AIDS and Behavior

, Volume 17, Issue 3, pp 987–1001 | Cite as

Effectiveness of Sport-Based HIV Prevention Interventions: A Systematic Review of the Evidence

Substantive Review


Interest in sport as a tool for behavioral HIV prevention has grown substantially in the past decade. With dozens of organisations now using sport-based HIV prevention (SBHP) approaches and upcoming randomized controlled trials in South Africa and Zimbabwe, there is a pressing need to synthesize previous evaluation findings and identify gaps in existing research. A systematic review on the effectiveness of SBHP interventions was carried out, identifying both published and unpublished studies on SBHP interventions that measured effectiveness quantitatively. Study quality was scored using an adapted Newcastle-Ottawa Scale. Random-effects meta-analyses were carried out across studies for effects on six categories of HIV-related outcomes. The review identified 952 publications, 21 of which met inclusion criteria. No randomised controlled trials on SBHP interventions and no studies assessing biological outcomes were identified. Mean study quality score was 5.1 (SD 3.1) out of 20 points. Overall strong evidence was observed for positive effects on HIV-related knowledge (RR = 1.26, 95 % CI = 1.15–1.37), stigma (RR = 1.13, 95 % CI = 1.02–1.24), self-efficacy (RR = 1.22, 95 % CI = 1.02–1.41), reported communication (RR = 1.24, 95 % CI = 1.06–1.41), and reported recent condom use (RR = 1.29, 95 % CI = 1.00–1.59). Generally, the review found encouraging evidence for some short-term effects but relied predominantly on low-quality studies. More rigorous research on SBHP is needed to objectively assess effectiveness. Randomised controlled trials could play an important role in guiding policies, strategies, and funding related to SBHP.


Systematic review HIV prevention Sport Effectiveness Evidence 



We are grateful to the Marshall Aid Commemoration Commission and the Rhodes Trust for the studentships supporting the first and second authors. We also wish to acknowledge organizations that shared grey literature sources for the review. In addition to the authors, Lucie Cluver at Oxford University provided input into the review’s design and Helen Weiss provided input into the meta-analysis.


