Context African-Americans constitute 13% of the U.S. population yet account for nearly 50% of new HIV infections. Implementation of efficacious behavioral interventions can help reduce infections in this vulnerable population. Objective To examine the efficacy of behavioral interventions to reduce HIV for African-Americans among 78 randomized controlled trials that sampled at least 50% African-Americans (N = 48,585, 81% African-American), measured condom use or number of sexual partners, and provided sufficient information to calculate effect sizes. Methods Independent raters coded participant characteristics, design and methodological features, and intervention content. Weighted mean effect sizes, using both fixed- and random-effects models, were calculated; positive effect sizes indicated more condom use and fewer sexual partners. Results Compared to controls, participants who received a HIV risk reduction intervention improved condom use at short-, intermediate-, and long-term assessments; change was better among MSM and people already infected with HIV, and when interventions provided intensive content across multiple sessions. Intervention participants reduced their number of sexual partners in interventions with intensive interpersonal skills training and in younger samples, especially at delayed intervals. Conclusions Sexual risk reduction interventions for African-Americans increased condom use without increasing the number of sexual partners. Translating these interventions and further enhancing them continue as a high priority.

A meta-analytic review of the influence of HIV risk reduction interventions on sexual occasions, number of partners, and abstinence was conducted to assess whether condom-related interventions inadvertently undermine sexual risk reduction efforts by increasing the frequency of sexual behavior. Included studies examined sexual risk reduction strategies and used a controlled design. Data from 174 studies (206 interventions, N = 116,735 participants) were included. In general, HIV risk reduction interventions neither increased nor decreased sexual occasions or number of partners reported. Participants in intervention conditions were less likely to be sexually active than those in control conditions. When samples included more black participants, interventions reduced the number of sexual occasions; interventions were more successful at reducing the number of partners in samples that included more men who have sex with men (MSM) or individuals engaged in sex trading. Samples that included more MSM were more likely to adopt abstinence as a risk reduction strategy. Interventions that included more information, motivational enhancement, and skills training also led to greater risk reduction. HIV risk reduction interventions do not increase the overall frequency of sexual activity. To the contrary, for some subgroups, interventions that include components recommended by behavioral science theory reduce the frequency of sexual events and partners.

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Using virtual reality (VR) to examine risky behavior that is mediated by interpersonal contact, such as agreeing to have sex, drink, or smoke with someone, offers particular promise and challenges. Social contextual stimuli that might trigger impulsive responses can be carefully controlled in virtual environments (VE), and yet manipulations of risk might be implausible to participants if they do not feel sufficiently immersed in the environment. The current study examined whether individuals can display adequate evidence of presence in a VE that involved potential interpersonally-induced risk: meeting a potential dating partner. Results offered some evidence for the potential of VR for the study of such interpersonal risk situations. Participants' reaction to the scenario and risk-associated responses to the situation suggested that the embodied nature of virtual reality override the reality of the risk's impossibility, allowing participants to experience adequate situational embedding, or presence.

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