Do women's levels of depression moderate sexual risk behavior change in HIV prevention interventions? A meta-analysis

Background: Rates of HIV/AIDS are rising in ethnic/racial minority women in the United States (CDC, 2008) and women are disproportionately affected by depression (CDC, 2009). HIV/AIDS and depression share a number of common risk factors, including drug and alcohol use and low socioeconomic status (Beadnell et al., 2003). The objective of this meta-analysis was to examine how depression affects sexual risk behavior outcomes in women participating in HIV/AIDS prevention interventions. Methods: HIV/AIDS primary prevention interventions that measured a sexual risk behavior and depression at baseline and follow-up(s) and reported separate results for women were included. Fourteen interventions (N = 5,250 women) met the inclusion criteria. Participants were, on average, 28 years old and African American. Effects sizes were calculated using the standardized mean difference (d). Results: A significant decrease in depression in both groups from baseline to short-term (d₊ = -0.29) and long-term (d₊ = -0.20) follow-ups was found as well as a significant decrease in sexual risk behavior from baseline to short-term (d₊ = -0.32) and long-term (d₊ = -0.20) follow-ups. Overall, baseline levels of depression acted as a moderator of sexual risk behavior, with higher levels of initial depression leading to greater decrease in sexual risk behavior at short-term and long-term follow-ups. Conclusions: Depression appears to play a role in decreasing sexual risk behavior, highlighting the need to consider addressing depression in intervention design content. Researchers who design interventions can look to meta-analysis findings as another tool for aiding in creating effective HIV prevention interventions.