熱帯病と公衆衛生ジャーナル

概要

Systematic Review of Behavioural Interventions Targeting Men to Prevent Heterosexual Transmission of HIV in Developing Countries

Ibrahim Audu Salisu, Chima E Onuekwe, Collins Owili

Background: People in developing countries and especially sub-Saharan Africa bear a huge brunt of HIV/AIDS pandemic. Transmission in adults is mostly heterosexual with men playing a key role in such dynamics. They do so because of risky sexual practices and behaviours which are shaped by cultural norms. Behavioural interventions are likely to reduce such transmissions. The primary objective of this study is to examine the evidence of the effectiveness of behavioural interventions targeting men to prevent heterosexual transmission of HIV in developing countries.

Method: We conducted a systematic review of studies evaluating the effect of behavioural interventions in developing countries published from 1990 to 2011. Five databases were searched; Pub Med, MEDLINE, Cochrane, Trip database, Eldis, Africa Health line, CINAHL and AIDSLINE. Contact has been made to SFH (Nigeria) and International AIDS Alliance at Brighton, UK and USAID (Nigeria). Data were extracted and qualitative thematicsynthesis was done to pool evidence, which was presented in a narrative format.

Results: Some 6339 articles yielded from the search. 501 titles of abstracts were reviewed, 82 studies were thoroughly examined and 22 met the inclusion criteria. All studies that met the inclusion criteria were critically appraised and reviewed. Only 5 RCT was found, reflecting the paucity of published rigorous studies in comparison to HIV/AIDS burden in this region. Other non-randomized evaluation studies were included in the analysis. Multi-component interventions produced more positive changes in behavioural outcomes. Interventions with short delivery time, targeting experienced men in workplaces were associated with more positive changes. Behavioural outcomes like knowledge of men about HIV, condom use, attitude towards condom, gender roles/GBV are easier to change than reduction in number of sexual partners/episodes of unprotected sex with CSW/other partners. Very few studies evaluated interventions impact on biological outcomes though also reported positive changes. Only limited evidence exists to show that interventions in which men participated in the evaluation process are more effective.

Conclusion: Although the evidence base is narrow, behavioural interventions can prevent heterosexual transmission of HIV by men in developing countries. Only a few rigorous studies evaluated intervention impacts on behavioural outcomes, though reported positive impacts. Policymakers and programmers should consider contextual factors in designing new interventions. Researchers should employ more rigorous methods in evaluating interventions to expand the existing body of evidence.