Data on incident STDs were available from 10 RCTs that included 10 944 participants. The aggregated effect size was marginally significant (OR = 0.88, 95% CI = 0.72, 1.07), indicating that the intervention groups had a 12% reduction in the odds of incident STD compared with comparison groups. The homogeneity test (Q10 = 18.61, P < 0.03) indicated heterogeneity between trials. Sensitivity tests indicated that excluding one trial  made the intervention effect significant (OR = 0.82, 95% CI = 0.69, 0.98, N = 9). However, none of the studies significantly reduced the overall heterogeneity. Additional sensitivity tests showed that marginally significant intervention effects were observed in studies with follow-ups longer than 12 months (OR = 0.77, 95% CI = 0.59, 1.00, N = 7), but the intervention effect was not significant in trials with follow-ups less than 12 months (OR = 1.00, 95% CI = 0.82, 1.21, k = 3).
On the basis of the linear regression test, we found evidence of publication bias for 35 trials that provided unprotected sex/condom use outcomes (t = −2.614, P = 0.013). The funnel plot was asymmetrical, suggesting that fewer studies with negative interventions effects and large variance were identified in this study (figure not shown). There is no evidence of publication bias for the STD outcomes (t = −0.631, P = 0.546).
Our study shows that behavioral interventions can significantly and positively influence sexual risk behaviors among heterosexual African Americans. The reduction in unprotected sex remained significant up to 6 months following the completion of interventions. Our overall finding (OR = 0.75) is comparable to the findings of other meta-analyses evaluating HIV prevention interventions for heterosexual adults  and adolescents . We also found a marginally significant effect on incident STDs (OR = 0.88), especially at follow-ups greater than 12 months after intervention. However, the effect became significant when eliminating the trial of the lowest methodological quality . This evidence suggests that behavioral interventions can be not only efficacious in changing unprotected sex behaviors but may also reduce incident STDs in heterosexual African Americans.
We identified a number of intervention components associated with risk reduction. Greater efficacy was found for interventions that utilized peer education and aimed to influence social norms about safer sex. Our findings suggest that the influence of peers and the perception of the norms of one's peers should be considered in developing effective interventions for heterosexual African Americans.
When exploring differences between interventions with a particular characteristic to those without that characteristic for the sex outcomes, we identified several patterns that may provide additional information for prevention efforts. Consistent with the findings of previous qualitative studies [16,18,19], cultural tailoring appears to be an important component for reducing sex risk behaviors among heterosexual African Americans. Intriguingly, we did not find any differential efficacy for the particular components of culturally tailored interventions. It is plausible that our inclusion criteria, which stipulated that trials be comprised of at least 80% African–American participants, reduced the variance necessary to detect an effect. More research is needed to assess which specific cultural tailoring components are the active ingredients underlying behavior change.
Additional intervention components that are likely to contribute to behavior change are skills training and negotiation. Utilizing skills training is typical of interventions guided by social cognitive theories, which represent a majority of the interventions in this analysis. There is also evidence of a dose–response relationship regarding number of sessions, time span, and duration of interventions. The independent contributions of these intervention characteristics cannot be disentangled within these data, as the majority of the interventions utilized multiple components and sessions over multiple days. However, the overall findings suggest that behavioral interventions are more likely to be successful if they incorporate skills training and provide opportunities for practicing skills. In addition, future interventions may benefit from utilizing multiple sessions over multiple days, lasting several hours in total length.
The findings of our study must be viewed within the context of the limitations of the available evidence. Interventions we reviewed primarily addressed heterosexual transmission of HIV, although some portions of men may have participated who also engaged in same-sex behavior but did not identify themselves as homosexual. Recent studies have indicated that nongay identified men who have sex with men are more likely to have a female partner and have had unprotected vaginal sex . Additionally, the majority of the trials were unblinded and relied on self-reported sexual behavior, which may result in social desirability bias . However, several factors reduce the likelihood of this being an undue influence. First, the majority of interventions made efforts to reduce this effect by techniques such as ensuring confidentiality. Second, our findings with behavioral outcomes are similar to our outcomes from STDs, which corroborates the self-reported sex behavior findings. Future research should include biological assessment as well as self-reported sexual behavior, as this would increase our ability to evaluate the impact of interventions. Finally, all the trials had a comparison group and the assignment method was randomization, which reduced the likelihood that individual characteristics influenced the intervention effect. Our findings were also limited in that the majority of interventions (23/26) did not distinguish between primary and secondary partners in their analysis. Given that condom use has been found to differ between these types of partners , we recommend that future studies examine these partner-level differences both when assessing and reporting episodes of unprotected sex and condom use. Our meta-analysis was also limited by the fact that we only included individual-level and group-level interventions. There were only a few randomized community-level and structural-level interventions available in the literature [73–75]. However, given that many risk factors associated with HIV risk-taking in heterosexual African Americans are structural (e.g., poverty, access to care), future research should evaluate community-level and structural-level interventions when more RCTs become available.
