AIDS and Behavior

, Volume 17, Issue 6, pp 1963–1978 | Cite as

An International Systematic Review and Meta-analysis of Multisession Psychosocial Interventions Compared with Educational or Minimal Interventions on the HIV Sex Risk Behaviors of People Who Use Drugs

  • Nicholas Meader
  • Salaam Semaan
  • Marie Halton
  • Henna Bhatti
  • Melissa Chan
  • Alexis Llewellyn
  • Don C. Des Jarlais
Substantive Review


This systematic review and meta-analysis examines the effectiveness of multisession psychosocial interventions compared with educational interventions and minimal interventions in reducing sexual risk in people who use drugs (51 studies; 19,209 participants). We conducted comprehensive searches (MEDLINE, EMBASE, CINAHL, Cochrane Central Register of Controlled Trials and PsychINFO 1998–2012). Outcomes (unprotected sex, condom use, or a composite outcome) were extracted by two authors and synthesised using meta-analysis. Subgroup analyses and meta-regression were conducted to explore heterogeneity. Multisession psychosocial interventions had modest additional benefits compared to educational interventions (K = 46; OR 0.86; 95 % CI 0.77, 0.96), and large positive effects compared to minimal interventions (K = 7; OR 0.60; 95 % CI 0.46, 0.78). Comparison with previous meta-analyses suggested limited progress in recent years in developing more effective interventions. Multisession psychosocial and educational interventions provided similar modest sexual risk reduction justifying offering educational interventions in settings with limited exposure to sexual risk reduction interventions, messages, and resources.


HIV/AIDS prevention People who use drugs Harm reduction Meta-analysis Sexual risk behavior 



The findings and conclusions in this paper are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention. Don Des Jarlais was supported in part by Grant R01 AI 083035 from the US National Institutes of Health. No conflicts of interest were declared by any authors.

Supplementary material

10461_2012_403_MOESM1_ESM.doc (66 kb)
Supplementary material 1 (DOC 67 kb)
10461_2012_403_MOESM2_ESM.doc (230 kb)
Supplementary material 2 (DOC 230 kb)


