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Meta-Analysis
. 2012 Feb 15;2012(2):CD005272.
doi: 10.1002/14651858.CD005272.pub3.

Behavioral interventions to reduce the transmission of HIV infection among sex workers and their clients in low- and middle-income countries

Windy M V Wariki  1 , Erika Ota, Rintaro Mori, Ai Koyanagi, Narumi Hori, Kenji Shibuya
Affiliations
Meta-Analysis

Behavioral interventions to reduce the transmission of HIV infection among sex workers and their clients in low- and middle-income countries

Windy M V Wariki et al. Cochrane Database Syst Rev. .

Abstract

Background: Various interventions have been adopted to reduce HIV transmission among sex workers and their clients but the effectiveness of these strategies has yet to be investigated using meta-analytic techniques.

Objectives: To evaluate the effectiveness of behavioral interventions to reduce the transmission of HIV infection among sex workers and their clients in low- and middle-income countries.

Search methods: The Cochrane Central Register of Controlled Trials (CENTRAL), the Cochrane HIV/AIDS group specialized register, the Cochrane Database of Systematic Reviews, MEDLINE, PsycINFO, Sociological Abstracts, CINAHL, Dissertation Abstract International (DAI), EMBASE, LILACS, BIOSIS, SciSearch, INDMED, Proquest, and various South Asian abstracting databases were included in the database list. The publication sites of the World Health Organization, the US Centers for Disease Control and Prevention, and other international research and non-governmental organizations also appeared in the database list.

Selection criteria: Randomized controlled trials (RCTs) and quasi-RCTs examining the effects on HIV transmission risk of different behavioral interventions or comparing behavioral interventions with no intervention, where described any one of the outcome measures, such as HIV incidence and prevalence, STI incidence and prevalence, change in self-reported of condom use, and other HIV-related outcome.

Data collection and analysis: Two authors independently assessed trials, extracted data and assessed the risk bias. Heterogeneity amongst trials was also tested.

Main results: A total of 13 trials with 8,698 participants were included. Primary outcomes (HIV and STI prevalence and incidence) were reported in seven trials. Of these, HIV incidence was reported in only three trials. After a 6-month follow-up assessment, there was no evidence that social cognitive behavioral intervention was effective in reducing HIV incidence (RR 0.12, 95% CI 0.01 to 2.22). However, there was a reduction in HIV incidence at 3-month follow-up assessment of promotion of female and male condom (RR 0.07, 95% CI 0.00 to 1.38). Social cognitive interventions and promotion of female and male condom use were significantly reduced STIs incidence (RR 0.57, 95% CI 0.34 to 0.96) and (RR 0.63, 95% CI 0.45 to 0.88), respectively. Secondary outcomes were identified in 13 trials. Meta-analyses showed evidence that interventions to promote the use of female and male condoms do reduce non-condom use (RR 0.83, 95% CI 0.65 to 1.05) compared to promotion of male condoms alone, and that social cognitive interventions reduced drug use among sex workers (RR 0.65, 95% CI 0.36 to 1.16) compared to standard care.

Authors' conclusions: Available evidence nevertheless suggests that compared with standard care or no intervention, behavioral interventions are effective in reducing HIV and the incidence of STIs amongst female sex workers (FSWs). Given the benefits of social cognitive theory and the promotion of condom use in reducing HIV/STI and the public health need to control transmission amongst FSWs, there is a clear finding in favour of behavioral interventions. However, it should be recognized that there is a lack of information about most other outcomes and target populations, and that all of the trials were conducted in low- and middle-income countries.

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Conflict of interest statement

We declare that we have no conflict of interest.

