Behavioral interventions to prevent HIV and other STIs

There is strong evidence that behavioral interventions to reduce HIV and other sexually transmitted infections (STIs) decrease sexual risk behaviors (Henderson 2020, Sagherian 2016, Perez 2018, von Sadovszky 2014, Lorimer 2013, Chin 2012, Cochrane-Johnson 2008, Wetmore 2010, Crepaz 2009, Crepaz 2007, Noar 2008,CG-HIV risk reduction MSM), increase condom use (Gause 2018, Evans 2020, Ruiz-Perez 2017, von Sadovszky 2014, Chin 2012, Cochrane-Shepherd 2011, Johnson 2011, Scott-Sheldon 2011, CG-HIV risk reduction MSM, Noar 2008), and decrease STI incidence (Henderson 2020, Ruiz-Perez 2017, von Sadovszky 2014, Chin 2012, Johnson 2011, Scott-Sheldon 2011, Wetmore 2010, Crepaz 2009, Henderson 2020, Crepaz 2007, Noar 2008).

Behavioral interventions are effective when implemented on the individual-, group-, and community-level (CG-HIV risk reduction MSM, Henderson 2020). They are effective in a variety of settings, including primary care (Cochrane-Shepherd 2011, Cochrane-Johnson 2008, Henderson 2020, CG-HIV risk reduction MSM), STI clinics (Henderson 2020, Crepaz 2007), and schools (Chin 2012). Such interventions have been shown to decrease risky sexual behaviors and STI incidence among men who have sex with men (Perez 2018, O'Donnell 2014, Lorimer 2013, Cochrane-Johnson 2008, Noar 2008, CG-HIV risk reduction MSM), people who are heterosexual (Noar 2008), Black (Gilbert 2021, Evans 2020, Henny 2012, Crepaz 2009, Darbes 2008, Crepaz 2007), or Hispanic (Crepaz 2007), as well as high-risk groups such as STI patients, people living with HIV, and people who use drugs (Henderson 2020, Noar 2008, Crepaz 2007). These interventions also appear to decrease STI incidence (Johnson 2011, Henderson 2020) and risky sexual behaviors among adolescents (Mullen 2002, Chin 2012, Cochrane-Shepherd 2011, Johnson 2011) and women of color with low incomes (Ruiz-Perez 2017).

The effects of behavioral interventions appear strongest among men who have sex with men, individuals who are HIV-positive, and Hispanics (Noar 2008). Behavioral interventions are more effective when culturally tailored (Gilbert 2021, Covey 2016, Crooks 2019, von Sadovszky 2014, Crepaz 2007, Crepaz 2009, Darbes 2008) or delivered by individuals who have similar identities to participants (Covey 2016, Henny 2012, Crepaz 2009, Crepaz 2007, CG-HIV risk reduction MSM). Interventions that include multiple sessions appear to be more effective than single sessions (Crooks 2019, Darbes 2008, CG-HIV risk reduction MSM), though single session interventions can be effective as well (Sagherian 2016, Eaton 2012). Longer counseling sessions of at least two hours appear to be more effective, though shorter sessions can also reduce STI incidence (Henderson 2020).

Interventions that incorporate skills building, such as proper condom use or negotiating safer sex, appear to be more effective than those that do not include skills building components (Gause 2018, von Sadovszky 2014, Lorimer 2013, Wetmore 2010, Darbes 2008, Crepaz 2007, CG-HIV risk reduction MSM). Providing medical services or referrals may increase the effectiveness of behavioral interventions for Black men and men who were formerly incarcerated (Henny 2012).

