A Systematic Review and Meta-Analysis of Combination Behavioral Interventions Co-Targeting Psychosocial Syndemics and HIV-Related Health Behaviors for Sexual Minority Men

Figures & data

Table 1. Intervention trials included in the systematic review (N = 44).

Author (Year)	Design & Sample characteristics	Intervention condition	Control condition	Syndemic effect size at most distal follow-up [95% CI]	Health behavior effect size at most distal follow-up [95% CI]
Antoni, et al. (2006)	RCT (follow-up at 6 months) N = 101; mean age = 41.6 (SD = 8.3); 84% predominantly or exclusively gay; 100% HIV+; 52% non-Hispanic White, 21% Af Am, 20% Hispanic	10 group sessions of MAT + CBSM	3 session of MAT alone	Depression symptoms, d = 0.39 [−.20, .98]	ARV adherence, d = −0.18 [−.58, .22]
Blashill, Safren, Wilhelm, Jampel, Taylor, O’Cleirigh, & Mayer (2017)	Pilot RCT (follow-up at 6 months) N = 44; 100% SMM; 100% HIV+; 63.6% White, 34.1% Af Am, 4.5% Native Am, 4.5% other	11 individual sessions of CBT-BISC	6 sessions of ETAU	Body image, d = 1.08 [.40, 1.75] Depression symptoms, d = .54 [−.10, 1.18]	ARV adherence, d = .57 [−.07, 1.22]
Brown, Vanable, Bostwick, and Carey (2019)	Pilot RCT (follow-up post-intervention and at 3 months) N = 79 (control N = 40; experimental N = 39) HIV+ = 100%; 62.8% White, 25.6% Af Am, 1.3% Asian, 1.3% Am Indian, 7.7% multiracial, 1.3% other	2 group sessions grounded in behavioral science + a “Poz Talk” session	Delayed intervention	Stress, d = .51 [.07, .96]	UAS, d = .29 [−.15, .73]
Berger, Schad, von Wyl, and Ehlert (2008)	RCT (follow-up at 12 months) N = 104; 100% HIV+; race not reported Intervention group: median age = 44.5; 64.2% gay, 15.1% female Control group: median age = 43.4; 54.9% gay; 13.7% female	12 group sessions of CBSM	Standard medical care	Depression & Anxiety symptoms Could not calculate effect sizes from data provided	CD4 count & HIV viral load Could not calculate effect sizes from data provided
Carrico et al. (2006)	RCT (follow-up at 10 weeks) N = 130; mean age = 41.6 (SD = 8.6); 100% gay and bisexual men; 100% HIV+; 52% White, 21% Af Am, 20% Hispanic	10 group sessions of MAT + CBSM	3 sessions of MAT alone	Depression symptoms, d = .19 [−.16, .54]	ARV adherence, d = − .19 [−.54, .16]
Carrico, Chesney, Johnson, Morin, Neilands, Remien, Rotheram-Borus, & Wong – for the NIMH Health Living Project Team (2009)	RCT (follow-up at 25 months) N = 469; mean age = 39.8; 79% male, 72% of whom were MSM; 100% HIV+; 32% White, 45% Af Am, 15% Hispanic, 8% other	15 individual sessions of CBT (The Healthy Living Project)	Wait-list control	Depression symptoms, d = .06 [−.07, .19] Anxiety Symptoms, d = .06 [−.07, .19] Perceived stress, d = .13 [.00, .26]	Sexual risk behavior Could not calculate effect sizes from data provided
Carrico, Flentje, Gruber, Woods, Discepola, Dilworth, Neilands, Jain, & Siever (2014) (Study, p. 1)	Uncontrolled pilot (follow-up at 12 months) N = 123; mean age = 40.7 (SD = 7.5); 98.4% male, 1.6% FtM; 63.6% HIV+; 7.5% Af Am, 21.7% Hispanic/Latino, 65.8% White, 1.7% Asian/Pacific Islander, .8% Am Indian/Alaskan, 2.5% multicultural	The Stonewall Project Harm Reduction Treatment Model (weekly individual and group sessions & medication when appropriate)	None	Substance use No between group analyses	ARV adherence & undetectable viral load No between group analyses
