HIV Prevention Interventions for Heterosexual African Americans: A Systematic Review, 1988 - 2006

Background: Surveillance data indicate that heterosexual contact accounts for 32% of HIV/AIDS cases reported in the U.S. from 2001-2005. African-American (AA) men and women account for 66% and 74%, respectively, among heterosexual adults infected with HIV. Evaluating what interventions have been developed and tested for reducing heterosexual HIV transmission among AA is critical. This systematic review identifies US-based HIV/STD behavioral interventions for heterosexual AAs and addresses areas in need of improvement.

Methods: Comprehensive searches were conducted to identify relevant studies published 1988-2006. Eligible studies were US-based HIV/STD behavioral interventions that targeted AA or enrolled an AA majority (> 50%), evaluated intervention effects with control trials, and reported any behavioral outcome (e.g. condom use) or incident HIV/STD.

Results: Preliminarily analyses yielded 66 relevant controlled trials with 35% of studies specifically targeting AAs. Forty-two percent solely targeted females and 17% targeted males. About 45% reported using gender-appropriate and 27% reported using culturally appropriate materials. Sixty-two percent matched interviewer and participants by gender and 45% by ethnic background. Sixty-one percent of trials recruited participants from health care settings (e.g. STD clinics). The majority of interventions provided skills training (76% teaching condom use skills; 62% teaching negotiation for safer sex).

Conclusions: More interventions were designed to change AA females' behavior than males' behavior. Given power imbalance existing in heterosexual relationships among AA, future prevention efforts should put more emphasis on male-focused or couple-focused interventions. More culturally sensitive/appropriate and gender-specific interventions may also be needed to maximize risk reduction among at-risk heterosexual AAs.