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Behavior Change Interventions to Prevent HIV Infection among Women Living in Low and Middle Income Countries: A Systematic Review

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Abstract

We conducted a systematic review of behavioral change interventions to prevent the sexual transmission of HIV among women and girls living in low- and middle-income countries. PubMed/MEDLINE, Web of Science, the Cochrane Library, and other databases and bibliographies were systematically searched for trials using randomized or quasi-experimental designs to evaluate behavioral interventions with HIV infection as an outcome. We identified 11 analyses for inclusion reporting on eight unique interventions. Interventions varied widely in intensity, duration, and delivery as well as by target population. Only two analyses showed a significant protective effect on HIV incidence among women and only three of ten analyses that measured behavioral outcomes reduced any measure of HIV-related risk behavior. Ongoing research is needed to determine whether behavior change interventions can be incorporated as independent efficacious components in HIV prevention packages for women or simply as complements to biomedical prevention strategies.

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References

  1. UNAIDS. Report on the Global AIDS Epidemic. Geneva 2008.

  2. Pettifor AE, Rees HV, Kleinschmidt I, et al. Young people’s sexual health in South Africa: HIV prevalence and sexual behaviors from a nationally representative household survey. AIDS. Sep 23 2005;19(14):1525–34.

    Google Scholar 

  3. Krishnan S, Dunbar MS, Minnis AM, Medlin CA, Gerdts CE, Padian NS. Poverty, gender inequities, and women’s risk of human immunodeficiency virus/AIDS. Ann N Y Acad Sci. 2008;1136:101–10.

    Article  PubMed  Google Scholar 

  4. Padian NS, van der Straten A, Ramjee G, et al. Diaphragm and lubricant gel for prevention of HIV acquisition in southern African women: a randomised controlled trial. Lancet. Jul 21 2007;370(9583):251–61.

    Google Scholar 

  5. Skoler-Karpoff S, Ramjee G, Ahmed K, et al. Efficacy of Carraguard for prevention of HIV infection in women in South Africa: a randomised, double-blind, placebo-controlled trial. Lancet. Dec 6 2008;372(9654):1977–87.

    Google Scholar 

  6. Peterson L, Nanda K, Opoku BK, et al. SAVVY (C31G) gel for prevention of HIV infection in women: a Phase 3, double-blind, randomized, placebo-controlled trial in Ghana. PLoS ONE. 2007;2(12):e1312.

    Article  PubMed  Google Scholar 

  7. Halpern V, Ogunsola F, Obunge O, et al. Effectiveness of cellulose sulfate vaginal gel for the prevention of HIV infection: results of a Phase III trial in Nigeria. PLoS ONE. 2008;3(11):e3784.

    Article  PubMed  Google Scholar 

  8. Turner AN, Morrison CS, Padian NS, et al. Men’s circumcision status and women’s risk of HIV acquisition in Zimbabwe and Uganda. AIDS. Aug 20 2007;21(13):1779–89.

    Google Scholar 

  9. Wawer M, Kigozi G, Serwadda D, et al. Trial of male circumcision in HIV + men, Rakai, Uganda: effects in HIV+ men and in women partners. Paper presented at: 15th Conference on Retroviruses and Opportunistic Infections 2008; Boston, MA.

  10. National Institute of Allergy and Infectious Diseases. Workshop Summary: scientific Evidence on Condom Effectiveness for Sexually Transmitted Disease (STD) Prevention 2000.

  11. French PP, Latka M, Gollub EL, Rogers C, Hoover DR, Stein ZA. Use-effectiveness of the female versus male condom in preventing sexually transmitted disease in women. Sex Transm Dis. May 2003;30(5):433–9.

    Google Scholar 

  12. Grosskurth H, Mosha F, Todd J, et al. Impact of improved treatment of sexually transmitted diseases on HIV infection in rural Tanzania: randomised controlled trial. Lancet. Aug 26 1995;346(8974):530–6.

    Google Scholar 

  13. Kiwanuka SN, Ekirapa EK, Peterson S, et al. Access to and utilisation of health services for the poor in Uganda: a systematic review of available evidence. Trans R Soc Trop Med Hyg. Nov 2008;102(11):1067–74.

