Department of Medicine, University of Chicago, Chicago, IL 60637, USA.
J Gen Intern Med. 2012 Aug;27(8):1047-67. doi: 10.1007/s11606-012-2036-2.
Racial and ethnic minorities are disproportionately affected by HIV/AIDS in the United States despite advances in prevention methodologies. The goal of this study was to systematically review the past 30 years of HIV prevention interventions addressing racial disparities. We conducted electronic searches of Medline, PsycINFO, CINAHL, and Cochrane Review of Clinical Trials databases, supplemented by manual searches and expert review. Studies published before June 5, 2011 were eligible. Prevention interventions that included over 50% racial/ethnic minority participants or sub-analysis by race/ethnicity, measured condom use only or condom use plus incident sexually transmitted infections or HIV as outcomes, and were affiliated with a health clinic were included in the review. We stratified the included articles by target population and intervention modality. Reviewers independently and systematically extracted all studies using the Downs and Black checklist for quality assessment; authors cross-checked 20% of extractions. Seventy-six studies were included in the final analysis. The mean DB score was 22.44--high compared to previously published means. Most of the studies were randomized controlled trials (87%) and included a majority of African-American participants (83%). No interventions were designed specifically to reduce disparities in HIV acquisition between populations. Additionally, few interventions targeted men who have sex with men or utilized HIV as a primary outcome. Interventions that combined skills training and cultural or interactive engagement of participants were superior to those depending on didactic messaging. The scope of this review was limited by the exclusion of non-clinic based interventions and intermediate risk endpoints. Interactive, skills-based sessions may be effective in preventing HIV acquisition in racial and ethnic minorities, but further research into interventions tailored to specific sub-populations, such as men who have sex with men, is warranted.
尽管预防方法学取得了进步，但美国的少数民族和族裔群体在艾滋病/艾滋病毒方面的受影响程度不成比例。本研究的目的是系统地回顾过去 30 年解决种族差异的艾滋病毒预防干预措施。我们对 Medline、PsycINFO、CINAHL 和 Cochrane 临床试验评论数据库进行了电子搜索，并辅以手动搜索和专家审查。符合条件的研究是在 2011 年 6 月 5 日之前发表的。包括超过 50%的少数民族/族裔参与者或按种族/族裔进行亚分析、仅测量避孕套使用情况或避孕套使用加性传播感染或艾滋病毒作为结果、与健康诊所有关联的预防干预措施包括在审查中。我们根据目标人群和干预方式对纳入的文章进行分层。审查员使用 Downs 和 Black 清单对所有研究进行独立和系统地提取，以进行质量评估；作者交叉检查了 20%的提取内容。76 项研究被纳入最终分析。平均 DB 得分为 22.44--与之前发表的平均值相比很高。大多数研究是随机对照试验（87%），参与者中大多数是非洲裔美国人（83%）。没有专门设计的干预措施来减少人群之间艾滋病毒感染的差异。此外，很少有干预措施针对男男性行为者或将艾滋病毒作为主要结果。结合技能培训和参与者的文化或互动参与的干预措施优于仅依赖说教信息的干预措施。本综述的范围受到排除非诊所干预措施和中间风险终点的限制。互动式、基于技能的课程可能对预防少数民族和族裔群体中的艾滋病毒感染有效，但需要进一步研究针对特定亚人群（如男男性行为者）的干预措施。
