What works to prevent HIV among heterosexual African Americans?

Behavioural HIV prevention interventions targeting heterosexual African Americans that are proven to work require several key characteristics, according to UCSF researchers.

“Peer education, skills training and cultural tailoring were critical factors we found in interventions that reduced HIV risk behaviours and led to lower rates of sexually transmitted infections,” said the study’s lead author, Lynae Darbes, PhD, assistant adjunct professor of medicine at UCSF’s Center for AIDS Prevention Studies and Global Health Sciences.

The results, published in the June 19 issue of the journal AIDS, were based on a meta-analysis of 38 randomised, controlled trials involving more than 14,000 participants.

“It is important to recognise the diversity that exists within the African American community, and we are not recommending ‘one size fits all’ types of interventions,” said Darbes. “Successful interventions homed in on specific aspects of the target populations.”

For instance, the social norms targeted may include influencing one’s perception of being at risk for HIV in one population, delaying sexual initiation in another, reducing the number of partners in another, or some combination of all of these, she said. In addition, actual members from the target population should conduct peer education.

“Cultural tailoring was crucial and, in effective interventions, was derived from activities such as formative research within the target community, using a ‘ground up’ approach as opposed to a ‘top down’ or ‘parachute’ approach. Understanding the community was important in developing efficacious interventions,” said Darbes.

The study’s meta-analysis focused on randomized, controlled trials that measured outcomes – such as changes in rates of unprotected sex, consistency of condom use or sexually transmitted infections – and reported at least one outcome post-intervention.

“This study shows how the technique of meta-analysis can be used to understand an entire literature and to find subtle but important associations that single studies simply can’t find,” said study co-author George W. Rutherford, MD, director of UCSF Global Health Sciences Prevention and Public Health Group.

Co-authors also include Nicole Crepaz and Cynthia Lyles from the Centers for Disease Control and Prevention (CDC) and Gail Kennedy from UCSF Global Health Sciences. The research was funded by the Office of AIDS, California Department of Health Services; the Office of Minority Health, US Department of Health and Human Services; the National Institutes of Health; and the CDC.

Established in 1986 in the early days of the HIV/AIDS epidemic, UCSF’s Center for AIDS Prevention Studies (CAPS) conducts domestic and international research to prevent the acquisition of HIV and to optimise health outcomes among HIV-infected individuals.

UCSF Global Health Sciences Prevention and Public Health Group is dedicated to improving health and reducing the burden of disease in the world’s most vulnerable populations through applied public health research, education and program improvement.

UCSF Global Health Sciences and CAPS are affiliated with the AIDS Research Institute (ARI) at UCSF. UCSF ARI houses hundreds of scientists and dozens of programs throughout UCSF and affiliated labs and institutions, making ARI one of the largest AIDS research entities in the world.

(Source: AIDS: The University of California, San Francisco: July 2008)