Results: active and passive programmes

Albarracin defined ‘active’ intervention programmes as those that required participants to practise a skill or do something else health enhancing. Activities include role-playing safer-sex negotiation situations, practising putting on condoms and taking an HIV test.

Active programmes produced an average 38% increase in occasions of sex in which condoms were used, relative to baseline. Because baseline condom use was 32.3%, this resulted in an absolute increase in condom use of 7.8%. These are the increases in the proportion of sex acts in which condoms were used. In addition, the baseline proportion of people using condoms ‘at least sometimes’ implies that 17% more people would start to use condoms at least sometimes.

‘Passive’ programmes were ones in which participants merely received a communication such as reading, or being taught information, or seeing a video. These produced on average a 13% increase in condom use, relative to baseline, or a 4.2% absolute increase.

Of note, there was also a condom-use increase of 8%, relative to baseline, in the control groups. This is probably due to the well-known effect in which inclusion of participants in the control group of a study tends to improve their results, not because of a ‘placebo effect’ in this case, but because control groups are generally provided with some intervention, such as leaflets, or are on the waiting list for interventions, and are therefore an already motivated group.

The effect of active interventions was, therefore, to increase condom use by 30% more than control groups, and by 5% more than passive interventions.

The only exception to this difference between passive and active interventions was in condom provision where – unsurprisingly – simply providing participants with condoms worked better than requiring them to actively ask for them to be provided.

Most types of intervention were effective to some degree, though ones that taught behavioural skills and which induced positive attitudes towards condom use worked best.

The effects observed were strongest for interventions that took place in clinical settings (which, in Albarracin’s definition, also included HIV voluntary organisations that offered some sort of clinically relevant service.) The effects of most types of intervention did not reach significance for interventions conducted in schools or in community settings, though condom provision had a significantly positive effect in community settings.