A Systematic Review and Meta-Analysis of Behavioral Interventions to Reduce HIV Risk Behaviors of Hispanics in the United States and Puerto Rico

Abstract

This systematic review examines the overall efficacy of HIV behavioral interventions designed to reduce HIV risk behaviors or incident sexually transmitted diseases (STDs) among Hispanics residing in the United States or Puerto Rico. Data from 20 randomized and nonrandomized trials (N = 6,173 participants) available through January 2006 were included in this review. Interventions successfully reduced the odds of unprotected sex and number of sex partners, increased the odds of condom use, and decreased the odds of acquiring new STD infections. Interventions successful in reducing the odds of any sex risk behavior used non-peer deliverers; included >or=4 intervention sessions; taught condom use or problem solving skills; or addressed barriers to condom use, sexual abstinence, or peer norms. Interventions that included the Hispanic cultural belief of machismo or those developed based on ethnographic interviews were successful in reducing the odds of sex risk behaviors among non-drug users. Interventions targeting injection drug users (IDUs; N = 3,569) significantly reduced the odds of injection drug use and the odds of sharing cotton or cookers, but did not significantly reduce the odds of engaging in risky sex behavior or needle sharing. Further development of culturally appropriate HIV prevention interventions for Hispanic populations, particularly men and persons living with HIV, are warranted.

HIV Prevention Interventions to Reduce Racial Disparities in the United States: A Systematic Review

“…12 Herbst's meta-analysis of 20 interventions among Latinos found significantly greater efficacy associated with interventions that included problem-solving skills coaching, that did not use peers, and that addressed the influences of machismo. 13 We extend the results of previous reviews by including a number of articles published in the last few years; the 2007 review by Crepaz et al only includes articles published through June 2005, 10 while our review includes 18 articles published since, including six interventions targeting adolescents, four targeting STD clinic patients, and the only two interventions identified in our review targeting high-risk men. Also, 10 of the studies in our review describe interventions not tested in random-ized control trials.…”

“…13,14 However, none of the studies included in these prior reviews directly manipulated the number of sessions as part of the trial. We identified two studies that directly examined number of sessions; one found no difference in intervention effects across groups assigned to two versus four sessions, 37 and the other found that patients randomized to an eight-session intervention had significantly better outcomes than zero-session controls, while those assigned a four-session intervention did not.…”

“…Future intervention evaluations should attempt to estimate the expected cost of implementation in order to facilitate costeffectiveness comparisons between HIV prevention interventions for community providers, a point which has been made by authors of previous meta-analyses in this field. 13 In an era of shrinking public health budgets, 51 digital interventions can be expected to be a growing area of interest as a method of inexpensively promoting HIV prevention.…”

“…According to our modified DB scoring system, the quality of the 76 intervention studies ranged from 15 to 29 with a mean of 22.44. Following a previously published DB rating system, 19 sixty-three (83 %) of the studies were rated as very good (>20), 12 (16 %) as good (16)(17)(18)(19), and only 1 (1 %) as fair (11)(12)(13)(14)(15); no study was rated poor (≤10). In linear regression analysis, a borderline significant linear trend of increasing quality over time was observed (r=0.11; p=0.075).…”

“…trials. [10][11][12][13][14] This review builds upon previous work by including interventions targeting a range of at-risk minorities as well as those evaluated in non-randomized trials, using a standardized metric to assess the quality of each study. Further, our review differs by limiting to interventions conducted directly within or linked to a clinical setting.…”