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A meta-analysis of the effect of HIV prevention interventions on
the sex behaviors of drug users in the United States.
Journal of Acquired Immune Deficiency Syndromes 2002;30(Suppl 1):S73-S93.
Semaan S, Des Jarlais DC, Sogolow E, Johnson WD, Hedges LV, Ramirez
G, Flores SA, Norman L, Sweat MD, Needle R.
Abstract
We examined the effectiveness of 33 U.S.-based HIV intervention studies in
reducing the sexual risk behaviors of drug users by reducing unprotected
sex or increasing the use of male condoms. The studies, identified as of
June 1998, through the HIV/AIDS Prevention Research Synthesis project, were
published in 1988 or later, measured behavioral or biologic outcomes, used
experimental designs or certain quasi-experimental designs, and reported
sufficient data for calculating an effect size for sexual risk reduction.
Of the 33 studies, 94% recruited injection drug users; 21% recruited crack
users. The mean age of participants was 36 years. Almost all studies were
randomized (94%), provided another HIV intervention to the comparison groups
(91%), and evaluated behavioral interventions (91%). On average, interventions
were conducted in 5 sessions (total, 10 hours) during 4.5 months. Interventions
compared with no interventions were strong and significant (k = 3; odds ratio
[OR], 0.60; 95% confidence interval [CI], 0.43-0.85). Interventions compared
with other HIV interventions showed a modest additional benefit (k = 30;
OR, 0.91; 95% CI, 0.81-1.03). When we extrapolated our result (an OR of 0.60)
to a population with a 72% prevalence of risk behavior, the proportion of
drug users who reduced their risk behaviors was 12.6% greater in the intervention
groups than in the comparison groups. Our meta-analysis shows that interventions
can lead to sexual risk reduction among drug users and justifies providing
interventions to drug users. Developing interventions with stronger effects
to further reduce sexual risk behaviors among drug users must remain a high
priority.