Figures

1
1
Study flow diagram.
2
2
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
3
3
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
1.1
1.1. Analysis
Comparison 1 Social cognitive theory versus standard counseling for promotion of condom use, Outcome 1 HIV incidence among FSWs at 6‐month.
1.2
1.2. Analysis
Comparison 1 Social cognitive theory versus standard counseling for promotion of condom use, Outcome 2 STIs incidence among FSWs at 6‐month.
1.3
1.3. Analysis
Comparison 1 Social cognitive theory versus standard counseling for promotion of condom use, Outcome 3 Consistent condom use by FSWs at 6‐month.
1.4
1.4. Analysis
Comparison 1 Social cognitive theory versus standard counseling for promotion of condom use, Outcome 4 Mean number of condom use by FSWs at past month.
1.5
1.5. Analysis
Comparison 1 Social cognitive theory versus standard counseling for promotion of condom use, Outcome 5 Mean number of protected sex among FSWs at 6‐month.
1.6
1.6. Analysis
Comparison 1 Social cognitive theory versus standard counseling for promotion of condom use, Outcome 6 Sexual activity outcomes by FSWs at past month.
1.7
1.7. Analysis
Comparison 1 Social cognitive theory versus standard counseling for promotion of condom use, Outcome 7 Injected drug use among FSWs at 6‐month.
1.8
1.8. Analysis
Comparison 1 Social cognitive theory versus standard counseling for promotion of condom use, Outcome 8 Alcohol use among FSWs at 6‐month.
1.9
1.9. Analysis
Comparison 1 Social cognitive theory versus standard counseling for promotion of condom use, Outcome 9 Drug use among FSWs at 6‐month.
2.1
2.1. Analysis
Comparison 2 Social cognitive theory versus no intervention for promotion of condom use, Outcome 1 Consistent condom use by FSWs.
2.2
2.2. Analysis
Comparison 2 Social cognitive theory versus no intervention for promotion of condom use, Outcome 2 HIV knowledge among FSWs at 6‐month.
2.3
2.3. Analysis
Comparison 2 Social cognitive theory versus no intervention for promotion of condom use, Outcome 3 Psychosocial barriers to condom use among FSWs at 6‐month.
3.1
3.1. Analysis
Comparison 3 Community empowerment versus standard care for promotion of condom use, Outcome 1 STIs prevalence among FSWs at 36‐month.
3.2
3.2. Analysis
Comparison 3 Community empowerment versus standard care for promotion of condom use, Outcome 2 Consistent condom use by FSWs with regular partners.
3.3
3.3. Analysis
Comparison 3 Community empowerment versus standard care for promotion of condom use, Outcome 3 Consistent condom use by FSWs with clients.
3.4
3.4. Analysis
Comparison 3 Community empowerment versus standard care for promotion of condom use, Outcome 4 Change in 100% condom use by FSWs.
3.5
3.5. Analysis
Comparison 3 Community empowerment versus standard care for promotion of condom use, Outcome 5 Change in any condom use by FSWs.
3.6
3.6. Analysis
Comparison 3 Community empowerment versus standard care for promotion of condom use, Outcome 6 HIV knowledge among FSWs.
3.7
3.7. Analysis
Comparison 3 Community empowerment versus standard care for promotion of condom use, Outcome 7 HIV testing by FSWs at 36‐month.
3.8
3.8. Analysis
Comparison 3 Community empowerment versus standard care for promotion of condom use, Outcome 8 Skills of risk and protective factors among FSWs at 16‐month.
4.1
4.1. Analysis
Comparison 4 Microenterprise plus education intervention versus education alone for reducing the number of sex partners, Outcome 1 Consistent condom use by FSWs at 6‐month.
4.2
4.2. Analysis
Comparison 4 Microenterprise plus education intervention versus education alone for reducing the number of sex partners, Outcome 2 Number of FSWs' partners at 6‐month.
5.1
5.1. Analysis
Comparison 5 Peer education versus standard care for promoting HIV testing and condom use, Outcome 1 Mean number of consistent condom use by FSWs at 6‐month.
5.2
5.2. Analysis
Comparison 5 Peer education versus standard care for promoting HIV testing and condom use, Outcome 2 Mean score of HIV knowledge among FSWs at 6‐month.
5.3
5.3. Analysis
Comparison 5 Peer education versus standard care for promoting HIV testing and condom use, Outcome 3 HIV testing by FSWs at 6‐month.
5.4
5.4. Analysis
Comparison 5 Peer education versus standard care for promoting HIV testing and condom use, Outcome 4 AIDS perceived control by FSWs at 6‐month.
5.5
5.5. Analysis
Comparison 5 Peer education versus standard care for promoting HIV testing and condom use, Outcome 5 AIDS perceived severity by FSWs at 6‐month.
6.1
6.1. Analysis
Comparison 6 Peer education plus clinic based counseling versus peer education only for promotion of condom use, Outcome 1 STIs prevalence among FSWs.