    Google Scholar 

  14. Kalichman SC. Time to take stock in HIV/AIDS prevention. AIDS Behav. May 2008;12(3):333–4.

    Google Scholar 

  15. Coates TJ, Richter L, Caceres C. Behavioural strategies to reduce HIV transmission: how to make them work better. Lancet. Aug 23 2008;372(9639):669–84.

    Google Scholar 

  16. Herbst JH, Sherba RT, Crepaz N, et al. A meta-analytic review of HIV behavioral interventions for reducing sexual risk behavior of men who have sex with men. J Acquir Immune Defic Syndr. Jun 1 2005;39(2):228–41.

    Google Scholar 

  17. Crepaz N, Horn AK, Rama SM, et al. The efficacy of behavioral interventions in reducing HIV 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. Sex Transm Dis. Jun 2007;34(6):319–32.

    Google Scholar 

  18. Darbes L, Crepaz N, Lyles C, Kennedy G, Rutherford G. The efficacy of behavioral interventions in reducing HIV risk behaviors and incident sexually transmitted diseases in heterosexual African Americans. Aids. Jun 19 2008;22(10):1177–94.

    Google Scholar 

  19. Mullen PD, Ramirez G, Strouse D, Hedges LV, Sogolow E. Meta-analysis of the effects of behavioral HIV prevention interventions on the sexual risk behavior of sexually experienced adolescents in controlled studies in the United States. 302002:S94–105.

  20. 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. Jan 9 2006;20(2):143–57.

    Google Scholar 

  21. Noar SM. Behavioral interventions to reduce HIV-related sexual risk behavior: review and synthesis of meta-analytic evidence. 122008:335–53.

  22. 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. Dec 2004;80 Suppl 2:ii49–56.

    Google Scholar 

  23. Lagarde E, Auvert B, Chege J, et al. Condom use and its association with HIV/sexually transmitted diseases in four urban communities of sub-Saharan Africa. AIDS. Aug 2001;15 Suppl 4:S71–78.

    Google Scholar 

  24. Cowan FM, Langhaug LF, Mashungupa GP, et al. School based HIV prevention in Zimbabwe: feasibility and acceptability of evaluation trials using biological outcomes. AIDS. Aug 16 2002;16(12):1673–8.

    Google Scholar 

  25. Kamb ML, Fishbein M, Douglas JM, Jr., et al. Efficacy of risk-reduction counseling to prevent human immunodeficiency virus and sexually transmitted diseases: a randomized controlled trial. Project RESPECT Study Group. JAMA. Oct 7 1998;280(13):1161–7.

    Google Scholar 

  26. Koblin B, Chesney M, Coates T. Effects of a behavioural intervention to reduce acquisition of HIV infection among men who have sex with men: the EXPLORE randomised controlled study. Lancet. Jul 3–9 2004;364(9428):41–50.

    Google Scholar 

  27. Kamali A, Quigley M, Nakiyingi J, et al. Syndromic management of sexually-transmitted infections and behaviour change interventions on transmission of HIV-1 in rural Uganda: a community randomised trial. Lancet. Feb 22 2003;361(9358):645–52.

    Google Scholar 

  28. 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.

    Article  PubMed  Google Scholar 

  29. Gregson S, Adamson S, Papaya S, et al. Impact and process evaluation of integrated community and clinic-based HIV-1 control: a cluster-randomised trial in eastern Zimbabwe. PLoS Med. Mar 27 2007;4(3):e102.

    Google Scholar 

  30. Pronyk PM, Hargreaves JR, Kim JC, et al. Effect of a structural intervention for the prevention of intimate-partner violence and HIV in rural South Africa: a cluster randomised trial. Lancet. Dec 2 2006;368(9551):1973–83.

    Google Scholar 

  31. The Cochrane Collaboration. Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.1 [updated September 2008]. 2008; Available from www.cochrane-handbook.org.

  32. Pettifor AE, Kleinschmidt I, Levin J, et al. A community-based study to examine the effect of a youth HIV prevention intervention on young people aged 15–24 in South Africa: results of the baseline survey. 102005:971–80.

  33. Efficacy of voluntary HIV-1 counselling and testing in individuals and couples in Kenya, Tanzania, and Trinidad: a randomised trial. The Voluntary HIV-1 Counseling and Testing Efficacy Study Group. Lancet. Jul 8 2000;356(9224):103–12.