Despite these limitations, our findings also pointed out several implications for future research. It is encouraging to see that several of the intervention studies [47,48] in our study were conducted with heterosexual African–American men, an understudied group [8,76]. Although studies targeting African–American adolescents were well represented in this study, few of these studies focused on younger adolescents. It is possible that the approach for HIV sex risk reduction among younger African–American adolescents may be different from older adolescents (e.g., interventions may emphasize delay of sexual initiation). We also did not identify any trials that examined prison populations, which have a high HIV prevalence compared with the general population .
Although our findings offer some evidence for factors associated with intervention efficacy in reducing HIV-risk sex behavior in heterosexual African Americans, to make a real impact on the HIV/AIDS epidemic, it is important to translate and disseminate evidence-based research. Some progress has been made in translating scientific-based knowledge into user-friendly intervention packages for dissemination through two CDC projects – Replicating Effective Programs (REP) and Diffusion of Effective Behavioral Interventions (DEBI). Several interventions for heterosexual African Americans have been packaged or are in the process of packaging (see PRS efficacy Web site http://www.cdc.gov/hiv/topics/research/prs/about.htm) . However, translating research findings into effective interventions in real-world settings remains challenging. Although additional research needs to be conducted with regard to this translation, and some limitations to our methodology have been discussed, our findings for both behavioral and biological outcomes suggest that the behavioral strategies utilized in the included interventions can reduce the frequency of HIV risk behaviors in heterosexual African Americans. Thus, we suggest that the following efficacious intervention components identified in this study should be incorporated into the development of future interventions and further evaluated for effectiveness: cultural tailoring, social norms in promoting safer sex behavior, peer education, skills training on correct use of condoms and communication skills needed for negotiating safer sex, and multiple sessions and opportunities to practice skills. Future interventions that are aimed at African–American heterosexual participants should take the unique needs of the community into account.
Other members of the HIV/AIDS Prevention Research Synthesis (PRS) Team who contributed to this review are (listed alphabetically) Julia Deluca, Jeffrey H. Herbst, Angela K. Horn, Linda Kay, Elizabeth Jacobs, Mary Mullins, Warren Passin, Sima Rama, Sekhar Thadiparthi, and Lev Zohrabyan.
L.A.D., G.E.K. and G.W.R. were supported in part by grants from the Office of AIDS, California Department of Health Services, and the Office of Minority Health, US. Department of Health and Human Services, and L.A.D. by NIH grant K08 MH 072380. The work of N.C. and C.M.L. was supported by the Prevention Research Branch, Division of HIV/AIDS Prevention, US. Centers for Disease Control and Prevention, and was not funded by any other organization.
All authors contributed to review concept and synthesis method. L.A.D. led the writing of Introduction and Discussion, scope screened studies, contacted authors for additional information, and abstracted qualitative data. N.C. led the writing of Methods and Results, abstracted qualitative and quantitative data, and conducted meta-analysis. C.M.L. abstracted qualitative and quantitative data, helped with quantitative analysis, and provided critical review of the manuscript. G.E.K. helped out screening studies, abstracted qualitative data, and provided critical review of the manuscript. G.W.R. provided critical review of the manuscript.
The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention.
1. Centers for Disease Control and Prevention. Atlanta: US Department of Health and Human Services, Centers for Disease Control and Prevention; 2004. HIV/AIDS Surveillance Report No. 16. http://www.cdc.gov/hiv/stats/hasrlink.htm
2. Centers for Disease Control and Prevention. Racial ethnic disparities in diagnoses of HIV/AIDS – 33 states, 2001–2004
. Morbidity Mortality Wkly Rep
3. Herbst JH, Sherba RT, Crepaz N, DeLuca JB, Zohrabyah L, Stall RD, Lyles CM, for the HIV/AIDS Prevention Research Synthesis Team. A meta-analytic review of HIV behavioral interventions for reducing sexual risk behavior of men who have sex with men. J Acquir Immune Defic Syndr 2005; 39:228–241.
