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 community1.
What could this strategy improve?
Expected Benefits
Our evidence rating is based on the likelihood of achieving these outcomes:
Reduced incidence of STIs
Reduced risky sexual behavior
Increased condom use
What does the research say about effectiveness? This strategy is rated scientifically supported.
There is strong evidence that behavioral interventions to reduce HIV and other sexually transmitted infections (STIs) decrease sexual risk behaviors1, 2, 3, 4, 5, 6, 7, 8, 9, increase condom use1, 2, 4, 9, 10, 11, 12, and decrease STI incidence2, 4, 6, 7, 8, 9, 11, 12, 13.
Behavioral interventions are effective when implemented on the individual, group, and community level1, 13. They are effective in a variety of settings, including primary care1, 5, 10, 13, STI clinics8, 13, and schools4. Such interventions have been shown to decrease risky sexual behaviors and STI incidence among men who have sex with men1, 3, 5, 9, heterosexuals9, blacks7, 8, 14, 15, and Hispanics8, as well as at-risk adults and high-risk groups such as STI patients8, 9, 13. These interventions also appear to decrease STI incidence11, 13 and risky sexual behaviors4, 10, 11, 16 among adolescents.
The effects of behavioral interventions appear strongest among men who have sex with men, HIV-positive individuals, and Hispanics9. Behavioral interventions are more effective when culturally tailored2, 8, 7, 15, or delivered by individuals similar to participants1, 7, 8, 14. Interventions that include multiple sessions appear to be more effective than single sessions1, 15, though single session interventions can be effective as well17.
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 components1, 2, 3, 6, 8, 15.
How could this strategy impact health disparities? This strategy is rated likely to decrease disparities.
Implementation Examples
The National Network of STD Clinical Prevention Training Centers provides behavioral intervention training18.
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.
Footnotes
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1 CG-HIV/AIDS and pregnancy - The Guide to Community Preventive Services (The Community Guide). HIV/AIDS, STIs, and pregnancy.
2 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.
3 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):133-150.
4 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):272-294.
5 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.
6 Wetmore 2010 - 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.
7 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.
8 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):319-332.
9 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):335-353.
10 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.
11 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.
12 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):489-498.
13 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.
14 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.
15 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.
16 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.
17 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.
18 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.
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