  34. Egger M, Smith GD, Altman DG, editors. Systematic reviews in health care: meta-analysis in context. 2nd ed. London: BMJ Publishing Group, BMJ Books; 2001.

    Google Scholar 

  35. Rothman K. Epidemiology, an introduction. New York: Oxford University Press; 2002.

    Google Scholar 

  36. Doyle A, Ross DA, Maganja K, Changalucha J, Hayes R, Team. atMkVT. Long-term impact of a behavioral change intervention on HIV, STI, knowledge, attitudes, and reported sexual behaviors among young people in rural Mwanza, Tanzania: results of a community randomized trial. 16th Conference on Retroviruses and Opportunistic Infections. Montreal, Canada 2009.

  37. Rothman KJ, Greenland S. Modern epidemiology. 2nd ed. Philadelphia: Lippincott Williams & Wilkins; 1998.

    Google Scholar 

  38. 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. Nov 2008;98(11):2051–7.

    Google Scholar 

  39. Archibald CP, Chan RK, Wong ML, Goh A, Goh CL. Evaluation of a safe-sex intervention programme among sex workers in Singapore. Int J STD AIDS. Jul–Aug 1994;5(4):268–72.

    Google Scholar 

  40. Hargreaves JR, Bonell CP, Morison LA, et al. Explaining continued high HIV prevalence in South Africa: socioeconomic factors, HIV incidence and sexual behaviour change among a rural cohort, 2001–2004. AIDS. Nov 2007;21 Suppl 7:S39–48.

    Google Scholar 

  41. Quigley MA, Kamali A, Kinsman J, et al. The impact of attending a behavioural intervention on HIV incidence in Masaka, Uganda. AIDS (London, England). 2004;18(15):2055–63.

    Google Scholar 

  42. 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. Sep 12 2007;21(14):1943–55.

    Google Scholar 

  43. Long-term Evaluation of the MEMA kwa Vijana Adolescent Sexual Health Programme in Rural Mwanza, Tanzania: a Randomised Controlled Trial. Technical Briefing Paper: No. 7 2008; http://www.memakwavijana.org/images/stories/Documents/mkv_technical_brief.pdf. Accessed 18 March 2009.

  44. Bhave G, Lindan CP, Hudes ES, et al. Impact of an intervention on HIV, sexually transmitted diseases, and condom use among sex workers in Bombay, India. Aids. Jul 1995;9 Suppl 1:S21–30.

    Google Scholar 

  45. Matovu JK, Gray RH, Makumbi F, et al. Voluntary HIV counseling and testing acceptance, sexual risk behavior and HIV incidence in Rakai, Uganda. AIDS. Mar 25 2005;19(5):503–11.

    Google Scholar 

  46. Mullen PD, Ramirez G, Strouse D, Hedges LV, Sogolow E. Meta-analysis of the effects of behavioral HIV prevention interventions on the sexual risk behavior of sexually experienced adolescents in controlled studies in the United States. J Acquir Immune Defic Syndr. Jul 2002;30 Suppl:S94–105.

    Google Scholar 

  47. Morris M, Kretzschmar M. Concurrent partnerships and transmission dynamics in networks. Soc Netw. 1995;17:299–318.

    Article  Google Scholar 

  48. Aral SO. Just one more day: the gap as population level determinant and risk factor for STI spread. Sex Transm Dis. May 2008;35(5):445–6.

    Google Scholar 

  49. Chen MI, Ghani AC, Edmunds J. Mind the gap: the role of time between sex with two consecutive partners on the transmission dynamics of gonorrhea. Sex Transm Dis. May 2008;35(5):435–44.

    Google Scholar 

  50. Pinkerton SD, Layde PM, DiFranceisco W, Chesson HW. All STDs are not created equal: an analysis of the differential effects of sexual behaviour changes on different STDs. Int J STD AIDS. May 2003;14(5):320–8.

    Google Scholar 

  51. Powers KA, Poole C, Pettifor AE, Cohen MS. Rethinking the heterosexual infectivity of HIV-1: a systematic review and meta-analysis. Lancet Infect Dis. Sep 2008;8(9):553–63.