Carrico et al. (2014) (Study, p. 2)	Uncontrolled pilot (follow-up at 6 months) N = 88; mean age = 43.3 (SD = 9); 100% male; 65.9% HIV+; 11.4% Af Am, 13.6% Hispanic/Latino, 67.1% White, 2.3% Asian/Pacific Islander, 5.7% multicultural	The Stonewall Project Harm Reduction Treatment Model (weekly individual and group sessions, & medication when appropriate)	None	Substance use No between group analyses	Sexual risk behavior & undetectable viral load No between group analyses
Carrico et al. (2015b)	Pilot RCT (follow-up at 3 months) N = 23; mean age = 45.5 (SD = 7.6); 100% MSM; 100% HIV+; 12 (N) White, 7 Af Am, 7 Hispanic/Latino, 3 multicultural, 2 Native Am, 2 Asian/Pacific Islander	7 individual sessions of RAP	7 sessions of attention matched control (neutral writing exercises)	HIV-related traumatic stress, d = −1.19 [−2.10, −.28] Stimulant use, d = .22 [−.62, 1.06]	Transmission risk behavior, d = 0 [−.84, .84]
Carrico et al. (2015a)	Pilot RCT (follow-up at 6 months) N = 21, mean age = 41.1 (SD = 9.0); 100% MSM; 47.6% HIV+; 48% White, 24% Af Am, 24% Hispanic, 5% multicultural	12 weeks of CM + 5 individual sessions of ARTEMIS	12 weeks of CM (standard program)	Meth use, d = −.85 [−1.75, .05]	Transmission risk behavior, d = 0 [−.86, .86]
Esposito-Smythers et al. (2014)	Uncontrolled pilot (follow-up at 3 months) N = 17; mean age = 21.1 (SD = 1.3); 16 MSM, 100% HIV+, 41.2% Black/Af Am, 11.8% White, 47.1% other/mixed, 41.2% Hispanic	15 individual sessions of CBT + CM	None	Substance use & Depression symptoms No between group analyses	ARV adherence & Sexual risk behavior No between group analyses
Hart, Stratton, Coleman, Wilson, Simpson, Julien, Hoe, Leahy, Maxwell & Adam (2016)	Uncontrolled pilot (follow-up at 3 months) N = 59; mean age = 42.4 (SD = 9); 100% MSM; 100% HIV+; 63.8% White, 15.5% Black, 12.1% Latin American, 3.5% South Asian, 5.2% East/Southeast Asian	7 group sessions of Gay Poz Sex	None	Depression symptoms & loneliness No between group analyses	Sexual risk behavior No between group analyses
Kahler, Pantalone, Mastroleo, Liu, Bove, Ramratnam, Monti, & Mayer (2018)	RCT (follow-up at 12 months) N = 180; mean age = 42.1 (SD = 10.4); 100% MSM; 100% HIV+; 75% White, 22.2% Black/Af Am, 3.9% Am Indian/Alaskan Native, 1.1% Asian, 5% mixed; 17.2% Hispanic or Latino	3 sessions of MI (Project ReACH)	Resource Referral Control	Drinking behavior, d = .33 [.02, .64]	# days of US, d = .37 [.06, .68]
Kennard, Brown, Hawkins, Risi, Radcliffe, Emslie, Mayes, King, Foxwell, Buyukdura & Bethel (2014)	Uncontrolled pilot (follow-up at week 24) N = 8; mean age = 21.5 (SD = 2.1); 87% male; 75% MSM; 100% HIV+; 87% Black/Af Am	14 individual sessions of H&W + CBT	None	Depression symptoms No between group analyses	ARV adherence No between group analyses
Kurtz et al. (2013)	RCT (follow-up at 12 months) N = 515; mean age = 39.21 (SD = 9.41) for intervention, 38.66 (9.88) for control; 100% MSM Intervention group: 44.8% HIV+; 46.4% White, 29% Hispanic, 20.2% Af Am/Caribbean, 4.4% other Control group: 50.6% White, 22.8% Hispanic, 21.7% Af Am/Caribbean, 4.9% other	4 groups sessions of BI (psychological empowerment)	1 session of risk assessment & counseling	Drug dependence, d = .04 [−.14, .23] Substance use during sex, d = .13 [−.06, .31]	Sexual risk behavior, d = .08 [−.11, .26], (Transmission risk behavior) d = .11 [−.07, .30] (UAS)