4. Johnson WD, Hedges LV, Ramirez G, Semann S, Norman LR, Sogolow E, et al
. HIV prevention research for men who have sex with men: a systematic review and meta-analysis. J Acquir Immune Defic Syndr 2002; 30(Suppl 1):S118–S129.
5. Johnson WD, Holtgrave DR, McClellan WM, Flanders WD, Hill AN, Goodman M. HIV intervention research for men who have sex with men: a 7-year update. AIDS Educ Prev 2005; 17:568–589.
6. Logan TK, Cole J, Leukefeld C. Women, sex, and HIV: social and contextual factors, meta-analysis of published interventions, and implications for practice and research. Psychol Bull 2002; 128:851–885.
7. Mize SJ, Robinson BE, Bockting WO, Scheltema KE. Meta-analysis of the effectiveness of HIV prevention interventions for women. AIDS Care 2002; 14:163–180.
8. Neumann MS, Johnson WD, Semaan S, Flores SA, Peersman G, Hedges LV, Sogolow E. Review and meta-analysis of HIV prevention intervention research for heterosexual adult populations in the United States. J Acquir Immune Defic Syndr 2002; 30(Suppl 1):S106–S117.
9. Semaan S, Des Jarlais DC, Sogolow E, Johnson WD, Hedges LV, Ramirez G, et al
. A meta-analysis of the effect of HIV prevention interventions on sex behavior of drug users in the U.S. J Acquir Immune Defic Syndr 2002; 30(Suppl 1):S73–S93.
10. Copenhaver MM, Johnson BT, Lee IC, Harman JJ, Carey MP, and SHARP Research Team. Behavioral HIV risk reduction among people who inject drugs: a meta-analytic evidence of efficacy. J Subst Abuse Treat 2006; 31:163–171.
11. Johnson BT, Carey MP, Marsh KL, Levin KD, Scott-Sheldon LA. Interventions to reduce sexual risk for the human immunodeficiency virus in adolescents, 1985–2000: a research synthesis. Arch Pediatr Adolesc Med 1985; 157:381–388.
12. Kim N, Stanton B, Li X, Dickersin K, Galbraith J. Effectiveness of the 40 adolescent AIDS-risk reduction interventions: a quantitative review. J Adolesc Health 1997; 20:204–215.
13. Herbst JH, Kay LS, Passin WF, Lyles CM, Crepaz N, Marin BV, for the HIV/AIDS Prevention Research Synthesis (PRS) Team. A systematic review and meta-analysis of behavioral interventions to reduce HIV risk behaviors of Hispanics in the United States and Puerto Rico. AIDS Behav 2007; 11:25–47.
14. Ward DJ, Rowe B, Pattison H. Reducing the risk of sexually transmitted infections in genitourinary medicine clinic patients: a systematic review and meta-analysis of behavioral interventions. Sex Transm Infect 2005; 81:386–389.
15. Crepaz N, Horn AK, Rama SM, Griffin T, Deluca JB, Mullins MM, et al
. The efficacy of behavioral interventions in reducing HIV risk sex behaviors and incident sexually transmitted disease in Black and Hispanic sexually transmitted disease clinic patients in the United States: a meta-analytic review. Sex Transm Dis 2007; 34:319–332.
16. Beatty LA, Wheeler D, Gaiter J. HIV prevention research for African Americans: current and future directions. J Black Psychol 2004; 31:40–58.
17. McNair LD, Prather CM. African American women and AIDS: factors influencing risk and reaction to HIV disease. J Black Psychol 2004; 30:106–123.
18. Williams PB. HIV/AIDS case profile of African Americans. Guidelines for ethnic-specific health promotion, education, and risk reduction activities for African Americans. Fam Community Health 2003; 26:289–306.
19. Darbes LA, Kennedy GE, Peersman G, Zohrabyan L, Rutherford G. A systematic review of behavioral HIV prevention interventions for African Americans in the U.S.