    Google Scholar 

  52. Pequegnat W, NIMH Collaborative HIV/STD Prevention Trial Group. Results of the RCT to Test the Community Popular Opinion Leader (C-POL) Intervention in Five Countries. Paper presented at: XVII International AIDS Conference 2008; Mexico City.

  53. Khumalo-Sakutukwa G, Morin SF, Fritz K, et al. Project Accept (HPTN 043): a community-based intervention to reduce HIV incidence in populations at risk for HIV in sub-Saharan Africa and Thailand. J Acquir Immune Defic Syndr. Dec 1 2008;49(4):422–31.

    Google Scholar 

  54. Cowan FM, Pascoe SJ, Langhaug LF, et al. The Regai Dzive Shiri Project: a cluster randomised controlled trial to determine the effectiveness of a multi-component community-based HIV prevention intervention for rural youth in Zimbabwe-study design and baseline results. Trop Med Int Health. Oct 2008;13(10):1235–44.

  55. Cowan F. Results of the Regai Dzive Shiri Project: Personal Communication.; May 2009.

  56. Cates W, Jr., Hinman AR. AIDS and absolutism—the demand for perfection in prevention. N Engl J Med. Aug 13 1992;327(7):492–4.

    Google Scholar 

  57. UNAIDS. Practical Guidelines for Intensifying HIV Prevention: Towards Universal Access. Geneva 2007.

  58. Piot P, Bartos M, Larson H, Zewdie D, Mane P. Coming to terms with complexity: a call to action for HIV prevention. Lancet. Sep 6 2008;372(9641):845–59.

    Google Scholar 

  59. Merson M, Padian N, Coates TJ, et al. Combination HIV prevention. Lancet. Nov 22 2008;372(9652):1805–6.

    Google Scholar 

  60. Eaton LA, Kalichman S. Risk compensation in HIV prevention: implications for vaccines, microbicides, and other biomedical HIV prevention technologies. Curr HIV/AIDS Rep. Dec 2007;4(4):165–72.

    Google Scholar 

  61. Rural AIDS and Development Action Research Programme. Social interventions for HIV/AIDS, intervention with microfinance for AIDS and gender equity. IMAGE Study Monograph No 2: Intervention 2002; http://web.wits.ac.za/NR/rdonlyres/3C2A3B30-DE20-40E0-8A0A-A14C98D0AB38/0/Intervention_monograph_picspdf.pdf. Accessed 18 March 2009.

  62. Obasi AI, Cleophas B, Ross DA, et al. Rationale and design of the MEMA kwa Vijana adolescent sexual and reproductive health intervention in Mwanza Region, Tanzania. AIDS Care. May 2006;18(4):311–22.

    Google Scholar 

  63. Jewkes R, Nduna M, Levin J, et al. A cluster randomized-controlled trial to determine the effectiveness of Stepping Stones in preventing HIV infections and promoting safer sexual behaviour amongst youth in the rural Eastern Cape, South Africa: trial design, methods and baseline findings. Trop Med Int Health. Jan 2006;11(1):3–16.

    Google Scholar 

  64. Patterson TL, Orozovich P, Semple SJ, et al. A sexual risk reduction intervention for female sex workers in Mexico: design and baseline characteristics. J HIV AIDS Soc Serv. 2006;5(2):115–37.

    Google Scholar 

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Acknowledgments

This work was supported by the International Initiative for Impact Evaluation (3ie). We are grateful to Dr. Temina Madon for helpful comments on the manuscript and Dr. Nick Jewell for statistical advice.

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Authors and Affiliations

  1. Women’s Global Health Imperative, RTI International, 114 Sansome Street, Suite 500, San Francisco, CA, 94104, USA

    Sandra I. McCoy & Nancy S. Padian

  2. Faculty of Health Sciences, Africa University, Mutare, Zimbabwe

    Rugare A. Kangwende

  3. Department of Epidemiology, University of California, Berkeley, CA, USA

    Nancy S. Padian

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  1. Sandra I. McCoy
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  2. Rugare A. Kangwende
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  3. Nancy S. Padian
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Correspondence to Sandra I. McCoy.

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McCoy, S.I., Kangwende, R.A. & Padian, N.S. Behavior Change Interventions to Prevent HIV Infection among Women Living in Low and Middle Income Countries: A Systematic Review. AIDS Behav 14, 469–482 (2010). https://doi.org/10.1007/s10461-009-9644-9

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