title: Interventions to reduce risky sexual behaviour for preventing HIV infection in workers in occupational settings.
abstract: BACKGROUND
  The workplace provides an important avenue to prevent HIV.
  
  
  OBJECTIVE
  To evaluate the effect of behavioral interventions for reducing HIV on high risk sexual behavior when delivered in an occupational setting.
  
  
  METHODS
  We searched the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE and PsycINFO up until March 2011 and CINAHL, LILACS, DARE, OSH Update, and EPPI database up until October 2010.
  
  
  METHODS
  Randomised control trials (RCTs) in occupational settings or among workers at high risk for HIV that measured HIV, sexual transmitted diseases (STD), Voluntary Counseling and Testing (VCT), or risky sexual behaviour.
  
  
  METHODS
  Two reviewers independently selected studies for inclusion, extracted data and assessed risk of bias. We pooled studies that were similar.
  
  
  RESULTS
  We found 8 RCTs with 11,164 participants but one study did not provide enough data. Studies compared VCT to no VCT and education to no intervention and to alternative education.VCT uptake increased to 51% when provided at the workplace compared to a voucher for VCT (RR=14.0 (95% CI 11.8 to16.7)). After VCT, self-reported STD decreased (RR = 0.10 (95% CI 0.01 to 0.73)) but HIV incidence (RR=1.4 (95% CI 0.7 to 2.7)) and unprotected sex (RR=0.71 (0.48 to 1.06)) did not decrease significantly. .Education reduced STDs (RR = 0.68 (95%CI 0.48 to 0.96)), unprotected sex (Standardised Mean Difference (SMD)= -0.17 (95% CI -0.29 to -0.05), sex with a commercial sex worker (RR = 0.88 (95% CI 0.81 to 0.96) but not multiple sexual partners (Mean Difference (MD) = -0.22 (95% CI -0.52 to 0.08) nor use of alcohol before sex (MD = -0.01 (95% CI of -0.11 to 0.08).
  
  
  CONCLUSIONS
  Workplace interventions to prevent HIV are feasible. There is moderate quality evidence that VCT offered at the work site increases the uptake of testing. Even though this did no lower HIV-incidence, there was a decrease in self-reported sexual transmitted diseases and a decrease in risky sexual behaviour. There is low quality evidence that educational interventions decrease sexually transmitted diseases, unprotected sex and sex with commercial sex workers but not sex with multiple partners and the use of alcohol before sex.More and better randomised trials are needed directed at high risk groups such as truck drivers or workers in areas with a very high HIV prevalence such as Southern Africa. Risky sexual behaviour should be measured in a standardised way.
authors.affiliation: Institute of Public Health and Clinical Nutrition, Occupational Health Unit, University of Eastern Finland, Yliopistonranta 1 C, B/3. Krs, Kuopio, Finland, FI-70211.
authors.forename: Olumuyiwa
authors.initials: O
authors.lastname: Ojo
authors.forename: Jos H
authors.initials: JH
authors.lastname: Verbeek
authors.forename: Kimmo
authors.initials: K
authors.lastname: Rasanen
authors.forename: Jarmo
authors.initials: J
authors.lastname: Heikkinen
authors.forename: Leena K
authors.initials: LK
authors.lastname: Isotalo
authors.forename: Nomusa
authors.initials: N
authors.lastname: Mngoma
authors.forename: Eija
authors.initials: E
authors.lastname: Ruotsalainen
mesh_terms: D003376:Counseling; D015658:HIV Infections / Q000453:epidemiology / Q000517:prevention & control* / Q000635:transmission; D040261:Harm Reduction; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D012309:Risk-Taking; D012749:Sexually Transmitted Diseases / Q000453:epidemiology / Q000517:prevention & control; D047568:Unsafe Sex / Q000517:prevention & control*; D017132:Workplace