Washington, DC: Department of Health and Human Services, Office of the Surgeon General. Government report. http://hivinsite.ucsf.edu/InSite?page=kb-00&doc=kb-07-04-09
20. Scott KD, Gilliam A, Braxton K. Culturally competent HIV prevention strategies for women of color in the United States. Healthc Women Int 2005; 26:17–45.
21. Wilson BDB, Miller RL. Examining strategies for culturally grounded HIV prevention: a review. AIDS Educ Prev 2003; 15:184–202.
22. Higgins JPT, Green S, editors. Cochrane handbook for systematic reviews of interventions 4.2.6 (updated September 2006)
. In: The Cochrane Library
, Issue 4, 2006. Chicester, UK: Wiley.
23. Lyles CM, Crepaz N, Herbst JH, Kay LS, for the HIV/AIDS Prevention Research Synthesis (PRS) Team. Evidence based HIV behavioral prevention from the perspective of CDC's HIV/AIDS Prevention Research Synthesis Team. AIDS Educ Prev 2006; 18(Suppl A):21–31.
24. Jadad AR, Moore RA, Carroll D, Jenkinson C, Reynolds DJM, Gavaghan DJ, McQuay HJ. Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials 1996; 17:1–12.
25. Altman DG, Schulz KF, Moher D, Egger M, Davidoff F, Elbourne D, et al
. The revised CONSORT statement for reporting randomized trials: explanation and elaboration. Ann Intern Med 2001; 134:663–694.
26. Cooper H, Hedges LV. The handbook of research synthesis. New York: Russell Sage Foundation; 1994.
27. Lipsey MW, Wilson DB. Practical meta-analysis. Thousand Oaks: Sage; 2001.
28. Hedges LV, Vevea JL. Fixed and random effects models in meta-analysis. Psychol Meth 1998; 3:486–504.
29. Sutton AJ, Abrams KR, Jones DR, Sheldon TA, Song F. Methods for meta-analysis in medical research. New York: Wiley; 2000.
30. Egger M, Smith GD, Schneider M, Minder C. Bias in meta-analysis detected by a sample, graphical test. BMJ 1997; 315:629–634.
31. Andersen MD, Hockman EM, Smereck GAD. Effect of a nursing outreach intervention to drug users in Detroit, Michigan. J Drug Issues 1996; 26:619–634.
32. Branson BM, Peterman TA, Cannon RO, Ransom R, Zaidi AA. Group counseling to prevent sexually transmitted disease and HIV: a randomized control trial
. Sex Transm Dis
33. Carey MP, Braaten LS, Maisto SA, Gleason JR, Forsyth AD, Durant LE, Jaworski BC. Using information, motivational enhancement and skills training to reduce the risk of HIV infection for low-income urban women: a second randomized clinical trial. Health Psychol 2000; 19:3–11.
34. Cottler LB, Compton WM, Abdallah AB, Cunningham-Williams R, Abram F, Fichtenbaum C, Dotson W. Peer-delivered interventions reduce HIV risk behaviors among out-of-treatment drug abusers. Public Health Rep 1998; 113(Suppl 1):31–41.
35. Dancy BL, Marcantonio R, Norr K. The long-term effectiveness of an HIV prevention intervention for low-income African American women. AIDS Educ Prev 2000; 12:113–125.
36. DeLamater J, Wagstaff DA, Havens KK. The impact of a culturally appropriate STD/AIDS education intervention on black male adolescents' sexual and condom use behavior. Health Educ Behav 2000; 27:454–470.
37. DiClemente RJ, Wingood GM. A randomized controlled trial of an HIV sexual risk-reduction intervention for young African-American women. JAMA 1995; 274:1271–1276.
38. DiClemente RJ, Wingood GM, Harrington KF, Lang DL, Davies SL, Hook EW, et al
. Efficacy of an HIV prevention intervention for African American adolescent girls: a randomized controlled trial. JAMA 2004; 292:171–179.
39. Ehrhardt AA, Exner TM, Hoffman S, Silberman I, Leu CS, Miller S, Levin B. A gender-specific HIV/STD risk reduction intervention for women in a healthcare setting: short- and long-term results of a randomized clinical trial. AIDS Care 2002; 14:147–161.
40. Gollub EL, French P, Loundou A, Latka M, Rogers C, Stein Z. A randomized trial of hierarchical counseling in a short, clinic-based intervention to reduce risk of sexually transmitted diseases in women. AIDS 2000; 14:1249–1255.
