenfeld RS. Behavioral drug and HIV risk reduction counseling (BDRC) with abstinence-contingent take-home buprenorphine: a pilot randomized clinical trial. Drug Alcohol Depend. 2008;94:281–4.

    Article  CAS  PubMed  Google Scholar 

  28. Chawarski MC, Zhou W, Schottenfeld RS. Behavioral drug and HIV risk reduction counseling (BDRC) in MMT programs in Wuhan, China: a pilot randomized clinical trial. Drug Alcohol Depend. 2011;115:237–9.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  29. Samet JH, Krupitsky EM, Cheng DM, et al. 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. 2008;103:1474–83.

    Article  PubMed Central  PubMed  Google Scholar 

  30. van Griensvan F, Keawkungwal J, Tappero JW, et al. Lack of increased HIV risk behavior among injection drug users participating in the AIDSVAX B/E HIV vaccine trial in Bangkok, Thailand. AIDS. 2004;18:295–301.

    Article  PubMed  Google Scholar 

  31. Jones DL, Ross D, Weiss SM, Bhat G, Chitalu N. Influence of partner participation on sexual risk behavior reduction among HIV-positive Zambian women. J Urban Health. 2005;82:92–100.

    Google Scholar 

  32. Jones DL, Chitalu N, Ndubani P, et al. Sexual risk reduction among Zambian couples. SAHARA J. 2009;6:69–75.

    Article  PubMed Central  PubMed  Google Scholar 

  33. Kamenga M, Ryder RW, Jingu M, et al. Evidence of marked sexual behavior change associated with low HIV-1 seroconversion in 149 married couples with discordant HIV-1 serostatus: experience at an HIV counselling center in Zaire. AIDS. 1991;5:61–7.

    Article  CAS  PubMed  Google Scholar 

  34. Kaul R, Kimani J, Nagelkerke NJ, et al. Reduced HIV risk-taking and low HIV incidence after enrollment and risk-reduction counseling in a sexually transmitted disease prevention trial in Nairobi, Kenya. J Acquir Immune Defic Syndr. 2002;30:69–72.

    Article  PubMed  Google Scholar 

  35. Ngugi EN, Chakkalackal M, Sharma A, et al. Sustained changes in sexual behavior by female sex workers after completion of a randomized HIV prevention trial. J Acquir Immune Defic Syndr. 2007;45:588–94.

    Article  PubMed  Google Scholar 

  36. Wechsberg WM, Luseno WK, Lam WK, Parry CD, Morojele NK. Substance use, sexual risk, and violence: HIV prevention intervention with sex workers in Pretoria. AIDS Behav. 2006;10:131–7.

    Article  PubMed  Google Scholar 

  37. Wechsberg WM, Luseno WK, Kline TL, Browne FA, Zule WA. Preliminary findings of an adapted evidence-based woman-focused HIV intervention on condom use and negotiation among at-risk women in Pretoria, South Africa. J Prev Interv Community. 2010;38:132–46.

    Article  PubMed Central  PubMed  Google Scholar 

  38. Simbayi LC, Kalichman SC, Skinner D, et al. Theory-based HIV risk reduction counseling for sexually transmitted infection clinic patients in Cape Town, South Africa. Sex Transm Dis. 2004;31:727–33.

    Article  PubMed  Google Scholar 

  39. Solomon SS, Solomon S, Masse BR, et al. Risk reduction counseling is associated with decreased HIV transmission-associated behaviors in high-risk Indian heterosexuals. J Acquir Immune Defic Syndr. 2006;42:478–83.

    Article  PubMed  Google Scholar 

  40. Jackson DJ, Rakwar JP, Richardson BA, et al. Decreased incidence of sexually transmitted diseases among trucking company workers in Kenya: results of a behavioural risk-reduction programme. AIDS. 1997;11:903–9.

    Article  CAS  PubMed  Google Scholar 

  41. Zhang H, Wu Z, Zheng Y, et al. A pilot intervention to increase condom use and HIV testing and counseling among men who have sex with men in Anhui, China. J Acquir Immune Defic Syndr. 2010;53(Suppl 1):S88–92.

    Article  PubMed  Google Scholar 

  42. Joint United Nations Programme on HIV/AIDS. Getting to Zero: 2011–2015 strategy. Geneva: UNAIDS; 2010.

    Google Scholar 

  43. Kennedy CE, Medley AM, Sweat MD, O’Reilly KR. Behavioral interventions for HIV positive prevention in developing countries: a systematic review and meta-analysis. Bull World Health Organ. 2010;88:615–23.

    Article  PubMed Central  PubMed  Google Scholar 

  44. Joint United Nations Programme on HIV/AIDS. Combination HIV prevention: tailoring and coordinating biomedical, behavioral and structural strategies to reduce new HIV infections. Geneva: UNAIDS; 2010.

    Google Scholar 

  45. Kurth AE, Celum C, Baeten JM, Vermund SH, Wasserheit JN. Combination HIV prevention: significance, challenges, and opportunities. Curr HIV/AIDS Rep. 2011;8:62–72.

    Article  PubMed Central  PubMed  Google Scholar 

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Acknowledgments

This research was supported by National Institute of Mental Health, Grant Number 1R01MH090173 and The Horizons Program. The Horizons Program was funded by The US Agency for International Development under the terms of HRN-A-00-97-00012-00. The first author is supported by the National Institute on Drug Abuse, Grant Numbers K12DA031794 and K23DA034879. The study authors thank Alicen Spaulding, Kiesha McCurtis, Hieu Pham, Eugenia Pyntikova, Jewel Gausman, Alexandria Smith, Erica Layer, Jeremy Lapedis, Erica Koegler, Lindsay Litwin, Canada Parrish, Taylor Whitten, Esther Lei, Swathi Manchikanti, Jenny Tighe, Isabelle Feldhaus, April Monroe, Sarah Robbins, Salwan Hager, and Hayley Droppert for their searching, screening, and coding work on this review.

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Authors and Affiliations

  1. Department of Psychiatry & Behavioral Medicine, Medical University of South Carolina, Charleston, SC, USA

    Kristyn Zajac, Kevin S. Armstrong & Michael D. Sweat

  2. Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

    Caitlin E. Kennedy & Virginia A. Fonner

  3. World Health Organization, Geneva, Switzerland

    Kevin R. O’Reilly

  4. 176 Croghan Spur Road, Suite 104, Charleston, SC, 29407, USA

    Kristyn Zajac

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  1. Kristyn Zajac
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  5. Kevin R. O’Reilly
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  6. Michael D. Sweat
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Correspondence to Kristyn Zajac.

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Zajac, K., Kennedy, C.E., Fonner, V.A. et al. A Systematic Review of the Effects of Behavioral Counseling on Sexual Risk Behaviors and HIV/STI Prevalence in Low- and Middle-Income Countries. AIDS Behav 19, 1178–1202 (2015). https://doi.org/10.1007/s10461-014-0893-x

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