  1. 1.
    Mathers BM, Degenhardt L, Phillips B, et al. Global epidemiology of injecting drug use and HIV among people who inject drugs: a systematic review. Lancet. 2008;372:1733–45.PubMedCrossRefGoogle Scholar
  2. 2.
    Go VF, Frankakis C, Le Nam V, et al. High HIV sexual risk behaviors and sexually transmitted disease prevalence among injection drug users in Northern Vietnam: implications for a generalized HIV epidemic. J Acquir Immune Defic Syndr. 2006;42:108–15.PubMedCrossRefGoogle Scholar
  3. 3.
    Des Jarlais DC, Feelemyer JP, Modi SN, et al. Transitions from injection-drug-use-concentrated to self-sustaining heterosexual HIV epidemics: patterns in the international data. PLoS One. 2012;7(3):e31227.Google Scholar
  4. 4.
    Des Jarlais DC, Arasteh,K, McKnigh, C, Hagan H, Perlman DC, Semaan S. Associations between herpes simplex virus type 2 and HCV with HIV among injecting drug users in New York City: the current importance of sexual transmission of HIV. Am J Public Health 2011;101:1277–1283.Google Scholar
  5. 5.
    Des Jarlais DC, Arasteh,K, McKnigh, C, Hagan H, Perlman D, Friedman SR. Using hepatitis C virus and herpes simplex virus-2 to track HIV among injecting drug users in New York City. Drug Alcohol Depend. 2009;101(1–2):88–91.Google Scholar
  6. 6.
    Strathdee SA, Sherman SG. The role of sexual transmission of HIV infection among injection and non-injection drug users. J Urban Health. 2003; 80(4): iii7–iii14.Google Scholar
  7. 7.
    Deiss RG, Lozada RM, Burgos JL, et al. HIV prevalence and sexual risk behaviour among non-injection drug users in Tijuana, Mexico. Global Public Health. 2012;7:175–83.PubMedCrossRefGoogle Scholar
  8. 8.
    Des Jarlais DC, Semaan S, Arasteh A. AT 30 years: HIV/AIDS and other STDs among persons who use psychoactive drugs. In: Hall BJ, Hall JC, Cockerell CJ, (eds) HIV/AIDS in the post-HAART era: manifestations, treatment, and epidemiology. Shelton, CT: People’s Medical Publishing House; 2011.Google Scholar
  9. 9.
    Semaan S, Steele B, Des Jarlais DC, Malow R. Methamphetamine use and HIV risk behaviors among heterosexual adolescents and adults in the United States. XVI International AIDS Conference; August 13–18; Toronto; 2006.Google Scholar
  10. 10.
    Des Jarlais DC, Arasteh K, Perlis T et al. Convergence of HIV seroprevalence among injecting and non-injecting drug users in New York City. AIDS. 2007; 21(2):231–235.Google Scholar
  11. 11.
    Semaan S, Des Jarlais DC, Sogolow E, Johnson WD, Hedges LV, Ramirez G. A meta-analysis of the effect of HIV prevention interventions on the sex behaviors of drug users in the United States. J Acquir Immune Defic Syndr. 2002;30(Suppl 1):S73–93.PubMedGoogle Scholar
  12. 12.
    Des Jarlais DC, Semaan S. Interventions to reduce the sexual risk behaviour of injecting drug users. Int J Drug Policy 2008;16S: S58–S66.Google Scholar
  13. 13.
    Semaan S, Des Jarlais DC, Malow R. Behavior change and health-related interventions for heterosexual risk reduction among drug users. Subst Use Misuse. 2006;41:1349–78.PubMedCrossRefGoogle Scholar
  14. 14.
    Abell-Ollo K, Rahu M, Rajaleid K, et al. Knowledge of HIV serostatus and risk behaviour among injecting drug users in Estonia. AIDS Care: Psychol Socio-Med Aspects of AIDS/HIV. 2009;21:851–7.Google Scholar
  15. 15.
    Meader N, Li R, Des Jarlais DC, Pilling S. Psychosocial interventions for reducing injection and sexual risk behaviour for preventing HIV in drug users. Cochrane Database for Systematic Reviews 2010; Issue 1: CD007195.Google Scholar
  16. 16.
    Des Jarlais D C, Semaan S. HIV and other sexually transmitted infections in injection drug users and crack cocaine smokers. In: Holmes KK, Sparling PF, Stamm WE, Piot P, Wasserheit JN, Corey L, Cohen L, Watts DH, editors. Sexually transmitted diseases. 4th ed. New York: Mc-Graw-Hill; 2008.Google Scholar
  17. 17.
    Moher D, Liberati A, Tetzlaff J, Altman DG, The PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;6(6):e1000097. doi: 10.1371/journal.pmed1000097.Google Scholar
  18. 18.
    National Institute of Health and Clinical Excellence. Guideline development methods. London: NICE; 2008.Google Scholar
  19. 19.
    Guyatt GH, Oxman AD, Vist GE. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ. 2008;336:924–6.PubMedCrossRefGoogle Scholar
  20. 20.
    Johnson WD, Semaan S, Hedges LV. A protocol for the analytical aspects of a systematic review of HIV prevention research. J Acquir Immune Defic Syndr 2002;30 (suppl 1):S62–72.Google Scholar
  21. 21.
    Cochrane Collaboration. Cochrane handbook for systematic reviews of interventions. Oxford: Cochrane Collaboration; 2009.Google Scholar
  22. 22.
    Cochrane Collaboration, Review Manager 5. Accessed 17th January 2011.
  23. 23.
    Hedges LV. Distribution theory for Glass’s estimator of effect size and related estimators. J Educ Stat. 1981;6:107–28.CrossRefGoogle Scholar
  24. 24.
    Lipsey MW, Wilson DB. Practical meta-analysis. Thousand Oaks: Sage; 2001.Google Scholar
  25. 25.
    Sanchez-Meca J, Marin-Martinez F, Chacon-Moscoso S. Effect-size indices for dichotomized outcomes in meta-analysis. Psychol Methods. 2003;8(4):448–67.PubMedCrossRefGoogle Scholar
  26. 26.
    Higgins JP, Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med. 2002;21:1539–58.PubMedCrossRefGoogle Scholar