Behavioral interventions to reduce HIV and other STIs have the potential to decrease disparities in HIV and STI incidence, if they are designed for those most at risk of HIV and STI infection. Inequalities by gender, race, geographic location, and economic status persist in HIV diagnosis and care (Taggart 2021). STIs disproportionately affect racial and sexual minority groups. In 2021, almost a third of chlamydia, gonorrhea, and syphilis infections were diagnosed in Black individuals, and men who have sex with men were diagnosed with around a third of gonorrhea cases and almost half of syphilis infections (CDC-STI Surveillance). In 2019, 29% of new HIV infections were among Hispanic/Latino individuals (CDC-Hispanic/Latino HIV Incidence) and 26% of new HIV infections were in Black gay and bisexual men (CDC-African American MSM HIV Incidence). Young Black men who have sex with men are at particularly high-risk for contracting HIV (Hergenrather 2016). Hispanic women are four times more likely to contract HIV than women who are white (Daniel-Ulloa 2016).

Available evidence suggests that behavioral interventions have been effective for Black and Hispanic men and women (Daniel-Ulloa 2016, Gilbert 2021, Perez 2018, Hergenrather 2016, Henny 2012), STI clinic patients (Crepaz 2007), and men who have sex with men (Perez 2018, Hergenrather 2016, O'Donnell 2014, Lorimer 2013, Noar 2008).

Tailoring interventions for specific groups appear to increase the effectiveness of the intervention (Covey 2016), and culturally tailored interventions can be more effective (Noar 2008, Gilbert 2021, Crooks 2019, von Sadovszky 2014, Crepaz 2007, Crepaz 2009, Darbes 2008). For example, women of color appear to benefit more from culturally grounded, group-based interventions that take place over multiple sessions (Crooks 2019). For Hispanic women, use of lay health advisors, culturally appropriate narratives, and incorporating the Theory of Gender and Power have been successfully used to address cultural factors (Daniel-Ulloa 2016).

Interventions specifically addressing racial and ethnic disparities in HIV prevention are relatively new (Hemmige 2012). More research is needed to understand the effectsof behavioral intervention among vulnerable and understudied populations like young men who have sex with men, particularly those who are also Black, homeless, incarcerated or in foster care (Hergenrather 2016). Additional research is needed on how best practices should be tailored for specific populations such as women of color, Black young men who have sex with men, and heterosexual Black men (Daniel-Ulloa 2016, Gilbert 2021, Hergenrather 2016, Henny 2012).

Sexually transmitted infections (STIs) have carried stigma for centuries, shaped by negative views of poverty, women, and sex (McGough 2005). STIs are associated with promiscuity and deviant behavior for women, while STIs in men are treated merely as a medical condition (East 2012). Stigma has continued to shape how STIs are studied, diagnosed, and treated. The racist and unethical Tuskegee Syphilis Study, administered by the federal government, intentionally withheld syphilis treatment from Black men for decades without their knowledge, to study the natural course of the disease, ultimately sowing widespread mistrust of health systems and medical research (Tobin 2022).

When the AIDS epidemic began, federal response was slow to acknowledge and respond to it, in part because it primarily affected gay men in a time when many states still criminalized homosexuality. While the first case of HIV/AIDS in the U.S. was reported in 1981 (HIV.gov, Bennington-Castro 2020), major federal funding wasn’t allocated until 1985 (Bennington-Castro 2020). HIV criminalization laws were passed in many states criminalizing behavior such as non-disclosure, exposure, and/or transmission of HIV, or increasing sentence length for crimes based on someone’s HIV status (CDC HIV-Exposure), long before pharmaceuticals were available to treat or prevent transmission (CDC HIV-Criminalization). Today, HIV criminalization unjustly applies criminal law to nonmalicious behavior by people living with HIV and the laws are disproportionately applied to people from groups who have been marginalized (Bernard 2022), While 13 states have repealed or modernized their HIV criminalization laws, 34 states still have HIV/STI/communicable disease criminalization laws in place in 2023. Such laws can carry penalties up to life in prison (CDC HIV-Exposure).

State and federal funding are important to address the rising incidence of STIs, however, historical trends show that funding has stagnated (NCSD-STD Funding).