  1. 1.
    UNAIDS. World AIDS Day Report 2011: Joint United Nations Programme on HIV/AIDS (UNAIDS); 2011.Google Scholar
  2. 2.
    Nations U. Declaration of Commitment on HIV/AIDS. United Nations General Assembly Special Session on HIV/AIDS, Geneva. 2001; 25–27 June 2001.Google Scholar
  3. 3.
    UNAIDS. Securing The Future Today: Synthesis of Strategic Information on HIV and Young People Geneva: UNAIDS. 2011.Google Scholar
  4. 4.
    Kirby DB, Laris BA, Rolleri LA. Sex and HIV education programs: their impact on sexual behaviors of young people throughout the world. J Adolesc Health. 2007;40:206–17.PubMedCrossRefGoogle Scholar
  5. 5.
    Ross DA, Changalucha J, Obasi AI, et al. Biological and behavioural impact of an adolescent sexual health intervention in Tanzania: a community-randomized trial. AIDS. 2007;21:1943–55.PubMedCrossRefGoogle Scholar
  6. 6.
    Jewkes R, Nduna M, Levin J, et al. Impact of stepping stones on incidence of HIV and HSV-2 and sexual behaviour in rural South Africa: cluster randomised controlled trial. BMJ. 2008;337:a506.PubMedCrossRefGoogle Scholar
  7. 7.
    Cowan FM, Pascoe SJ, Langhaug LF, et al. The Regai Dzive Shiri project: results of a randomized trial of an HIV prevention intervention for youth. AIDS. 2010;24:2541–52.PubMedCrossRefGoogle Scholar
  8. 8.
    Ross DA. Behavioural interventions to reduce HIV risk: what works? AIDS. 2010;24(Suppl 4):S4–14.PubMedCrossRefGoogle Scholar
  9. 9.
    Brown BR Jr, Baranowski MD, Kulig JW, Stephenson JN, Perry B. Searching for the Magic Johnson effect: AIDS, adolescents, and celebrity disclosure. Adolescence. 1996;31:253–64.PubMedGoogle Scholar
  10. 10.
    Kalichman SC. Magic Johnson and public attitudes toward AIDS: a review of empirical findings. AIDS Educ Prev. 1994;6:542–57.PubMedGoogle Scholar
  11. 11.
    Quadagno D, Eberstein IW, Foster K, Sittig JE, Sly DF, Kistner JA. Magic Johnson and children’s conceptions of AIDS. AIDS Educ Prev. 1997;9:359–72.PubMedGoogle Scholar
  12. 12.
    Using football for HIV/AIDS prevention in Africa. Football for an HIV Free Generation. 2010. Accessed 14 Aug 2011.
  13. 13.
    2010 World Cup Provides Platform for Major HIV Prevention Initiative. Grassroot Soccer, Inc. 2008. Accessed 14 Aug 2011.
  14. 14.
    Factsheet: HIV & AIDS prevention through sport. Lausanne: International Olympic Committee. July 2011.Google Scholar
  15. 15.
    Iwg S. Harnessing the power of sport for development and peace: recommendations to governments. Toronto: Sport for Development and Peace International Working Group; 2008.Google Scholar
  16. 16.
    Bandura A. Social learning theory. New York: General Learning Press; 1977.Google Scholar
  17. 17.
    The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. OHRI. 2011. 14 Aug 2011.
  18. 18.
    Mercy Corps. Commitment to practice: a playbook for practitioners in HIV, youth and sport. 2007.Google Scholar
  19. 19.
    Clark TS, Friedrich GK, Ndlovu M, Neilands TB, McFarland W. An adolescent-targeted HIV prevention project using African professional soccer players as role models and educators in Bulawayo. Zimb AIDS Behav. 2006;10:S77–83.CrossRefGoogle Scholar
  20. 20.
    Delva W, Michielsen K, Meulders B, et al. HIV prevention through sport: the case of the Mathare Youth Sport Association in Kenya. AIDS Care. 2010;22:1012–20.PubMedCrossRefGoogle Scholar
  21. 21.
    Fuller CW, Junge A, DeCelles J, Donald J, Jankelowitz R, Dvorak J. ‘Football for Health’—a football-based health-promotion programme for children in South Africa: a parallel cohort study. Br J Sports Med. 2010;44:546–54.PubMedCrossRefGoogle Scholar
  22. 22.
    Fuller CW, Junge A, Dorasami C, DeCelles J, Dvorak J. ‘11 for Health’, a football-based health education programme for children: a two-cohort study in Mauritius and Zimbabwe. Br J Sports Med. 2011;45:612–8.PubMedCrossRefGoogle Scholar
  23. 23.
    Kaufman Z, Perez K, Adams LV, Khanda M, Ndlovu M, Holmer H. Long-term behavioral impact of a soccer-themed, school-based HIV Prevention program in Zimbabwe and Botswana. In: Poster, editor. XVIII International AIDS conference, Vienna; 2010.Google Scholar
  24. 24.
    Kaufman Z, Welsch R, Erickson JD, Craig S, Ross DA. Effectiveness of a sports-based HIV prevention intervention in the Dominican Republic: a quasi-experimental study. AIDS Care 2011.Google Scholar
  25. 25.
    Kruse SE. Review of kicking AIDS out: is sport an effective tool in the fight against HIV/AIDS?. Oslo: NORAD; 2006.Google Scholar
  26. 26.
    Maro CN, Roberts GC, Sorensen M. Using sport to promote HIV/AIDS education for at-risk youths: an intervention using peer coaches in football. Scand J Med Sci Sports. 2009;19:129–41.PubMedCrossRefGoogle Scholar
  27. 27.
    Peacock-Villada P, DeCelles J, Banda PS. Grassroot Soccer resiliency pilot program: building resiliency through sport-based education in Zambia and South Africa. New Dir Youth Dev. 2007;141–54:13.Google Scholar
  28. 28.
    Rhodes SD, Hergenrather KC, Bloom FR, Leichliter JS, Montano J. Outcomes from a community-based, participatory lay health adviser HIV/STD prevention intervention for recently arrived immigrant Latino men in rural North Carolina. AIDS Educ Prev. 2009;21:103–8.PubMedCrossRefGoogle Scholar
  29. 29.
    Gray D, Betzel A, Workman L, Roux P. Investigating the benefit of a novel HIV/AIDS information workbook as a teaching aid in a school life-skills program in the Western Cape, South Africa. In: IV SA AIDS Conference. Durban; 2009.Google Scholar
  30. 30.
    Wardell C. Implementation and Evaluation of a Sports-Based HIV/AIDS Prevention Education Program for Preadolescents in St. Lucia: University of Vermont; 2009.Google Scholar
  31. 31.
    Luppe T. Evaluation of the grassroots soccer club HIV/AIDS programme in Musina, South Africa. Johannesburg: University of the Witwatersrand School of Public Health; 2010.Google Scholar
  32. 32.
    Rajan N, Nanda, Franca-Koh, Orleans-Lindsay. Creating a youth “Movement” to combat HIV/AIDS. In: 136th APHA annual meeting, San Diego; 2008.Google Scholar
  33. 33.
    Kim S. The grassroot project. Washington: George Washington School of Public Health and Health Services; 2010.Google Scholar
  34. 34.
    Braunschweig EN, Kaufman ZA, Decelles J, Clark TS, Ross DA. Generation Skillz: development process for a sports-based HIV prevention intervention and preliminary evaluation results. Cape Town:Grassroot Soccer; 2011.Google Scholar
  35. 35.
    Harvey A. Evaluation of the grassroot project: the George Washington University; 2011.Google Scholar
  36. 36.
    Plummer ML, Ross DA, Wight D, et al. “A bit more truthful”: the validity of adolescent sexual behaviour data collected in rural northern Tanzania using five methods. Sex Transm Infect 2004;80 (Suppl 2):ii49–56.Google Scholar

Copyright information

© Springer Science+Business Media New York 2012

Authors and Affiliations

  1. 1.Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical MedicineLondonUK
  2. 2.Wits Reproductive Health and HIV InstituteJohannesburgSouth Africa
  3. 3.Department of Public HealthOxford UniversityOxfordUK

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