Behavioral Interventions for Prevention and Control of Sexually Transmitted Diseases

Behavioral Interventions for Prevention and Control of Sexually Transmitted Diseases / Edition 1

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Includes information on populations at greatest risk, examples of prevention programs or interventions, and how to make the most of your dollar with high-impact prevention. The document also highlights gaps in local and state-level prevention efforts. Included data and statistics on the individual, group, and community level. Also outlines many barriers to implementing programs in rural communities and offers strategies to address some of these challenges.

Skip to main content Menu Search. The program promotes condom use, educates about sexual health topics, and encourages testing for sexually transmitted infections. This intervention delivers HIV prevention and education at the individual level, in the format of brief interactive behavioral counseling sessions. Participants can attend two HIV counseling sessions, receive a free HIV test and follow-up counseling, and, if necessary, referrals for additional social services.

This prevention intervention is implemented on a smaller scale and involves HSC staff traveling to college campuses to conduct the prevention counseling activities.

Utility and delivery of behavioural interventions to prevent sexually transmitted infections

The organization seeks to achieve this mission by providing evidence-based HIV prevention programming. This intervention is being implemented in Chattanooga, Tennessee, and within surrounding rural counties. This intervention specifically targets heterosexual African American and Latino adult populations. The program aims to promote a sense of community among these men and to develop relationships that promote safe sex. Each summer there is a statewide gathering for the program. Five studies were conducted both in Spain 7.

Three studies were respectively from China 4. Two studies were conducted in United Kingdom 3. The rest of studies were conducted in other countries Table 1. The majority of the studies were conducted in either North or South America Africa was the setting for the As seen in Table 1 , the mean HDI for countries in the sample during the year of publication was. The mean of the very high HDI countries ranged from. Low HDI countries included Liberia.

The sample comprised 59, adolescents at pretest, with 23, in control conditions and 36, in experimental conditions, with a mean age of When the study did not include control group, participants were considered as part of the experimental group receiving the intervention. Social cognitive therapy, the theory of reasoned action, and the theory of planned action were the most used theoretical models, which is consistent with the meta-analysis conducted by Robin et al. Only Of the 63 analyzed studies, 25 There were 20 cluster-randomized control trials Of the 45 studies including a control group, 30 Control groups were usually health promotion interventions basically drug avoidance, diet, exercise, and family life education [ 46 , 47 , 49 , 75 , 93 , ].

For example, Armitage and Talibudeen [ 45 ] provided information on the history of the condom to the participants assigned to control group. Jones et al. Treatment as usual or the traditional sexual health promotion intervention offered by the school was implemented as the control condition in a few studies [ 45 , 72 , 95 ]. See Table 1 for more information on the main descriptive characteristics of the included studies.

Interventions significantly enhanced 6 of the 9 evaluated outcomes Table 2. The studies were widely heterogeneous in the outcomes selected. The interventions also had a significant, positive short-term impact on attitude towards sexual health including HIV, preventing pregnancy, and beliefs about abstinence, condom use, and people who have sex with same sex Fig 3. Interventions also increased and self-efficacy to use condoms Fig 4 and behavioral intentions, including intention to refuse sex Fig 5 and intention to use condoms Fig 6.

No impact on subjective norms, abstinence self-efficacy, and communication about sex with the sexual partner was found in the short-term.

Objective:

Interventions increased condom use Fig 7. Only one study indicated a reduction in self-reported STIs among adolescents that were already sexually active at baseline; however, the intervention had no impact on pregnancy rate [ 53 ]. It is important to consider how the high heterogeneity across the studies may influence interpretation of results, and moderators are described below. Effects are ordered from most successful to least successful. The overall estimate for each is represented at the end of the list of studies.

The interventions also had a significant and positive impact on sexual health in general and attitude towards sexual health including HIV, preventing pregnancy, and beliefs about abstinence, condom use, and people who have sex with same sex. Positive effects were found for self-efficacy to use condoms, condom use intention, and condom use Fig 8.

