What This Means
This research synthesized evidence from 34 clinical trials involving nearly 13,000 people living with HIV (PLWH) to compare different types of sexual health programs aimed at reducing risky sexual behaviors, particularly unprotected sex. Using a statistical technique called network meta-analysis, the researchers were able to compare multiple intervention types against each other simultaneously, even when head-to-head trials did not exist. The study found that 'goal-oriented interventions' — programs that help individuals set specific personal goals around safer sex practices — were the most effective approach, nearly halving the odds of engaging in condomless sex compared to standard care. A second type, 'safe sex skills training,' also showed a significant benefit, though it was less consistent across different subgroups of patients and settings.
For the outcome of having multiple sexual partners, none of the interventions studied showed a statistically significant effect, though only six trials measured this outcome, limiting the conclusions that can be drawn. The findings held up across a range of subgroup analyses, including by country wealth level, how the intervention was delivered, where participants were recruited, and the type of participant — suggesting goal-oriented interventions may be broadly applicable across diverse contexts.
This research suggests that healthcare systems and public health programs targeting PLWH should prioritize goal-oriented behavioral interventions when aiming to reduce condomless sex. This matters not only for the well-being of PLWH themselves but also because unprotected sex among this population can lead to transmission of other sexually transmitted infections and potentially HIV recombination, where different strains of HIV mix — a concern for long-term epidemic management. The authors registered their review protocol in advance (CRD42023414692), which adds transparency to their methodology.