41. Harris RM, Bausell RG, Scott DE, Hetherington SE, Kavanagh KH. An intervention for changing high-risk HIV behaviors of African-American drug-dependent women. Res Nurs Health 1998; 21:239–250.
42. Jemmott JB, Jemmott LS, Fong GT. Reductions in HIV risk-associated sexual behaviors among Black male adolescents: effects of an AIDS prevention intervention. Am J Public Health 1992; 82:372–377.
43. Jemmott JB, Jemmott LS, Fong GT. Abstinence and safer sex HIV risk-reduction interventions for African-American adolescents: a randomized controlled trial. JAMA 1998; 279:1529–1536.
44. Jemmott JB, Jemmott LS, Fong GT, McCaffree K. Reducing HIV risk-associated sexual behavior among African American adolescents: testing the generality of intervention effects. Am J Community Psychol 1999; 27:161–187.
45. Kalichman SC, Rompa D, Coley B. Experimental component analysis of a behavioral HIV-AIDS prevention intervention for inner-city women. J Consult Clin Psychol 1996; 64:687–693.
46. Kalichman SC, Cherry C. Male polyurethane condoms do not enhance brief HIV-STD risk reduction interventions for heterosexually active men: results from a randomized test of concept. Int J STD AIDS 1999; 10:548–553.
47. Kalichman SC, Cherry C, Browne-Sperling F. Effectiveness of a video-based motivational skills-building HIV risk-reduction intervention for inner-city African American men. J Consult Clin Psychol 1999; 67:959–966.
48. Kalichman SC, Cain D, Weinhardt L, Benotsch E, Presser K, Zweben A, et al
. Experimental components analysis of brief theory-based HIV/AIDS risk-reduction counseling for sexually transmitted infection patients. Health Psychol 2005; 24:198–208.
49. Kamb ML, Fishbein M, Douglas JM Jr, Rhodes F, Rogers J, Bolan G, et al
., for the Project RESPECT Study Group. Efficacy of risk-reduction counseling to prevent Human Immunodeficiency Virus and sexually transmitted diseases: A randomized controlled trial
50. Kelly JA, Murphy DA, Washington CD, Wilson TS, Koob JJ, Davis DR, et al
. The effects of HIV/AIDS intervention groups for high-risk women in urban clinics. Am J Public Health 1994; 84:1918–1922.
51. Kennedy MG, Mizuno Y, Hoffman R, Baume C, Strand J. The effect of tailoring a model HIV prevention program for local adolescent target audiences. AIDS Educ Prev 2000; 12:225–238.
52. Latkin CA, Sherman S, Knowlton A. HIV prevention among drug users: outcome of a network-oriented peer outreach intervention. Health Psychol 2003; 22:332–339.
53. Maher JE, Peterman TA, Osewe PL, Odusanya S, Scerba JR. Evaluation of a community-based organizations' intervention to reduce the incidence of sexually transmitted diseases: a randomized controlled trial. Southern Med J 2003; 96:248–253.
54. Malow RM, West JA, Corrigan SA, Pena JM, Cunningham SC. Outcome of psychoeducation for HIV risk reduction. AIDS Educ Prev 1994; 6:113–125.
55. Mansfield CJ, Conry ME, Emans SJ, Woods ER. A pilot study of AIDS education and counseling of high-risk adolescents in an office setting. J Adolesc Health 1993; 14:115–119.
56. McCoy CB, Weatherby NL, Metsch LR, McCoy HV, Rivers JE, Correa R. Effectiveness of HIV interventions among crack users. Drugs Soc 1996; 9:137–154.
57. McCoy CB, Khoury EL. The effectiveness of a risk reduction program in Belle Glade, Florida at the six-month follow-up assessment
. Paper presented at the Second Annual NADR National, Meeting; Bethesda, Maryland, USA.
58. Metcalf CA, Malotte K, Douglas JM, Paul SM, Dillon BA, Cross H, et al
, for the Respect-2 Study group. Efficacy of a booster counseling session 6 months after HIV testing and counseling: a randomized controlled trial (RESPECT-2). Sex Transm Dis 2005; 32:123–129.
59. NIMH Multisite HIV Prevention Trial Group. The NIMH multisite HIV prevention trial: reducing HIV sexual risk behavior
60. O'Donnell CR, O'Donnell L, San Doval A, Duran R, Labes K. Reductions in STD infections subsequent to an STD clinic visit: using video-based patient education to supplement provider interactions. Sex Transm Dis 1998; 25:161–168.
