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Behavioral interventions to prevent HIV and other STIs

Behavioral interventions aim to improve healthy behavior, psychosocial functioning, and quality of life through individual-level, group-level, and community-level interventions. Interventions at all levels involve education; individual and group-level interventions may also include training and support. Group-level intervention activities and information can be reinforced with peer pressure. Community-level interventions often focus both on sharing information and changing social norms within the target community (CG-HIV/AIDS and pregnancy).

Expected Beneficial Outcomes (Rated)

  • Reduced incidence of STIs

  • Reduced risky sexual behavior

  • Increased condom use

Evidence of Effectiveness

There is strong evidence that behavioral interventions to reduce HIV and other sexually transmitted infections (STIs) decrease sexual risk behaviors (, , , Wetmore 2011, Crepaz 2009, Crepaz 2007, , CG-HIV/AIDS and pregnancy), increase condom use (, , Johnson 2011, , CG-HIV/AIDS and pregnancy, ), and decrease STI incidence (, Johnson 2011, , Wetmore 2011, Crepaz 2009, Lin 2008, Crepaz 2007, ).

Behavioral interventions are effective when implemented on the individual, group, and community level (CG-HIV/AIDS and pregnancy, Lin 2008). They are effective in a variety of settings, including primary care (, , Lin 2008, CG-HIV/AIDS and pregnancy), STI clinics (Lin 2008, Crepaz 2007), and schools (). Such interventions have been shown to decrease risky sexual behaviors and STI incidence among men who have sex with men (, , , CG-HIV/AIDS and pregnancy), heterosexuals (), blacks (, Crepaz 2009, Darbes 2008, Crepaz 2007), and Hispanics (Crepaz 2007), as well as at-risk adults and high-risk groups such as STI patients (Lin 2008, , Crepaz 2007). These interventions also appear to decrease STI incidence (Johnson 2011, Lin 2008) and risky sexual behaviors (Mullen 2002, , , Johnson 2011) among adolescents.

The effects of behavioral interventions appear strongest among men who have sex with men, HIV-positive individuals, and Hispanics (). Behavioral interventions are more effective when culturally tailored (Crepaz 2007, Crepaz 2009, Darbes 2008), or delivered by individuals similar to participants (, Crepaz 2009, Crepaz 2007, CG-HIV/AIDS and pregnancy). Interventions that include multiple sessions appear to be more effective than single sessions (Darbes 2008, CG-HIV/AIDS and pregnancy), though single session interventions can be effective as well (Eaton 2012).

Interventions that incorporate skills building, such as  proper condom use or negotiating safer sex, appear to be more effective than those that do not include skills building components (, Wetmore 2011, Darbes 2008, Crepaz 2007, CG-HIV/AIDS and pregnancy).

Impact on Disparities

Likely to decrease disparities

Implementation Examples

The National Network of STD Clinical Prevention Training Centers provides behavioral intervention training (NNCPTC-BPTC).

Implementation Resources

NNCPTC-BPTC - National Network of STD Clinical Prevention Training Centers (NNCPTC). Behavioral Prevention Training Centers (BPTC): courses that teach the use of evidence-based STD/HIV prevention interventions at the individual, group, and community level.

Citations - Evidence

* Journal subscription may be required for access.

Lin 2008 - Lin JS, Whitlock E, Connor EO, Bauer V. Behavioral counseling to prevent sexually transmitted infections: a systematic review for the US Preventative Services Task Force. Annals of Internal Medicine. 2008;149(7):497-508.

Cochrane-Johnson 2008* - Johnson WD, Diaz RM, Flanders WD, et al. Behavioral interventions to reduce risk for sexual transmission of HIV among men who have sex with men. Cochrane Database of Systematic Reviews. 2008;(3):CD001230.

Cochrane-Shepherd 2011* - Shepherd JP, Frampton GK, Harris P. Interventions for encouraging sexual behaviours intended to prevent cervical cancer. Cochrane Database of Systematic Reviews. 2011;(4):CD001035.

CG-HIV/AIDS and pregnancy - The Guide to Community Preventive Services (The Community Guide). HIV/AIDS, STIs, and pregnancy.