In the medium-term, interventions had no significant impact on variables on the rest of studied outcomes. There were too few studies that provided medium-term data in order to run detailed models. Interventions did not have impact on variables on the rest of studied outcomes.

Only two studies reported long-term measures for condom use, which prevented fitting detailed models. An important caveat is that there is heterogeneity in the effect sizes, and that therefore, other factors are likely influencing their magnitude. All studies that evaluated condom use in the medium term 12—18 months included a control or comparison group; therefore, control group was not included as moderator in the analyses. As Table 3 shows, seven of the 10 moderator dimensions evaluated were statistically significant moderators of condom use.

Relative to the characteristics of the intervention and sample, the interventions to reduce risk for STIs and pregnancy in adolescents were more effective in increasing condom use when: 1 the study took place in a nation with a very high HDI vs. Gender and age of the participants were not moderators of the efficacy of the interventions. Regarding the evaluation methodology, the interventions increased condom use more when: 1 the study randomly assigned participants into an experimental group or a control group RCT vs. The present meta-analysis summarized the efficacy of interventions for STI prevention and sexual health promotion for adolescents performed in recent years — , and identified the moderators of the efficacy of such interventions to increase medium-term condom use.

The results indicated that interventions had the biggest and more reaching impact in the short-term. The interventions were effective in increasing sexual health-related knowledge, promoting a favorable attitude towards HIV and methods of protection, self-efficacy to use condoms, behavioral intention including condom use intention and intention to refuse sex, and increasing condom use among adolescents. Intervention effect size magnitudes were low to moderate, except for knowledge, which was high [ 33 ].

These results are consistent with previous meta-analyses [ 17 , 24 , 31 , ] and, as with these same meta-analyses, overall heterogeneity was large Table 2.

Introduction:

Our team was successful at applying several a priori moderators in models of the medium-term condom use effect size Table 3 , and we comment on these results below. This unexpected result suggests that the subjective norms component needs to be greater attention as it is one of the precursors of condom use according to multiple theories [ 29 , ] and empirical studies [ 61 ].

Exceptionally, the COMPAS intervention—implemented in Spanish schools—had an impact on subjective norms one year after its implementation [ 83 ]. Only two studies provided long-term condom use effects after the month follow up [ 80 , ]. Because of the lack of monitoring data for the medium- and long-term, we cannot draw firm conclusions. These patterns are consistent with the systematic review of school-based cognitive-behavioral interventions conducted by Kavanagh et al. This finding conflicts with results from a meta-analysis of 37 interventions for HIV prevention 28 studies applied in Latin American and Caribbean Nations from to ; specifically, Huedo-Medina et al.

According to these authors [ 14 ], the conditions of poverty and deprivation imply resource deficits that the interventions address, in part.

Public Health at a Glance - Sexually Transmitted Infections in Developing Countries

Yet this review did not target studies of adolescents, and it is true that in all societies, adolescents are sheltered by parents and to some extent schools and peer groups, which can be supportive to prevent sexual risk behaviors. These networks tend to be stronger in high HDI nations, which may explain our results. Another variable that may explain the relationship between HDI and intervention efficacy is community-level stigma.

Reid, Dovidio, Ballester and Johnson [ ] found that in communities with high levels of stigma, HIV prevention interventions were not successful in increasing condom use.

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Since stigma has been directly associated with lower socioeconomic and lower educational levels [ ], it could be expected that interventions have a lower impact on condom use over time in low HDI nations. We believe that the availability of schools, the learning context, and the ease access to adolescents, even some time after applying the intervention monitoring are factors that make schools a recommendable setting to promote sexual health during adolescence.

The most successful interventions to increase condom use were based in theoretical approaches and did not promote sexual abstinence. Similarly, Johnson et al.

Interventions showed greater efficacy when participants were randomly assigned to the experimental conditions RCT compared non-randomized control trials , and when the control group did not received another intervention compared to those receiving an alternative intervention. Findings may be explained by methodological quality of studies.

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