Landovitz et al. (2012)	Uncontrolled pilot (follow-up at 3 months) N = 53; mean age = 36.1 (SD = 7.9); 100% MSM; 100% HIV-; 54.7% White/White, 9.4% Af Am/Black, 30.2% Hispanic/Latino 1.9% Asian/Pacific Islander, 3.8% Other/multiracial	8 weeks of individual CM	None	Meth use No between group analyses	Sexual risk behavior No between group analyses
Landovitz, Fletche, Shoptaw, & Reback (2015)	RCT (follow-up at 6 months) N = 140; mean age = 36.8 (SD = 11.1); 100% MSM; 100% HIV-; 37.1% White/White, 37.1% Af Am/Black, 2.9% Native Am, 2.1% Asian/Pacific Islander, 17.9% Hispanic/Latino, 2.9% multiracial/other	8 weeks of individual CM	Non-contingent yoked control (incentives not tied to substance abstinence)	Meth use, d = .36 [.03, .70]	Sexual risk behavior, d = .12 [−.24, .49] (UAS)
Lelutiu-Weinberger et al. (2015)	Uncontrolled pilot (follow-up at 3 months) N = 41; mean age = 25.2 (SD = 3.22); 100% MSM; 53.7% White, 17.1% Black, 22% Latino, 7.3% other	8 individual online sessions of MI + CBT (MiCHAT)	None	Drinking behavior No between group analyses	Sexual risk behavior No between group analyses
Mansergh, Koblin, McKirnan, Hudson, Flores, Wiegand, Purcell, Colfax & the Project MIX Study Team (2010)	RCT (follow-up at 12 months) N = 1,686; Age groups: 11.3% 18–24, 27.9% 25–34, 39.9% 35–44: 21% ≤45; 100 MSM; 45.6% HIV+, 8.1% unknown status; 30.7% Black, 18.9% Hispanic/Latino, 40.5% White, 9.9% other	6 group sessions of CBT (Project MIX)	6 sessions of attention control (MSM-related content unrelated to intervention)	Substance use w/sex, d = − .03 [−.15, .09] (Alcohol + UAS), d = −.11 [−.22, .01] (Drug + UAS)	Sexual risk behavior, d = − .07 [−.19, .05] (UAS)
Mimiaga et al. (2012)	Uncontrolled pilot (follow-up at 6 months) N = 16; mean age = 40 (SD = 9.56); 100% MSM; 100% HIV−; 63% White	10 individual sessions of BA-RR	None	Substance use & depression No between group analyses	Sexual risk behavior No between group analyses
Morgenstern et al. (2009)	RCT (follow-up at 12 months) N = 150; mean age = 37.8 (SD = 8.8), 100% MSM, 59.5% HIV+, 36.3% White, 33.6% Black, 15.7% other, 14.4% Hispanic	4 individual sessions of MI	4 sessions of health education	Club drug use, d = .61 [.11, 1.12]	Sexual risk behavior Could not calculate effect sizes from data provided
O’Cleirigh, Safren, Taylor, Goshe, Bedoya, Marquez, … & Shipherd, (2019)	Pilot RCT (follow-up at 9 months) N = 43; HIV+ = 0%; 62.8% White, 25.6% Af Am, 7% Hispanic/Latino, 4.7% other	10 sessions of CPT integrated with HIV risk reduction counseling	HIV/STI voluntary counseling and testing	PTSD symptoms, d = .52 [−.08, 1.14]	Sexual risk behavior d = .49 [−.11, 1.10]
Pachankis et al. (2015)	RCT (follow-up at 3 months) N = 67 Intervention group: mean age = 26.19 (SD = 4.26), 100% SMM, 100% HIV-, 50% White, 31.3% other/mixed, 18.8% Black, 3.1% Pacific Islander; 37.5% Latino Control group: mean age = 25.69 (SD = 4.28), 100% SMM, 100% HIV-, 54.8% White, 32.3% other/mixed, 12.9% Black, 9.7% Asian, 3.2% Pacific Islander; 35.5% Latino	10 individual sessions of ESTEEM	Wait-list control	Alcohol use, d = 1.03 [.50, 1.56] Depression symptoms, d = .55 [.05, 1.05] Anxiety symptoms, d = .47 [−.03, .97]	Sexual risk behavior, d = .59 [.09, 1.09] (UAS)
Parsons et al. (2007)	RCT (follow-up at 6 months) N = 143; mean age = 43.6 (SD = 6.9); 21% women; 100% HIV+; 65.9% Af Am, 17.5% Hispanic, 5.6% White, 11.1% other	8 individual sessions of MI + CBST (Project PLUS)	8 sessions of health education	Alcohol use, d = .20 [−.17, .57] (standard drinking)	Viral load, d = .20 [−.17, .57]
