title: Do prevention interventions reduce HIV risk behaviours among people living with HIV? A meta-analytic review of controlled trials.
abstract: OBJECTIVE
  To conduct a meta-analytic review of HIV interventions for people living with HIV (PLWH) to determine their overall efficacy in reducing HIV risk behaviours and identify intervention characteristics associated with efficacy.
  
  
  METHODS
  Comprehensive searches included electronic databases from 1988 to 2004, hand searches of journals, reference lists of articles, and contacts with researchers. Twelve trials met the stringent selection criteria: randomization or assignment with minimal bias, use of statistical analysis, and assessment of HIV-related behavioural or biologic outcomes at least 3 months after the intervention. Random-effects models were used to aggregate data.
  
  
  RESULTS
  Interventions significantly reduced unprotected sex [odds ratio (OR), 0.57; 95% confidence interval (CI) 0.40-0.82] and decreased acquisition of sexually transmitted diseases (OR, 0.20; 95% CI, 0.05-0.73). Non-significant intervention effects were observed for needle sharing (OR, 0.47, 95% CI, 0.13-1.71). As a whole, interventions with the following characteristics significantly reduced sexual risk behaviours: (1) based on behavioural theory; (2) designed to change specifically HIV transmission risk behaviours; (3) delivered by health-care providers or counsellors; (4) delivered to individuals; (5) delivered in an intensive manner; (6) delivered in settings where PLWH receive routine services or medical care; (7) provided skills building, or (8) addressed a myriad of issues related to mental health, medication adherence, and HIV risk behaviour.
  
  
  CONCLUSIONS
  Interventions targeting PWLH are efficacious in reducing unprotected sex and acquisition of sexually transmitted diseases. Efficacious strategies identified in this review should be incorporated into community HIV prevention efforts and further evaluated for effectiveness.
authors.forename: Nicole
authors.initials: N
authors.lastname: Crepaz
authors.forename: Cynthia M
authors.initials: CM
authors.lastname: Lyles
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Wolitski
authors.forename: Warren F
authors.initials: WF
authors.lastname: Passin
authors.forename: Sima M
authors.initials: SM
authors.lastname: Rama
authors.forename: Jeffrey H
authors.initials: JH
authors.lastname: Herbst
authors.forename: David W
authors.initials: DW
authors.lastname: Purcell
authors.forename: Robert M
authors.initials: RM
authors.lastname: Malow
authors.forename: Ron
authors.initials: R
authors.lastname: Stall
mesh_terms: D000328:Adult; D018849:Controlled Clinical Trials as Topic; D005260:Female; D015658:HIV Infections / Q000517:prevention & control* / Q000523:psychology / Q000635:transmission; D006801:Humans; D008297:Male; D012309:Risk-Taking; D021841:Safe Sex / Q000706:statistics & numerical data; D012725:Sexual Behavior