International Centre for Reproductive Health, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
AIDS. 2010 May 15;24(8):1193-202. doi: 10.1097/QAD.0b013e3283384791.
Systematically assess the effectiveness of HIV-prevention interventions in changing sexual behaviour of young people (10-25 years) in sub-Saharan Africa.
Three online databases were searched using prespecified terms. Additional articles were identified on websites of international organizations and by searching bibliographies. Randomized and nonrandomized trials of interventions aiming to reduce risk behaviour were included as well as single-arm studies reporting effects of differential exposure to an intervention. Data were extracted independently in duplicate using predefined data fields.
Thirty-one studies on 28 interventions met the inclusion criteria, including 11 randomized trials. Difficulties with implementing planned activities were reportedly common and differential exposure to intervention was high. Two hundred and seventeen outcome measures were extracted: 88 early (within 1 year of intervention) and 129 late outcomes (more than 1 year after the end of the intervention). Sex education and condom promotion among youth did not increase sexual behaviour as well as risky sexual behaviour. No positive effects on sexual behaviour were detected either and condom use at last sex only increased among males [relative risk = 1.46; 95% confidence interval = 1.31-1.64]. One study reported a reduction of herpes simplex virus-2, but not HIV incidence.
There remains a stark mismatch between the HIV burden in youth and the number of attempts to design and test prevention interventions - only two trials report biological outcomes. More effective interventions targeting youth are needed. Attention should go to studying implementation difficulties, sex differences in responses to interventions, determinants of exposure to interventions and perhaps inclusion of other factors apart from HIV/AIDS which influence sexual behaviour.
系统评估艾滋病毒预防干预措施在改变撒哈拉以南非洲青年（10-25 岁）性行为方面的效果。
使用预设术语在三个在线数据库中进行搜索。还在国际组织的网站上和通过搜索参考文献确定了其他文章。纳入旨在减少风险行为的干预措施的随机和非随机试验以及报告干预措施差异暴露效果的单臂研究。使用预定义的数据字段独立地重复提取数据。
31 项研究（28 项干预措施）符合纳入标准，包括 11 项随机试验。据报道，实施计划活动的困难很常见，干预措施的差异暴露率很高。共提取了 217 个结果指标：88 个早期（干预后 1 年内）和 129 个晚期（干预结束后 1 年以上）结果。对青年进行性教育和推广避孕套并没有增加性行为和危险性行为。也没有发现性行为方面的积极影响，只有男性的最后一次性行为时避孕套使用增加[相对风险=1.46；95%置信区间=1.31-1.64]。一项研究报告了单纯疱疹病毒 2 感染的减少，但没有 HIV 感染的减少。
艾滋病毒在青年中的负担与设计和测试预防干预措施的尝试数量之间仍然存在明显的不匹配——只有两项试验报告了生物学结果。需要更有效的针对青年的干预措施。应关注研究实施困难、干预措施反应的性别差异、干预措施暴露的决定因素，以及除影响性行为的艾滋病毒/艾滋病之外可能包括其他因素。
