title: Behavioral interventions to promote condom use among women living with HIV.
abstract: BACKGROUND
  High rates of HIV infection among women of reproductive age have dramatic consequences for personal and public health. Prophylaxis during sexual intercourse in the form of condoms has been the most effective way to prevent both STI and HIV transmission among people living with HIV.
  
  
  OBJECTIVE
  To investigate the effectiveness of behavioral interventions in promoting condom use among women living with HIV.
  
  
  METHODS
  We conducted a comprehensive literature search in several scientific databases, clinical trials databases, conference proceedings, and conference websites to identify studies produced between 1980 and May 2010 that met our selection criteria.
  
  
  METHODS
  Studies were included in the analysis if they conducted a randomized controlled trial that examined the effects of behavioral interventions on condom use among HIV-positive women; considered at least one HIV-related behavioral outcome (e.g., reported protected anal, vaginal, or oral sex) or biological outcome (e.g., acquisition of STIs); and one follow-up assessment three months or more after the intervention. Studies were assessed irregardless of langauge or publication status.
  
  
  METHODS
  We used random effects models to summarize odds ratios (ORs) that compared intervention and control groups with respect to a dichotomous outcome (consistent versus inconsistent condom use). We used funnel plots to examine publication bias and a χ(2) statistic to test for heterogeneity. The methodological and evidence quality was evaluated through risk of bias criteria and the GRADE system, respectively.
  
  
  RESULTS
  Five primary studies that collectively researched a total of 725 women living with HIV were analysed. When compared to standard care or minimal HIV support intervention, meta-analysis showed that behavioral interventions had no effect on increasing condom use among HIV-positive women. This finding was consistent at various follow-up meetings (3, 6, and 12-months) as well as over the entire 12-month follow-up period (OR= 0.82; 95% CI 0.65-1.04; p=0.11). Only one study presented adequate data to analyze the relationship between behavioral interventions and STI incidence. Studies included in this analysis demonstrated low risk of bias based on the risk of bias criteria. However, sample size was considered inadequate across all studies.
  
  
  CONCLUSIONS
  Meta-analysis shows that behavioral interventions have little effect on increasing condom use among HIV-positive women. However, these findings should be used with caution since results were based on a few small trials that were targeted specifically towards HIV-positive women. To decrease sexual transmission of HIV among this population, we recommend interventions that combine condom promotion, family planning provision and counselling, and efforts to reduce viral loads among HIV-positive women and their partners (e.g., HAART treatment provision). New research is needed to address the needs of HIV-positive women, including an assessment of the impact of interventions that combine safer sexual behavior and harm reduction approaches.
authors: Centro de Estudos de Aids / DST do Rio Grande do Sul (CEARGS), Rua Demétrio Ribeiro, 55/04, Centro, Porto Alegre, RS, Brazil, CEP 90.010-312.
authors: Fernanda T
authors: FT
authors: Carvalho
authors: Tonantzin R
authors: TR
authors: Gonçalves
authors: Evelise R
authors: ER
authors: Faria
authors: Jean A
authors: JA
authors: Shoveller
authors: C A
authors: CA
authors: Piccinini
authors: Mauro C
authors: MC
authors: Ramos
authors: Lídia Rf
authors: LR
authors: Medeiros
mesh_terms: D000328:Adult; D017280:Condoms / Q000706:statistics & numerical data*; D005260:Female; D015658:HIV Infections / Q000517:prevention & control* / Q000635:transmission; D006679:HIV Seropositivity / Q000523:psychology; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D040242:Risk Reduction Behavior; D012749:Sexually Transmitted Diseases / Q000517:prevention & control / Q000635:transmission; D059039:Standard of Care