title: Behavioral interventions to promote condom use among women living with HIV: a systematic review update.
abstract: Behavioral interventions have been essential components of HIV prevention approaches, especially those aimed to promote safe sexual practices. We conducted a comprehensive literature search without language restrictions between 1980 and July 2014 to identify randomized controlled trials or controlled studies investigating behavioral interventions which: included women living with HIV; focused on condom use promotion; presented/analyzed outcomes by gender; used a 3-month follow-up or more; and considered at least one HIV-related behavioral or biological outcome. Eight studies comprising a total of 1,355 women living with HIV were included in the meta-analyses, and 13 studies were qualitatively described. When compared to standard care or minimal support intervention, behavioral interventions did not demonstrate an effect on increasing consistent condom use at the 3-month follow-up (RR = 0.92; 95%CI: 0.73, 1.16; p = 0.48), 6-month follow-up (RR = 1.13; 95%CI: 0.96, 1.34; p = 0.15), and 12-month follow-up (RR = 0.91; 95%CI: 0.77, 1.08; p = 0.30). Behavioral interventions also failed to reach positive effect in reduction of unprotected sexual intercourse at 6-months (MD = -1.80; 95%CI: -4.21, 0.62; p = 0.14) and 12-months follow-up (MD = -1.39; 95%CI: -2.29, 0.21; p = 0.09). These findings should be interpreted with caution since they are based on a few small trials. New researches are needed to assess the potential gains from a combination of interventions that promote safe sexual behavior with a harm reduction and gender approach, particularly in developing countries where HIV infection rates remain high.
authors.affiliation: Pós-graduação em Saúde Coletiva, Universidade do Vale do Rio dos Sinos, São Leopoldo, Brasil.
authors.forename: Tonantzin Ribeiro
authors.initials: TR
authors.lastname: Gonçalves
authors.affiliation: Grupo Hospitalar Conceição, Porto Alegre, Brasil.
authors.forename: Evelise Rigoni
authors.initials: ER
authors.lastname: Faria
authors.affiliation: Ambulatório de Dermatologia Sanitária, Secretaria Estadual da Saúde do Rio Grande do Sul, Porto Alegre, Brasil.
authors.forename: Fernanda Torres de
authors.initials: FT
authors.lastname: Carvalho
authors.affiliation: Programa de Pós-graduação em Psicologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brasil.
authors.forename: Cesar Augusto
authors.initials: CA
authors.lastname: Piccinini
authors.affiliation: School of Population & Public Health, University of British Columbia, Vancouver, Canada.
authors.forename: Jean Anne
authors.initials: JA
authors.lastname: Shoveller
mesh_terms: D001938:Brazil; D002986:Clinical Trials as Topic; D017280:Condoms / Q000706:statistics & numerical data*; D005260:Female; D015658:HIV Infections / Q000517:prevention & control* / Q000635:transmission; D006293:Health Promotion; D006801:Humans; D021841:Safe Sex / Q000706:statistics & numerical data*