The Efficacy of HIV/STI Behavioral Interventions for African American Females in the United States: A Meta-Analysis

• Published in: American journal of public health (1971) Vol. 99; no. 11; pp. 2069 - 2078
• Main Authors: Crepaz, Nicole, Marshall, Khiya J, Aupont, Latrina W, Jacobs, Elizabeth D, Mizuno, Yuko, Kay, Linda S, Jones, Patricia, McCree, Donna Hubbard, O'Leary, Ann
• Format: Journal Article
• Language: English
• Published: Washington, DC Am Public Health Assoc 01.11.2009; American Public Health Association
• Subjects: Acquired immune deficiency syndrome; African Americans; African Americans - psychology; AIDS; Behavior; Biological and medical sciences; Condoms; Epidemiology. Vaccinations; Female; General aspects; Health Education; Health Knowledge, Attitudes, Practice; HIV; HIV Infections - prevention & control; Human immunodeficiency virus; Human viral diseases; Humans; Immunodeficiencies; Immunodeficiencies. Immunoglobulinopathies; Immunopathology; Infectious diseases; Medical sciences; Miscellaneous; Odds Ratio; Public health; Public health. Hygiene; Public health. Hygiene-occupational medicine; Research and Practice; Risk Reduction Behavior; Sexual Behavior; Sexually transmitted diseases; Sexually Transmitted Diseases - prevention & control; Socioeconomic factors; STD; Studies; Systematic review; United States; Viral diseases; Viral diseases of the lymphoid tissue and the blood. Aids; United States; North America; America; Human; Immunopathology; Evaluation; AIDS; Immune deficiency; Metaanalysis; Infection; Sexually transmitted disease; Viral disease; Female; Behavior; Public health; African American
• ISSN: 0090-0036; 1541-0048
• DOI: 10.2105/AJPH.2008.139519

We evaluated the efficacy of HIV behavioral interventions for African American females in the United States, and we identified factors associated with intervention efficacy. We conducted a comprehensive literature review covering studies published from January 1988 to June 2007, which yielded 37 relevant studies. Data were analyzed using mixed-effects models and meta-regression. Overall, behavioral interventions had a significant impact on reductions in HIV-risk sex behaviors (odds ratio [OR] = 0.63; 95% confidence interval [CI] = 0.54, 0.75; n = 11 239; Cochrane Q(32) = 84.73; P < .001) and sexually transmitted infections (STIs; OR = 0.81; 95% CI = 0.67, 0.98; n = 8760; Cochrane Q(16) = 22.77; P = .12). Greater intervention efficacy was observed in studies that specifically targeted African American females used gender- or culture-specific materials, used female deliverers, addressed empowerment issues, provided skills training in condom use and negotiation of safer sex, and used role-playing to teach negotiation skills. Behavioral interventions are efficacious at preventing HIV and STIs among African American females. More research is needed to examine the potential contribution of prevention strategies that attend to community-level and structural-level factors affecting HIV infection and transmission in this population.