6.2
6.2. Analysis
Comparison 6 Peer education plus clinic based counseling versus peer education only for promotion of condom use, Outcome 2 Male condom use with clients.
6.3
6.3. Analysis
Comparison 6 Peer education plus clinic based counseling versus peer education only for promotion of condom use, Outcome 3 Male condom use with non‐paying partners.
6.4
6.4. Analysis
Comparison 6 Peer education plus clinic based counseling versus peer education only for promotion of condom use, Outcome 4 Female condom use by FSWs with clients.
6.5
6.5. Analysis
Comparison 6 Peer education plus clinic based counseling versus peer education only for promotion of condom use, Outcome 5 Male and female condom use with clients.
6.6
6.6. Analysis
Comparison 6 Peer education plus clinic based counseling versus peer education only for promotion of condom use, Outcome 6 Male and female condom use in the last sex with non‐paying partner.
7.1
7.1. Analysis
Comparison 7 Peer education plus manager training versus standard care for promoting HIV testing and condom use, Outcome 1 Mean number of consistent condom use by FSWs at 6‐month.
7.2
7.2. Analysis
Comparison 7 Peer education plus manager training versus standard care for promoting HIV testing and condom use, Outcome 2 Mean score of HIV knowledge among FSWs at 6‐month.
7.3
7.3. Analysis
Comparison 7 Peer education plus manager training versus standard care for promoting HIV testing and condom use, Outcome 3 HIV testing by FSWs at 6‐month.
7.4
7.4. Analysis
Comparison 7 Peer education plus manager training versus standard care for promoting HIV testing and condom use, Outcome 4 AIDS perceived control by FSWs at 6‐month.
7.5
7.5. Analysis
Comparison 7 Peer education plus manager training versus standard care for promoting HIV testing and condom use, Outcome 5 AIDS perceived severity by FSWs at 6‐month.
8.1
8.1. Analysis
Comparison 8 Manager training versus standard care for promoting HIV testing and condom use, Outcome 1 Mean number of consistent condom use by FSWs at 6‐month.
8.2
8.2. Analysis
Comparison 8 Manager training versus standard care for promoting HIV testing and condom use, Outcome 2 Mean score of HIV knowledge among FSWs at 6‐month.
8.3
8.3. Analysis
Comparison 8 Manager training versus standard care for promoting HIV testing and condom use, Outcome 3 HIV testing by FSWs at 6‐month.
8.4
8.4. Analysis
Comparison 8 Manager training versus standard care for promoting HIV testing and condom use, Outcome 4 AIDS perceived control by FSWs at 6‐month.
8.5
8.5. Analysis
Comparison 8 Manager training versus standard care for promoting HIV testing and condom use, Outcome 5 Mean score of perceived themselves at greater risk (by FSWs at 6‐month).
9.1
9.1. Analysis
Comparison 9 Promotion of female and male condom versus promotion of male condom, Outcome 1 HIV incidence among FSWs at 3‐month.
9.2
9.2. Analysis
Comparison 9 Promotion of female and male condom versus promotion of male condom, Outcome 2 STIs incidence among FSWs at 3‐month.
9.3
9.3. Analysis
Comparison 9 Promotion of female and male condom versus promotion of male condom, Outcome 3 Consistent male condom use at 3‐months.
9.4
9.4. Analysis
Comparison 9 Promotion of female and male condom versus promotion of male condom, Outcome 4 Consistent female condom use by FSWs at 3‐month.
9.5
9.5. Analysis
Comparison 9 Promotion of female and male condom versus promotion of male condom, Outcome 5 Consistent female condom use by FSWs at 24‐month.
9.6
9.6. Analysis
Comparison 9 Promotion of female and male condom versus promotion of male condom, Outcome 6 Consistent male condom use at 24‐month.
10.1
10.1. Analysis
Comparison 10 Intensive STI screening versus basic STI screening to control STI, Outcome 1 HIV incidence among FSWs at 6‐month.
10.2
10.2. Analysis
Comparison 10 Intensive STI screening versus basic STI screening to control STI, Outcome 2 STIs prevalence among FSWs at 6‐month.
10.3
10.3. Analysis
Comparison 10 Intensive STI screening versus basic STI screening to control STI, Outcome 3 Consistent condom use by FSWs at 6‐month.
11.1
11.1. Analysis
Comparison 11 VCT versus standard care of STI for increasing condom use, Outcome 1 STIs prevalence among FSWs at 6‐month.
11.2
11.2. Analysis
Comparison 11 VCT versus standard care of STI for increasing condom use, Outcome 2 Consistent condom use by FSWs with clients at 6‐month.
11.3
11.3. Analysis
Comparison 11 VCT versus standard care of STI for increasing condom use, Outcome 3 HIV/STI knowledge among FSWs at 6‐month.
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References

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