Parsons et al. (2014)	RCT (follow-up at 12 months) N = 143; mean age not reported; 100% SMM; 100% HIV-; 62.9% men of color	4 individual sessions of MI	4 sessions of educational control	Drug use, d = .11 [−.26, .48]	UAS, d = .15 [−.22, .52]
Parsons et al. (2017)	Uncontrolled pilot (follow-up at 3 months) N = 13; mean age = 34.4 (SD = 9.6); 100% SMM; 100% HIV+; 45.5% Black, 27.3% Latino, 18.2% White, 9.1% other	10 individual sessions of ESTEEM	None	Emotion dysregulation sexual compulsivity, Depression, generalized anxiety and obsessive compulsive symptoms No between group analyses	Sexual risk behavior No between group analyses
Parsons et al. (2018)	RCT (follow-up at 12 months) N = 210; mean age = 40.8 (SD = 8.7); 100% SMM; 100% HIV+; 34.3% Black, 33.3% White, 25.7% Latino, 6.7% other	8 individual sessions of MI + CBT	8 sessions of health education	Meth use, d = −.07 [−34, .20]	Viral load, d = −.23 [−.50, .05]
Reback and Fletcher (2017)	Uncontrolled study (follow-up at 90 days) N = 585; mean age = 37.6 (SD = 10.2); 100% MSM; 20.1% HIV+, 78.5% HIV−, 1.4% unknown; 32.3% White, 25.5% Black, 22.6% Hispanic/Latino, 17.5% multiracial/other, 2.2% Asian/Pacific Islander	Up to 3 individual session/unlimited group sessions of “GUYS”	None	Substance use No between group analyses	Sexual risk behavior No between group analyses
Reisner, O’Cleirigh, Hendriksen, McLain, Ebin, Lew, Callis, Cranston, Carr, Giovanniello, & Gonzalez (2011)	Uncontrolled pilot (follow-up unclear) N = 84; mean age = 51.21 (SD = 7.43); 26.19% HIV+, 52.38% HIV-, 21.43 unknown/not reported; 100% SMM; race/ethnicity only collected for earlier participants (N = 33): 85% White, 6% Black, 6% Latino, 3% Asian Am	6 group sessions of “40 and Forward”	None	Depression symptoms, social anxiety, loneliness & fear of negative evaluation No between group analyses	Condom use efficacy & UAS No between group analyses
Rotheram-Borus et al. (2004)	RCT (follow-up at 15 months) N = 175; median age = 23 (range = 16–29); 69% gay/bisexual men & 76% gay/bisexual/questioning; 100% HIV+; 42% Latino, 26% Black, 23% White, 8% other	18 individual sessions (in-person or phone) of BI	Wait-list control	Substance use, emotional distress Could not calculate effect sizes from data provided	Sexual risk behavior, ARV adherence, missed appointments Could not calculate effect sizes from data provided
Safren et al. (2001)	Pilot RCT (follow-up at 12 weeks) N = 56; mean age = 40.8 years (SD = 8.3); 67% SMM; 100% HIV+; 57% men of color	1 individual session of LifeSteps	Self-monitoring	Depression symptoms Could not calculate effect sizes from data provided	ARV adherence Could not calculate effect sizes from data provided
Safren et al. (2009)	RCT (follow-up at 3 months) N = 45; 64% gay/bisexual male, 4% gay/bi female; 44% undetectable viral load; 51% White, 31% Af Am, 18% Latinx	10-12 individual sessions of CBT-AD	Enhanced TAU w/1 session of ARV adherence	Depression symptoms, d = .59 [−.005, 1.19]	ARV adherence, d = 1.36 [.71, 2.01]
Safren et al. (2013)	RCT (follow-up at 12 months) N = 201; mean age = 40.7 (SD = 7.8); 100% MSM; 100% HIV+; 74.6% White	9 individual sessions of case management	Standard care	Depression symptoms & substance use Could not calculate effect sizes from data provided	Transmission risk behavior, d = − .08 [−.36, .20]
