Huedo-Medina, T. B., Boynton, M. H., Warren, M. R., LaCroix, J. M., Carey, M. P. and Johnson, B. T. (2010) Efficacy of HIV prevention interventions in Latin American and Caribbean nations, 1995–2008: a meta-analysis. Aids and Behavior, 14(6), pp. 1237–1251Link to Source
The authors included evidence from 37 HIV prevention interventions from 28 studies conducted in Latin America and the Caribbean region.
The authors find that despite heterogeneous results, HIV prevention interventions aimed at reducing sexual risk have significantly increased condom use and HIV-related knowledge, suggesting that HIV prevention interventions could be an appropriate strategy to effectively reduce HIV transmission. The results also suggest that intensive interventions (those with 3 or more hours of intervention content) are particularly effective in high-risk individuals and in countries with lower Human Development Index scores and with less socioeconomic inequality. The authors also conclude that structural factors (setting, culture, etc.) rather than individual factors are key in explaining the effectiveness of HIV prevention interventions.
Variability in these factors across studies explains the heterogeneous results of the review. Overall, the authors highlight the importance of interventions considering culture and addressing socioeconomic barriers to condom use when designing interventions to effectively target HIV transmission. The authors acknowledge the need for more research on the sustainability of interventions and on the impact of HIV prevention interventions on vulnerable groups.
According to the Joint United Nations Programme on HIV/AIDS, almost 1.7 million people in Latin America and Caribbean are HIV positive. In addition to poverty and a lack of education, cultural patterns in this region reinforce the traditional roles of men having unprotected sex with multiple women and of women being submissive as well as family values against condom use and homosexuality. These cultural beliefs complicate the success of sexual health interventions. By addressing sexual behaviour beliefs, HIV behavioural interventions can be effective strategies to target HIV transmission. In this systematic review, the authors explored how the strengths and weaknesses of these programmes can contribute to better informed design of HIV prevention interventions in Latin America, and if other sample or study characteristics contribute to the differences in effectiveness among them.
To synthesise and assess the evidence regarding the effectiveness of HIV prevention interventions in Latin American and Caribbean countries.
The authors included in the review studies assessing the effectiveness of sexual risk reduction interventions in Latin America and the Caribbean focussed on increasing HIV-related knowledge or condom use with some face-to-face interaction on a sexual risk reduction marker. The authors included randomised controlled trials and studies that evaluated success relative to the baseline.
The authors conducted a systematic search in electronic databases, including among others MEDLINE, PsycINFO and AIDSearch. They also searched conference proceedings and checked reference lists for additional studies. They searched for and included studies available by January 2009 written in English, Spanish or Portuguese.
For each included study, two reviewers coded independently information on methodology, sample and intervention characteristics and estimated the effect sizes for each of the outcomes (standardised mean differences for continuous variables and odds ratios). The authors grouped the results by outcome measure (condom use and knowledge about HIV transmission and prevention method) and examined the homogeneity of the effect sizes. The authors also tested for any bias in the distribution of the effect sizes using Begg’s and Egger’s tests. Finally, they synthesised the results using meta-analysis and checked the robustness of the results to the use of different models. The authors also carried out subgroup analysis by region, inequality level and Human Development Index, with the aim of exploring whether the latter factors influence the effectiveness of HIV prevention interventions.
The authors analysed the efficacy of HIV prevention interventions using appropriate methods of statistical analysis. However, the review does not systematically assess risk of bias assessment/ quality of included studies and this is a major limitation. As the review adopts broad inclusion criteria for study design this is a particular concern. This is partially mitigated by analysis assessing if study design has moderating effects on the results, but the lack of transparent reporting of the quality of each study is still a weakness of the review and it is not clear to users what quality of evidence the findings are based on.