61. O'Leary A, Ambrose TK, Raffaelli M, Maibach E, Jemmott LS, Jemmott JB, et al
. Effects of an AIDS risk reduction project on sexual risk behavior of low-income STD patients. AIDS Educ Prev 1998; 10:483–492.
62. Robinson BB, Uhl G, Miner M, Bockting WO, Scheltema KE, Rosser BR, Westover B. Evaluation of a sexual health approach to prevent HIV among low income, urban, primarily African American women: results of a randomized controlled trial. AIDS Educ Prev 2002; 14(3 Suppl A):81–96.
63. Shain RN, Piper JM, Newton ER, Perdue ST, Ramos R, Champion JD, Guerra FA. A randomized, controlled trial of a behavioral intervention to prevent sexually transmitted disease among minority women. N Engl J Med 1999; 340:93–100.
64. Stanton BF, Li X, Ricardo I, Galbraith J, Feigelman S, Kaljee L. A randomized controlled effectiveness trial of an AIDS prevention program for low-income African-American youths. Arch Pediatr Adolesc Med 1996; 150:363–372.
65. Sterk CE, Theall KP, Elifson KW, Kidder D. HIV risk reduction among African-American women who inject drugs: a randomized controlled trial. AIDS Behav 2003; 7:73–86.
66. Wechsberg WM, Lam WKK, Zule WA, Bobashev G. Efficacy of a woman-focused intervention to reduce HIV risk and increase self-sufficiency among African American crack abusers. Am J Public Health 2004; 94:1165–1173.
67. Wenger NS, Linn LS, Epstein M, Shapiro MF. Reduction of high-risk sexual behavior among heterosexuals undergoing HIV antibody testing: a randomized clinical trial. Am J Public Health 1991; 81:1580–1581.
68. Wu Y, Stanton BF, Galbraith J, Kaljee L, Cottrell L, Li X, et al
. Sustaining and broadening intervention impact: a longitudinal randomized trial of 3 adolescent risk reduction approaches. Pediatrics 2003; 111:32–38.
69. Mullen PD, Ramirez G, Strouse D, Hedges LV, Sogolow E. Meta-analysis of the effects of behavioral HIV prevention interventions on the sexual risk behavior of sexually experienced adolescents in controlled studies in the United States. J Acquir Immune Defic Syndr 2002; 30(Suppl 1):S94–S105.
70. Wolitski RJ, Jones KT, Wasserman JL, Smith JC. Self-identification as ‘don low’ among men who have sex with men (MSM) from 12 US cities. AIDS Behav 2006; 10:519–529.
71. Weinhardt LS, Forsyth AD, Carey MP, Jaworski BC, Durant LE. Reliability and validity of self-report measures of HIV-related sexual behavior: progress since 1990 and recommendations for research and practice. Arch Sex Behav 1998; 27:155–180.
72. Moreno CL, El-Bassel N, Morrill AC. Heterosexual women of color and HIV risk: sexual risk factors for HIV among Latina and African-American women. Women Health 2007; 45:1–15.
73. Sikkema KJ, Anderson ES, Kelly JA, Winett RA, Gore-Felton C, Roffman RA, et al
. Outcomes of a randomized controlled community-level HIV prevention intervention for adolescents in low-income housing developments. AIDS 2005; 19:1509–1516.
74. Sikkema KJ, Kelly JA, Winett RA, Solomon LJ, Cargill VA, Roffman RA, et al
. Outcomes of a randomized community-level HIV prevention intervention for women living in 18 low-income housing developments. Am J Public Health 2000; 90:57–63.
75. Ross MW, Chatterjee NS, Leonard L. A community level syphilis prevention programme: outcome data from a controlled trial. Sex Transm Infect 2004; 80:100–104.
76. Marin BV. Analysis of AIDS prevention among African Americans and Latinos in the United States
. A report prepared for the Office of Technology Assessment for the Congress of the United States; August 1995.
78. Lyles CM, Kay LS, Crepaz N, Herbst JH, Passin WF, Kim AS, et al
, for the HIV/AIDS Prevention Research Synthesis Team. Best-evidence interventions: findings from a systematic review of HIV behavioral interventions for U.S. populations at high risk, 2000–2004. Am J Public Health 2007; 97:133–143.