  27. 27.
    Huedo-Medina TB, Sanchez-Meca J, Marin-Martinez F, Botella J. Assessing heterogeneity in meta-analysis: Q statistic or I2 index? Psychol Methods. 2006;11(2):193–206.PubMedCrossRefGoogle Scholar
  28. 28.
    Egger M, Smith GD, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. BMJ. 1997;315:629–34.PubMedCrossRefGoogle Scholar
  29. 29.
    StataCorp, Stata version 10. Texas: StataCorp; 2008Google Scholar
  30. 30.
    Scott-Sheldon LA, Huedo-Medina TB, Warren MR, Johnson BT, Carey MP. Efficacy of behavioral interventions to increase condom use and reduce sexually transmitted infections: a meta-analysis, 1991 to 2010. J Acquir Immune Defic Syndr. 2011;58(5):489–98.PubMedCrossRefGoogle Scholar
  31. 31.
    Johnson BT, Scott-Sheldon LA, 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.PubMedCrossRefGoogle Scholar
  32. 32.
    Abraham C, Michie S. A taxonomy of behavior change techniques used in interventions. Health Psychol. 2008;27(3):379–87.PubMedCrossRefGoogle Scholar
  33. 33.
    Michie S, Prestwick A. Are interventions theory-based? Development of a theory coding scheme. Health Psychol. 2010;29:1–8.PubMedCrossRefGoogle Scholar
  34. 34.
    Higgins JP, Thompson SG. Controlling the risk of spurious findings from meta-regression. Stat Med. 2004;23:1663–82.PubMedCrossRefGoogle Scholar
  35. 35.
    Magura S, Kang S, Shapiro JL. Outcomes of intensive AIDS education for male adolescent drug users in jail. J Adolesc Health. 1994;15:457–63.PubMedCrossRefGoogle Scholar
  36. 36.
    Copenhaver MM, Johnson BT, Lee I-C, Harman JJ, Carey MP. Behavioral HIV risk reduction among people who inject drugs: Meta-analytic evidence of efficacy. J Subst Abuse Treat. 2006;31:163–71.PubMedCrossRefGoogle Scholar
  37. 37.
    Eaton LA, Huedo-Medina TB, Kalichman SC, et al. Meta-analysis of single-session behavioral interventions to prevent sexually transmitted infections: implications for bundling prevention packages. Am J Public Health. 2012;102:e34–44.PubMedCrossRefGoogle Scholar
  38. 38.
    Pinkerton SD, Holtgrave DR, DiFranceisco WJ, Semaan S, Coyle SL, Johnson-Masotti AP. Cost-Threshold analyses of the national AIDS demonstration research HIV prevention interventions. AIDS. 2000;14:1257–68.PubMedCrossRefGoogle Scholar
  39. 39.
    Centers for Disease Control and Prevention. A Public health approach for advancing sexual health in the United States: Rationale and options for implementation. Meeting Report of an extramural consultation, Atlanta, GA. CDC, December 2010.Google Scholar
  40. 40.
    World Health Organization. Developing sexual health programs. Accessed 10 May, 2012.
  41. 41.
    Semaan S, Neumann MS, Hutchins K, D’Anna LH, Kamb ML. Brief counseling for reducing sexual risk and bacterial STIs among drug users: results from project respect. Drug Alcohol Depend. 2010;106:7–15.PubMedCrossRefGoogle Scholar
  42. 42.
    Strathdee SA, Hallett TB, Bobrova N, et al. HIV and risk environment for injecting drug users: the past, present and future. Lancet. 2010;376:268–84.PubMedCrossRefGoogle Scholar
  43. 43.
    Deren S, Kang S-Y, Mino M, Guarino H. Conducting peer outreach to migrants: outcomes for drug treatment patients. J Immigrant Minority Health. 2012;14:251–8.CrossRefGoogle Scholar
  44. 44.
    Crepaz N, Lyles CM, Wolitski RJ, et al. Do prevention interventions reduce HIV risk behaviours among people living with HIV? A meta-analytic review of controlled trials. AIDS. 2006;20:143–57.PubMedCrossRefGoogle Scholar
  45. 45.
    Metsch LR, Feaster DJ, Gooden L, et al. Implementing rapid HIV testing with or without risk-reduction counselling in drug treatment centers: Results of a randomized trial. Am J Public Health. 2012;102:1160–7.PubMedCrossRefGoogle Scholar
  46. 46.
    Volkow ND, Montaner J. The urgency of providing comprehensive and integrated treatment for substance abusers with HIV. Health Aff. 2011;30:1411–9.CrossRefGoogle Scholar
  47. 47.
    Centers of Disease Control and Prevention. Integrated prevention services for HIV infection, viral hepatitis, sexually transmitted diseases, and tuberculosis for persons who use drugs illicitly: summary guidance from CDC and the U.S. Department of Health and Human Services. Mortality and morbidity weekly reports, recommendation and reports 2012; 61(5):1–47.Google Scholar
  48. 48.
    Copenhaver MM, Lee I-C. Optimizing a community-friendly HIV risk reduction intervention for injection drug users in treatment: a structural equation modeling approach. J Urban Health. 2006;83(6):1132–42.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Nicholas Meader
    • 1
  • Salaam Semaan
    • 2
  • Marie Halton
    • 3
  • Henna Bhatti
    • 3
  • Melissa Chan
    • 5
  • Alexis Llewellyn
    • 1
  • Don C. Des Jarlais
    • 4
  1. 1.Centre for Reviews and DisseminationUniversity of YorkYorkUK
  2. 2.Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB PreventionAtlantaUSA
  3. 3.National Collaborating Centre for Mental Health, Royal College of Psychiatrists Research UnitLondonUK
  4. 4.Beth Israel Medical Center, Baron Edmond de Rothschild Chemical Dependency InstituteNew YorkUSA
  5. 5.University of Hong KongPokfulamHong Kong

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