A Systematic Review of the Effects of Behavioral Counseling on Sexual Risk Behaviors and HIV/STI Prevalence in Low- and Middle-Income Countries

December 2014 - Behavioral Prevention

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Zajac, K., Kennedy, C. E., Fonner, V. A., et al. AIDS and Behavior (September 2014), E-publication ahead of print.

The authors of this review found that behavioral counseling (BC) programs and interventions exerted limited to moderate effects on risky sexual behaviors and prevalence of HIV and sexually transmitted infections (STIs) in low- and middle-income countries. The authors examined 30 studies published between 1990 and 2011 that used multi-arm or pre-post designs and provided post-intervention data. They presented results on BC interventions in five groups: (a) people living with HIV; (b) people who use drugs and alcohol; (c) serodiscordant couples; (d) key populations for HIV prevention; and (e) people at low to moderate HIV risk. Changes in sexual behavior and HIV or STI prevalence were at best moderate across all target groups. The authors added that some studies indicated improvements in sexual behaviors and biological indicators following BC interventions, but it was unclear whether the improvements were due to BC interventions or to services already available in the communities. The authors concluded that BC strategies alone are insufficient for reducing sexual transmission risk in people living with HIV, people who abuse drugs and/or alcohol, and those at high risk for HIV transmission. However, additional research is needed to clarify the efficiency of BC interventions for serodiscordant couples and people at low to moderate risk for HIV.

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