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Unfortunately, most of these meta-analyses have considered a limited number of studies and/or selected a single population, thus failing to systematically analyze efficacy associations with gender, race/ethnicity, age, or behavioral risk let alone compare these results with present social disparities. In this context, are the experimentally tested HIV-prevention interventions more likely to reach and reduce the behavioral risk of men than women, Black/African-Americans and Latinos than whites, or men who have sex with men, injection-drug users (IDUs), and multiple-partner heterosexuals (MPHs) than other groups?Ī number of meta-analyses have summarized the results of interventions as they are being tested in the trials designed to establish intervention efficacy, hereafter termed “experimental interventions” ( Noar, 2008). And here again, these sex- and drug-related behaviors are sometimes higher in people living with HIV than the US population as a whole ( Brady et al., 2008 National Opinion Research Center, 1998).
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With respect to behavior, 53% of people living with HIV contracted the virus through male-to-male sexual contact, 32% through high-risk heterosexual contact, 12% through injection-drug use, and 3% through either male-to-male sexual contact or injection-drug use ( Centers for Disease Control, 2007). With respect to age, 50% of the HIV cases are between 16 and 34 years old ( Centers for Disease Control, 2007) even though only 40% of the general population falls in this age range ( United States Census, 2007). Likewise, 16% of the HIV cases are Latino ( Centers for Disease Control, 2007) even though only 15% of the general population is Latino ( United States Census, 2007). With respect to race/ethnicity, 60% of the HIV cases are African-Americans ( Centers for Disease Control, 2007) even though only 13% of the general population is African-American ( United States Census, 2007). With respect to gender, 74% of HIV cases are male ( Centers for Disease Control, 2007) even when the general population has comparable representations of men and women ( United States Census, 2007). Of course, early in an epidemic, intervention practices are unlikely to say much about disparities in HIV prevalence and incidence, but how about after 25 years of HIV-prevention-intervention research? Is a lack of analysis of the impact of our HIV-prevention interventions justified? On the basis of currently available data, are our experimental interventions likely to correct current social disparities in HIV? Are experimental interventions more or less acceptable and efficacious for the groups that bear the burden of the disease than other groups?Ĭonsider US social disparities in HIV prevalence. It is perhaps less common to scrutinize health interventions as potential contributors to these health disparities. The epidemic has clearly distributed HIV in a way that further burdens already oppressed groups such as ethnic and sexual-orientation minorities. It is both common and justified to link HIV disparities to unequal structural forces, including differential access to HIV-prevention resources, uneven decision-making power, and unfair distribution of poverty ( Sumartojo, 2000 Sweat & Denison, 1995). 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. Specifically, after accounting for interactions of intervention and facilitator features with characteristics of the recipient population (e.g.
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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. older) people, as well as men who have sex with men, injection-drug users, and multiple partner heterosexuals (vs. other groups), but ill poised to correct the higher prevalence and incidence among younger (vs. females) and African-Americans and Latinos (vs.
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under testing) interventions is well poised to correct the higher prevalence and incidence among males (vs. This review suggested that, if uniformly applied across populations, the analyzed set of experimental (i.e. 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. 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.