Wetmore 2011 - Wetmore CM, Manhart LE, Wesserheit JN. Randomized controlled trials of interventions to prevent sexually transmitted infections: Learning from the past to plan for the future. Epidemiologic Reviews. 2010;32(1):121-36.

Darbes 2008 - Darbes L, Crepaz N, Lyles C, Kennedy G, Rutherford G. The efficacy of behavioral interventions in reducing HIV risk behaviors and incident sexually transmitted diseases in heterosexual African Americans. AIDS. 2008;22(10):1177-94.

Mullen 2002 - Mullen PD, Ramirez G, Strouse D, Hedges LV, Sogolow E. Meta-analysis of the effects of behavioral HIV prevention interventions on the sexual risk behavior of sexually experienced adolescents in controlled studies in the United States. Journal of Acquired Immune Deficiency Syndromes. 2002;30(Suppl 1):S94-105.

Crepaz 2007 - Crepaz N, Horn AK, Rama SM, et al. The efficacy of behavioral interventions in reducing HIV risk sex behaviors and incident sexually transmitted disease in black and hispanic sexually transmitted disease clinic patients in the United States: A meta-analytic review. Sexually Transmitted Diseases. 2007;34(6):319-32.

Chin 2012* - Chin HB, Sipe TA, Elder R, et al. The effectiveness of group-based comprehensive risk-reduction and abstinence education interventions to prevent or reduce the risk of adolescent pregnancy, Human Immunodeficiency Virus, and sexually transmitted infections: Two systematic reviews for the Guide to Community Preventive Services. American Journal of Preventive Medicine. 2012;42(3):272-94.

Crepaz 2009 - Crepaz N, Marshall KJ, Aupont LW, et al. The efficacy of HIV/STI behavioral interventions for African American females in the United States: A meta-analysis. American Journal of Public Health. 2009;99(11):2069-78.

Henny 2012* - Henny KD, Crepaz N, Lyles CM, et al. Efficacy of HIV/STI behavioral interventions for heterosexual African American men in the United States: A meta-analysis. AIDS and Behavior. 2012;16(5):1092–114.

Johnson 2011 - Johnson BT, Scott-Sheldon LAJ, Huedo-Medina TB, Carey MP. Interventions to reduce sexual risk for human immunodeficiency virus in adolescents: A meta-analysis of trials, 1985-2008. Archives of Pediatrics & Adolescent Medicine. 2011;165(1):77–84.

Lorimer 2013* - Lorimer K, Lawrence M, McPherson K, Cayless S, Cornish F. Systematic review of reviews of behavioural HIV prevention interventions among men who have sex with men. AIDS Care. 2013;25(2):133–50.

Noar 2008* - Noar SM. Behavioral interventions to reduce HIV-related sexual risk behavior: Review and synthesis of meta-analytic evidence. AIDS and Behavior. 2008;12(3):335–53.

Scott-Sheldon 2011* - Scott-Sheldon LAJ, Huedo-Medina TB, Warren MR, Johnson BT, Carey MP. Efficacy of behavioral interventions to increase condom use and reduce sexually transmitted infections: A meta-analysis, 1991 to 2010. Journal of Acquired Immune Deficiency Syndromes. 2011;58(5):489–98.

Eaton 2012 - Eaton LA, Huedo-Medina TB, Kalichman SC, et al. Meta-analysis of single-session behavioral interventions to prevent sexually transmitted infections: Implications for bundling prevention packages. American Journal of Public Health. 2012;102(11):e34–44.

von Sadovszky 2014* - von Sadovszky V, Draudt B, Boch S. A systematic review of reviews of behavioral interventions to promote condom use. Worldviews on Evidence-Based Nursing. 2014;11(2):107–17.

Citations - Implementation Examples

* Journal subscription may be required for access.

NNCPTC-BPTC - National Network of STD Clinical Prevention Training Centers (NNCPTC). Behavioral Prevention Training Centers (BPTC): courses that teach the use of evidence-based STD/HIV prevention interventions at the individual, group, and community level.

Date Last Updated

Sep 23, 2014