Safren, Bedoya, O’Cleirigh, Biello, Pinkston, Stein, Traeger, Kojic, Robbins, Lerner, Herman, Mimiaga, & Mayer (2016)	RCT (follow-up at 4 months) N = 240; age range = 46.5–47.1; 59%-69% non-heterosexual; 100% HIV+; 63%–67% White	11 individual sessions of ISP-AD + CBT-AD	1 session of ETAU	Depression symptoms, d = .48 [.13, .83]	Viral load, d = .19 [−.15, .54]
Santos, Coffin, Vittinghoff, DeMicco, Das, Matheson, Raiford, Carry, Colfax, Herbst, & Dilley (2014)	RCT (follow-up at 3 months) N = 326; mean age = 33.6; 100% MSM; 100% HIV-; 47% White, 26% Hispanic/Latino, 11% Asian/Pacific Islander, 10% Black/Af Am, 6% mixed/other	1 individual session of PCC	Standard care	Substance use Could not calculate effect sizes from data provided	Sexual risk behavior Could not calculate effect sizes from data provided
Shoptaw, Reback, Peck, Yang, Rotheram-Fuller, Larkins, Veniegas, Freese, & Hucks-Ortiz (2005)	RCT (follow-up at 12 months) N = 162; mean age by group: CBT = 37.5, CM = 34.8, CBT+CM = 38.0, GCBT = 38.5; 100% MSM; 60.5% HIV+; 79.7% White, 12.9% Hispanic, 3.1% Af Am, 3.1% Asian Am, 1.2% Native Am	48 group sessions (CBT, CBT+CM, GCBT)	None	Substance use Could not calculate effect sizes from data provided	Sexual risk behavior Could not calculate effect sizes from data provided
Shoptaw, Reback, Larkins, Wang, Rotheram-Fuller, Dang, &Yang (2008)	RCT (follow-up at week 52) N = 128; 100% MSM; 100% gay/bisexual GCBT: mean age 38.1 (SD = 7.1); 54% HIV+; 66% White GSST: mean age = 36 (SD = 8.1); 56% HIV+; 64% White	48 group sessions of GCBT	48 group sessions of GSST	Amphetamine use, d = .50 [.10, .90]	Sexual risk behavior Could not calculate effect sizes from data provided
Shoptaw, Reback Larkins, Wang, Rotheram-Fuller, Dang & Yang (2008)	RCT (week 52) N = 128; 100% MSM GCBT group: mean age = 38.1 (SD = 7.1); 54% HIV+; 66% White, 22% Latino, 13% other GSST group: mean age = 36.0 (SD = 8.1); 56% HIV-positive; 64% White, 22% Latino, 14% other	16 week of GCBT	16 weeks of GSST	Substance use d = 1.39 [−.02, 2.79] (alcohol) d = .74 [−.20, 1.68] (cocaine) d = − .50 [−.90, −.10] (Meth) d = − .38 [−.72, −.03] (marijuana)	Sexual risk behavior Could not calculate effect sizes from data provided
Smith et al. (2017)	Uncontrolled pilot (follow-up at 3 months) N = 33; mean age = 21.91 (SD = 2.15); 48% gay; 100% MSM; 100% HIV-; 54.6% White, 21.2% Black, 9.1% Asian, 6.1% Latino, 3% other	8 groups sessions of Project PRIDE	None	Depression symptoms, anxiety symptoms, loneliness & substance use No between group analyses	Sexual risk behavior No between group analyses
Velasquez et al. (2009)	RCT (follow-up at 12 months) N = 253; mean age = 38.6 years (SD = 6.73); 100% MSM; 100% HIV+; 53.8% Af Am, 19.8% Latino/Hispanic, 17% White, 9.5% other	8 individual and group sessions of TTM+MI	Detailed referral guide	Alcohol use, d = .18 [−.09, .45] (drinks)	Sexual risk behavior under the influence of alcohol, d = .59 [.31, .86]
Williams et al. (2008)	RCT (follow-up at 6 months) N = 137; mean age = 43.5 (SD = 8.0); 41% MSM; 59% MSMW; 100% HIV+; 65% Af Am, 35% Latino	6 group sessions of S-HIM	6 sessions of SHP (attention control)	Depression symptoms, d = .15 [−.19, .49]	Sexual risk behavior, d = −.05 [−.39, .28]
Williams et al. (2013)	RCT (follow-up at 6 months) N = 88; mean age = 46.6 (SD = 8.3); 100% HIV+; 100% Af Am	6 groups sessions of ES-HIM	6 sessions of HP	PTSD symptoms, d = − .06 [−.48, .36] Depression symptoms, d = − .06 [−.48, .36]	Sexual risk behavior, d = .02 [−.40, .44] (URAS)
