Robinson Jennifer L, Narasimhan Manjulaa, Amin Avni, Morse Sophie, Beres Laura K, Yeh Ping Teresa, Kennedy Caitlin Elizabeth
Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America.
Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland.
PLoS One. 2017 Aug 24;12(8):e0180699. doi: 10.1371/journal.pone.0180699. eCollection 2017.
Many women living with HIV experience gendered power inequalities, particularly in their intimate relationships, that prevent them from achieving optimal sexual and reproductive health (SRH) and exercising their rights. We assessed the effectiveness of interventions to improve self-efficacy and empowerment of women living with HIV to make SRH decisions through a systematic review.
We included peer-reviewed articles indexed in PubMed, PsycINFO, CINAHL, Embase, and Scopus published through January 3, 2017, presenting multi-arm or pre-post intervention evaluations measuring one of the following outcomes: (1) self-efficacy, empowerment, or measures of SRH decision-making ability, (2) SRH behaviors (e.g., condom use, contraceptive use), or (3) SRH outcomes (e.g., sexually transmitted infections [STIs]). Twenty-one studies evaluating 11 intervention approaches met the inclusion criteria. All were conducted in the United States or sub-Saharan Africa. Two high-quality randomized controlled trials (RCTs) showed significant decreases in incident gonorrhea and chlamydia. Sixteen studies measuring condom use generally found moderate increases associated with the intervention, including in higher-quality RCTs. Findings on contraceptive use, condom self-efficacy, and other empowerment measures (e.g., sexual communication, equitable relationship power) were mixed. Studies were limited by small sample sizes, high loss to follow-up, and high reported baseline condom use.
While more research is needed, the limited existing evidence suggests that these interventions may help support the SRH and rights of women living with HIV. This review particularly highlights the importance of these interventions for preventing STIs, which present a significant health burden for women living with HIV that is rarely addressed holistically. Empowerment-based interventions should be considered as part of a comprehensive package of STI and other SRH services for women living with HIV.
许多感染艾滋病毒的女性经历性别权力不平等，尤其是在亲密关系中，这阻碍她们实现最佳性与生殖健康（SRH）并行使自身权利。我们通过系统评价评估了旨在提高感染艾滋病毒女性做出SRH决策的自我效能感和赋权的干预措施的有效性。
我们纳入了截至2017年1月3日在PubMed、PsycINFO、CINAHL、Embase和Scopus中索引的同行评审文章，这些文章呈现多组或干预前后评估，测量以下结果之一：（1）自我效能感、赋权或SRH决策能力的测量指标；（2）SRH行为（如使用避孕套、使用避孕药具）；或（3）SRH结果（如性传播感染[STIs]）。评估11种干预方法的21项研究符合纳入标准。所有研究均在美国或撒哈拉以南非洲进行。两项高质量随机对照试验（RCTs）显示淋病和衣原体感染发病率显著降低。16项测量避孕套使用情况的研究总体上发现干预措施使其适度增加，包括在高质量RCTs中。关于避孕药具使用、避孕套自我效能感和其他赋权措施（如性沟通、平等关系权力）的结果不一。研究受到样本量小、随访失访率高以及报告的基线避孕套使用率高的限制。
虽然需要更多研究，但现有有限证据表明这些干预措施可能有助于支持感染艾滋病毒女性的SRH和权利。本综述特别强调了这些干预措施对于预防性传播感染的重要性，性传播感染给感染艾滋病毒的女性带来重大健康负担，但很少得到全面解决。基于赋权的干预措施应被视为针对感染艾滋病毒女性的性传播感染及其他SRH服务综合套餐的一部分。
