Interventions to modify sexual risk behaviours for preventing HIV in homeless youth.
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Date
2011
Journal Title
Journal ISSN
Volume Title
Publisher
John Wiley & Sons, Ltd.
Abstract
Background - Homeless youth are at high risk for HIV infection as a consequence of risky
sexual behavior. Interventions in homeless youth are challenging. Assessment of the effectiveness
of interventions to modify sexual risk behaviours for preventing HIV in homeless youth is needed.
Objectives - To evaluate and summarize the effectiveness of interventions for modifying sexual
risk behaviours and preventing transmission of HIV among homeless youth.
Search methods - We searched electronic databases (CENTRAL, Medline, EMBASE,
AIDSearch, Gateway, PsycInfo, LILACS), reference lists of eligible articles, international health
agency publication lists, and clinical trial registries. The search was updated January 2010. We
contacted authors of published reports and other key role players.
Selection criteria - Randomized studies of interventions to modify sexual risk behavior
(biological, self-report sexual-risk behavior or health seeking behavior) in homeless youth (12–24
years).
Data collection and analysis - Data from eligible studies were extracted by two reviewers.
We assessed risk of bias per the Cochrane Collaborations tool. None of the eligible studies
reported any primary biological outcomes for this review and the reporting of self-report sexual
risk behavior outcomes was highly variable across studies precluding calculation of summary
measures of effect; we present the outcomes descriptively for each study. We contacted authors
for missing or ambiguous data.
Results - We identified three eligible studies after screening a total of 255 unique records. All
three were performed in the United States of America and recruited substance-abusing male and
female adolescents (total N=615) through homeless shelters into randomised controlled trials of
independent and non-overlapping behavioural interventions. The three trials differed in theoretical background, delivery method, dosage (number of sessions,) content and outcome assessments.
Overall, the variability in delivery and outcomes precluded estimation of summary of effect
measures. We assessed the risk of bias to be high for each of the studies. Whilst some effect of the
interventions on outcome measures were reported, heterogeneity and lack of robustness in these
studies necessitate caution in interpreting the effectiveness of these interventions.
Authors’ conclusions - The body of evidence does not permit conclusions on the impact of
interventions to modify sexual risk behaviour in homeless youth. More research is required. While
the psychosocial and contextual factors that fuel sexual risk behaviours among homeless youth
challenge stringent methodologies of RCT’s, novel ways for program delivery and trial retention
are in need of development. Future trials should endeavour to comply with rigorous methodology
in design, delivery, outcome measurement and reporting.
Description
Keywords
AIDS (Disease) in adolescence., Youth--Sexual behaviour., Homeless youth--Health and hygiene., Clinical trials--Evaluation.
Citation
Published in final edited form as: Naranbhai, V., Abdool Karim, Q., Meyer-Weitz, A. 2011. Interventions to modify sexual risk behaviours for preventing HIV in homeless youth. Cochrane Database Syst Rev. (1): CD007501.