Psychosocial interventions for reducing injection and sexual risk behaviour for preventing HIV in drug users.
BACKGROUND
Drug users (including both injection drug users and crack cocaine users), are at high levels of risk for contracting HIV. Therefore it is important to reduce the injection and/or sexual risk behaviours of these groups both for the benefit of themselves and for society as a whole.


OBJECTIVE
To assess the efficacy of multi-session psychosocial interventions in comparison with standard education and minimal intervention controls for the reduction of injection and sexual risk behaviour.


METHODS
Electronic searches were conducted of a number of bibliographic databases (including Cochrane Library, CINAHL, MEDLINE, PsycINFO). In addition, other methods of locating papers were employed including contacting various authors working in the field of HIV risk reduction and examining reference lists of applicable papers identified in the electronic search.


METHODS
The inclusion criteria consisted of randomised and quazi-randomised trials assessing the efficacy of psychosocial interventions in the reduction of injection and sexual risk behaviour for people who misused opiates, cocaine, or a combination of these drugs.


METHODS
Two authors independently assessed the eligibility of studies identified by the search strategy, quality assessed these studies and extracted the data. A total of 35 trials met the eligibility criteria of the review providing data on 11,867 participants.


RESULTS
There were minimal differences identified between multi-session psychosocial interventions and standard educational interventions for both injection and sexual risk behaviour. Although it should be noted there were large pre-post changes for both groups suggesting both were effective in reducing risk behaviours. In addition, there was some evidence of benefit for multi-session psychosocial interventions when compared with minimal controls. Subgroup analyses suggest that people in formal treatment are likely to respond to multi-session psychosocial interventions. It also appears single-gender groups may be associated with greater benefit.


CONCLUSIONS
There is limited support for the widespread use of formal multi-session psychosocial interventions for reducing injection and sexual risk behaviour. Brief standard education interventions appear to be a more cost-effective option. Further research is required to assess if there are particular groups of drug users more likely to respond to such interventions.
Meader
Nicholas
N
National Collaborating Centre for Mental Health, Royal College of Psychiatrists Research and Training Unit, University College, London, Standon House, 4th Floor, 21 Mansell Street, London, UK, E1 8AA.
Li
Ryan
R
Des Jarlais
Don C
DC
Pilling
Stephen
S
D055030:Drug Users; D015658:HIV Infections / Q000517:prevention & control* / Q000635:transmission; D006801:Humans; D011613:Psychotherapy / Q000379:methods*; D016032:Randomized Controlled Trials as Topic; D040242:Risk Reduction Behavior; D012309:Risk-Taking; D015819:Substance Abuse, Intravenous / Q000517:prevention & control* / Q000523:psychology; D047568:Unsafe Sex / Q000517:prevention & control*