Efficacy of HIV/AIDS Prevention Interventions in Asia, 1995-2009: A Meta-Analysis

Background: The HIV/AIDS epidemic continues to grow in pockets across Asia, despite early successes at curtailing its spread in countries like Thailand. Recent evidence documents dramatic increases in incidence among risk groups and, alarmingly, the general population; such state of affairs calls for swift measures. This meta-analysis answers this call by summarizing the efficacy of sexual risk-reduction interventions for the prevention of HIV-infection in Asia. Method: Sexual risk-reduction outcomes (e.g., condom use, number of sexual partners, incident sexually transmitted infections, including HIV) from 46 behavioral intervention studies with a comparison condition and available by August 2010 were synthesized using meta-analysis. Analyses examined whether intervention effects varied as a function of hypothesized moderator variables. Results: Overall, behavioral interventions in Asia consistently reduced sexual risk outcomes. Condom use efficacy was stronger when interventions sampled more women, included motivational content, and did not include STI testing and treatment. Incident HIV/STI efficacy was stronger when interventions sampled more women, were conducted more recently, and included STI counseling and testing. Sexual frequency efficacy was stronger in interventions that were conducted in countries with lower human development capacities, with younger individuals, and included condom-skills training. Conclusions: Interventions for sexual risk-reduction interventions are efficacious; the magnitude of the effects covaries with specific intervention and structural components. The impact of structural factors on HIV intervention efficacy must be considered when implementing and evaluating behavioral interventions. Implications for HIV/AIDS intervention work, human development, and gender equity are discussed.