Sexual risk reduction for persons living with HIV: research synthesis of randomized controlled trials, 1993 to 2004

Abstract

Objective: To conduct a meta-analytic review of interventions to reduce HIV individuals' sexual risk.

Design: Studies were included if they examined a deliberate sexual risk-reduction strategy in a sample that included HIV participants, used a randomized controlled trial design, measured condom use or number of sexual partners after the intervention, and provided sufficient information to calculate effect size (ES) estimates.

Method: Reports were gathered from computerized databases, by contacting individual researchers, by searching relevant journals and conference proceedings, and by reviewing reference sections of obtained papers. Data from 15 studies (N = 3234 participants) available as of November 30, 2004 were included. ES estimates were standardized mean differences.

Results: Across the studies, intervention participants exhibited lowered sexual risk relative to control participants on condom use (mean ES = 0.16, 95% confidence interval [CI]: 0.08 to 0.25) but not for number of sexual partners (mean ES = -0.01, 95% CI: -0.16 to 0.14). Interventions were more successful at increasing condom use if the sample included fewer men who have sex with men (MSM) or younger participants and when interventions included motivational and skills components.

Conclusions: Behavioral interventions reduced sexual risk especially if they included motivational and skills components. Such interventions have been less effective for older samples, suggesting the need for further refinement to enhance their efficacy. Motivation-and skill-based interventions have not yet been tested with HIV MSM who, in general, seem to have benefited less from extant risk-reduction interventions.

Figure 1

Selection process of study inclusion in the meta-analysis

Figure 2

Forest plots of effect sizes for interventions that assessed condom use (top, A) or number of partners (bottom, B). The delta symbol for each effect size is sized proportionally to its weight in the analyses. The confidence interval for each effect size is indicated by its line and for the mean by the width of its diamond. Zero values indicate exactly no difference between the two groups. Effect sizes that significantly favor the intervention appear in green (right side); those that favor the control group appear in red (left side).