Wray et al. (2019)	Pilot RCT (single session) N = 40; MSM = 100%; HIV+ = 0%; Control (White = 65%, Black = 20%, Multiracial = 15%); Experimental (White = 75%, Asian = 10%, Multiracial = 10%, Black = 5%)	Single session online drinking behavior intervention and HIV testing counseling session	HIV testing counseling session	Drinking behaviors Could not calculate effect sizes from data provided	Sexual risk behavior Could not calculate effect sizes from data provided
Wu et al. (2011)	Uncontrolled pilot (follow-up at 2 months) N = 68 (34 couples); mean age = 41.5 (SD = 8.7); 100% MSM; 94.1% HIV+; 91.2% Black/Af Am, 7.4% Latino/Hispanic/Chicano, 1.5% mixed	7 couples sessions of Connect With Pride	None	Substance use No between group analyses	Sexual risk behavior No between group analyses
Zule et al. (2012)	Uncontrolled pilot (follow-up at 2 months) N = 31; mean age = 38.3 (SD = 8.5); 100% MSM; 48% HIV+; 45% White, 52% Af Am, 5% other	Single individual session of MI (MASH)	None	Meth use No between group analyses	Sexual risk behavior No between group analyses

If there was more than one outcome measure included within each of the syndemic or health behavior categories, we list each and report effect sizes separately. Af Am = African American, Am = American, ARTEMIS = CM-Affect Regulation Treatment to Enhance Meth Intervention Success, ARV = Antiretroviral, BA-RR = Behavioral Activation therapy and Risk Reduction counseling, BI = Behavioral Intervention, CBSM = Cognitive Behavioral Stress Management, CBT = Cognitive Behavioral Therapy, CBT-AD = Cognitive Behavioral Therapy for Adherence and Depression, CBT-BISC = Cognitive Behavioral Therapy for Body Image and Self-Care, CM = Contingency Management, CPT = Cognitive Processing Therapy, ES-HIM = Enhanced Sexual Health Intervention for Men, ESTEEM = Effective Skills to Empower Effective Men, ETAU = Enhanced Treatment As Usual, GCBT = Gay-specific Cognitive Behavioral Therapy, GSST = Gay-specific Social Support Therapy, GUYS = Guys Understanding Your Situation, ISP-AD = Information and Supportive Psychotherapy with Adherence counseling, MASH = Men’s Attitudes on Sex and Health, MAT = Medication Adherence Treatment, MI = Motivational Interviewing, MSM = Men who have Sex with Men, PCC = Personalized Cognitive Counseling, Project PRIDE = Promoting Resilience In Discriminatory Environments, Project ReACH = Reducing Alcohol-related Comorbidities in HIV treatment, RAP = Resilient Affective Processing, RCT = Randomized Control Trial, S-HIM = Sexual Health Intervention for Men, SHP/HP = Sexual Health Promotion/Health Promotion, SMM = Sexual Minority Men, TTM = Transtheoretical Model, US = unprotected sex, UAS = unprotected anal sex, URAS = unprotected receptive anal sex

Figure 1. PRISMA flow diagram.

Figure 2. Forest plot of RCT syndemic outcomes.

Figure 3. Forest plot of RCT health behavior outcomes.

Table 2. Effect sizes and sensitivity analyses for syndemics and health behavior outcomes.

Outcomes	# of effects	d	Lower CI (95%)	Upper CI (95%)	Z score	p value for Z score	Q statistic	p value for Q statistic
Syndemics	29	0.20	0.12	0.29	4.71	<.001	73.47	<.001
Mental Health	16	0.23	0.12	0.34	4.06	<.001	28.67	0.018
Substance Use	13	0.17	0.05	0.30	2.67	.008	40.64	<.001
Health Behaviors	19	0.16	0.03	0.30	2.36	.018	58.17	<.001
Antiretroviral Adherence	7	0.17	−0.14	0.49	1.08	.282	26.66	<.001
Sexual Risk Behavior	12	0.17	0.02	0.32	2.29	.022	31.23	.001

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