Are we going to close social gaps in HIV? Likely effects of behavioral HIV-prevention interventions on health disparities

Abstract

Although experimental behavioral interventions to prevent HIV are generally designed to correct undesirable epidemiological trends, it is presently unknown whether the resulting body of behavioral interventions is adequate to correct the social disparities in HIV-prevalence and incidence present in the United States. Two large, diverse-population meta-analytic databases were reanalyzed to estimate potential perpetuation and change in demographic and behavioral gaps as a result of introducing the available behavioral interventions advocating condom use. This review suggested that, if uniformly applied across populations, the analyzed set of experimental (i.e. under testing) interventions is well poised to correct the higher prevalence and incidence among males (vs. females) and African-Americans and Latinos (vs. other groups), but ill poised to correct the higher prevalence and incidence among younger (vs. older) people, as well as men who have sex with men, injection-drug users, and multiple partner heterosexuals (vs. other behavioral groups). Importantly, when the characteristics of the interventions most efficacious for each population were included in the analyses of behavior change, results replicated with three exceptions. Specifically, after accounting for interactions of intervention and facilitator features with characteristics of the recipient population (e.g. gender), there was no behavior change bias for men who have sex with men, younger individuals changed their behavior more than older individuals, and African-Americans changed their behavior less than other groups.

Keywords:

• health disparities
• HIV
• communication
• persuasion

Notes

1. Note that more detailed analyses of interactions among these behavioral and demographic variables would be ideal but is precluded by the lack of sufficient data in the areas of enrollment and completion.

2. When the N at the pretest differed from the N at the posttest, the smaller N was used.

3. Five hundred seventy four papers were excluded. Among those, 18.8% were theoretical or review papers, 16.8% were surveys, 8.7% were qualitative, 15.7% were reported interventions that did not target condom use, 12.5% had data on condom use interventions without a pretest, 11.9% reported otherwise usable interventions but the statistics could not be used to derive the effect sizes we needed, 12.0% reported no standardized intervention, 1.4% were not HIV related at all, and 2.1% had no outcome variable that we were interested in synthesizing.

4. When the N at the pretest differed from the N at the posttest, the smaller N was used.