Abstract

Efficacy of interventions with behavioral components for HIV prevention in Latin American nations: a meta-analysis

T.B. Huedo-Medina¹, M.H. Boynton¹, J.M. LaCroix¹, M.R. Warren¹, M.P. Carey², B.T. Johnson<sup>1

1</sup>University of Connecticut, Center for Health, Intervention, and Prevention, Storrs, United States, ²Syracuse University, Center for Health and Behavior, Syracuse, United States

Background: An estimated 1.7 million people were HIV-positive across Latin American and Caribbean nations (LACNs) in 2007, of which 140,000 were newly infected. Recently a critical mass of HIV prevention intervention work has appeared; prior reviews have noted that these trials' results vary widely. The current work is the first to examine the efficacy of HIV/AIDS interventions targeting people living in LACNs.
Methods: Employed were a wide variety of systematic search strategies of both English and Spanish electronic databases for eligible publications. Qualifying studies
(a) examined risk-reduction interventions in Africa that focused on increasing HIV-related knowledge or condom use with some face-to-face interaction,
(b) compared a risk-reduction marker (i.e., condom use, number of partners, HIV/STD prevalence or HIV knowledge) against a control or a baseline, and
(c) presented information needed for effect size (ES) calculation.
Excluded were studies that focused on perinatal transmission contexts or behaviors. Intervention efficacy was analyzed in terms of increased HIV/AIDS knowledge and condom use. Analyses examined how effect sizes from 33 interventions (derived from 26 studies involving 34,597 participants) related to coded study, structural-level, sample, and intervention characteristics.
Results: The interventions increased both knowledge and condom use but with varying success. For condom use, interventions that matched the culture of the sample were more successful and intensive interventions (≥ 3 hours of content) succeeded better when Human Development Index values and income inequality (Gini coefficient) was lower, and when they were conducted in Mexico or the Caribbean.
Conclusions: These patterns reveal that HIV prevention activities succeed best in LACNs where the need is greatest. An implication is that HIV interventionists should integrate components of evidence-based economic interventions. The current results do not suggest optimal intervention length; this and other limitations are discussed.
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