[Combined HIV prevention? Systematic review of interventions with women from low- and middle-income countries]. / Prevenção combinada do HIV? Revisão sistemática de intervenções com mulheres de países de média e baixa renda.

The scope of this systematic review was to characterize interventions for HIV prevention that included adult women and was conducted in low- and middle-income countries after 1996, identifying how they covered individual, social and programmatic vulnerabilities. Databases were accessed from 1997 to July 2016 and the studies selected included adult women, with combined strategies or otherwise, only excluding biomedical or mass media interventions. Thus, 72 interventions developed in 32 countries were selected, most of them in African countries and/or in the upper-middle income bracket, with 26 focusing solely on women. Among the 64 interventions that evaluated results in behavioral, psychosocial and biomedical knowledge on HIV/STI and use of health services, 62 reported positive results, but also of no-effect (n = 52). Few of them reported a reduction in HIV/STI incidence (n = 9), in partner numbers (n = 12) and in stigma and violence reports (n = 7). The content analysis of the interventions revealed that the majority (n = 51) considered only individual vulnerabilities. The need to strengthen preventive approaches targeting structural determinants of the epidemic, encompassing the social contexts of women in a relational and intersectional perspective of vulnerabilities was discussed.

Prevenção combinada do HIV? Revisão sistemática de intervenções com mulheres de países de média e baixa renda / Combined HIV prevention? Systematic review of interventions with women from low- and middle-income countries

Resumo A revisão sistemática objetivou caracterizar as intervenções para prevenção do HIV que incluíam mulheres adultas e desenvolvidas em países de baixa e média renda após 1996, identificando como abarcavam as vulnerabilidades individuais, sociais e programáticas. Foram acessadas bases de dados de 1997 a julho de 2016 e selecionados estudos que incluíam mulheres adultas, com estratégias combinadas ou não, excluindo-se intervenções apenas biomédicas ou de mídia em massa. Foram selecionadas 72 intervenções desenvolvidas em 32 países, sendo a maioria africanos e/ou de renda média-alta e 26 só com mulheres. Entre 64 intervenções que avaliaram aspectos comportamentais, psicossociais, biomédicos, de conhecimentos sobre HIV/IST e uso de serviços de saúde, 62 tiveram resultados positivos, mas também de não efeito (n = 52). Poucas relataram diminuição na incidência de HIV/IST (n = 9), no número de parceiros (n = 12), dos relatos de estigma e de violências (n = 7). A análise de conteúdo das intervenções mostrou que a maioria (n = 51) contemplava apenas vulnerabilidades individuais. Discute-se a necessidade de fortalecer abordagens preventivas que atuem nos determinantes estruturais da epidemia, abarcando os contextos sociais das mulheres numa perspectiva relacional e interseccional das vulnerabilidades.

Abstract The scope of this systematic review was to characterize interventions for HIV prevention that included adult women and was conducted in low- and middle-income countries after 1996, identifying how they covered individual, social and programmatic vulnerabilities. Databases were accessed from 1997 to July 2016 and the studies selected included adult women, with combined strategies or otherwise, only excluding biomedical or mass media interventions. Thus, 72 interventions developed in 32 countries were selected, most of them in African countries and/or in the upper-middle income bracket, with 26 focusing solely on women. Among the 64 interventions that evaluated results in behavioral, psychosocial and biomedical knowledge on HIV/STI and use of health services, 62 reported positive results, but also of no-effect (n = 52). Few of them reported a reduction in HIV/STI incidence (n = 9), in partner numbers (n = 12) and in stigma and violence reports (n = 7). The content analysis of the interventions revealed that the majority (n = 51) considered only individual vulnerabilities. The need to strengthen preventive approaches targeting structural determinants of the epidemic, encompassing the social contexts of women in a relational and intersectional perspective of vulnerabilities was discussed.