Effectiveness of sexual health interventions for reducing risky sexual behaviors among people living with HIV: a network meta-analysis and systematic review

Objectives To assess and rank the effectiveness of different sexual health interventions designed to address risky sexual behaviors in PLWH.

We systematically searched studies published between Jan. 2010 and Dec. 2024. Randomized controlled trails (RCTs) were included if they recruited PLWH over 18 years old, reported original quantitative data on condomless behavior and multiple sexual partners across different groups. We calculated odds ratios (ORs) or standardized mean differences (SMDs) with 95% CIs to summarize the intervention effects.

Our analysis included 34 RCTs with 12,967 participants across four intervention types. Goal-oriented intervention was most effective against the likelihood of engaging in condomless sex (OR: 0.54, 95%CI: 0.39 to 0.76), followed by safe sex skills training (OR: 0.65, 95%CI: 0.43 to 0.99). For reducing the number of condomless sex, goal-oriented intervention also ranked highest but showed no advantages compared to standard of care (SMD: −0.26, 95%CI: −-0.53 to 0.02). Six studies reported the data of multiple sexual partners among PLWH, no significant results were found.

Goal-oriented interventions should be prioritized in reducing condomless sex among PLWH. However, strategies to effectively address the issue of multiple sexual partners among PLWH remain unclear, underscoring the need for further high-quality evidence. Competing Interest Statement The authors have declared no competing interest. Funding Statement This work was supported by the National Natural Science Foundation of China (grant number: 82204169), National Natural Science Foundation of Hunan Province (grant number: 2023JJ40787), and the Young Scientists Fund of the National Natural Science Foundation of China (grant number: 82404386). Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Data Availability This systematic review and network meta-analysis did not involve the collection of primary data and thus did not require ethical approval. All data were obtained from publicly available sources.