• Who is currently providing behavioral interventions in your community? How are the interventions tailored to reflect the cultures of people in your community?
• How does stigma, and other systematic barriers, prevent people from accessing behavioral interventions in your community? What additional strategies can be implemented to overcome those barriers?
• Who already has access to your program? Are there certain groups in your community that would benefit from a behavioral intervention to prevent and reduce HIV/STI that currently are not involved?

The National Network of STD Clinical Prevention Training Centers provides behavioral intervention training (NNCPTC-BPTC). The Centers for Disease Control and Prevention (CDC) provides resources for HIV/STI prevention including information on effective interventions (CDC-STDs Effective Interventions, CDC-Prevent HIV).

‡ Resources with a focus on equity.

CDC-Prevent HIV - Centers for Disease Control and Prevention (CDC). HIV: Effective interventions. Prevent: Behavioral, biomedical, and structural interventions.

CDC-STDs Effective Interventions^‡ - Centers for Disease Control and Prevention (CDC). Sexually Transmitted Diseases (STDs). Effective interventions: Reviews of specific intervention strategies.

Follins 2017^‡ - Follins LD, Dacus J. Conceptualizing and developing behavioral HIV prevention interventions for Black gay men. Journal of HIV/AIDS & Social Services. 2017;16(1):75-88.

NNCPTC-BPTC - National Network of STD Clinical Prevention Training Centers (NNCPTC). Behavioral Prevention Training Centers (BPTC): courses that teach the use of evidence-based STD/HIV prevention interventions at the individual, group, and community level.

* Journal subscription may be required for access.

Bennington-Castro 2020 - Bennington-Castro J. How AIDS remained an unspoken—but deadly—epidemic for years. History. 2020.

Bernard 2022 - Bernard, E. J., Symington, A., & Beaumont, S. (2022). Punishing vulnerability through HIV criminalization. American Journal of Public Health, 112(S4), S395–S397.

CDC HIV-Criminalization - Centers for Disease Control and Prevention (CDC). (2023). HIV criminalization and ending the HIV epidemic in the U.S. Retrieved April 7, 2026.

CDC HIV-Exposure - Centers for Disease Control and Prevention (CDC). (2023, March 3). HIV and STD criminalization laws. Retrieved April 7, 2026.

CDC-African American MSM HIV Incidence - Centers for Disease Control and Prevention (CDC). HIV: HIV by group. HIV and African American Gay and Bisexual Men: HIV Incidence.

CDC-Hispanic/Latino HIV Incidence - Centers for Disease Control and Prevention (CDC). HIV: HIV by group. HIV and Hispanic/Latino People: HIV Incidence.

CDC-Prevent HIV - Centers for Disease Control and Prevention (CDC). HIV: Effective interventions. Prevent: Behavioral, biomedical, and structural interventions.

CDC-STDs Effective Interventions - Centers for Disease Control and Prevention (CDC). Sexually Transmitted Diseases (STDs). Effective interventions: Reviews of specific intervention strategies.

CDC-STI Surveillance - Centers for Disease Control and Prevention (CDC). Sexually Transmitted Infections Surveillance.

CG-HIV risk reduction MSM - The Guide to Community Preventive Services (The Community Guide). The effectiveness of individual-, group-, and community-level HIV behavioral risk reduction interventions for adult men who have sex with men: A systematic review.

Chin 2012* - Chin HB, Sipe TA, Elder R, et al. The effectiveness of group-based comprehensive risk-reduction and abstinence education interventions to prevent or reduce the risk of adolescent pregnancy, Human Immunodeficiency Virus, and sexually transmitted infections: Two systematic reviews for the Guide to Community Preventive Services. American Journal of Preventive Medicine. 2012;42(3):272-294.

Cochrane-Johnson 2008* - Johnson WD, Diaz RM, Flanders WD, et al. Behavioral interventions to reduce risk for sexual transmission of HIV among men who have sex with men. Cochrane Database of Systematic Reviews. 2008;(3):CD001230.

Cochrane-Shepherd 2011* - Shepherd JP, Frampton GK, Harris P. Interventions for encouraging sexual behaviours intended to prevent cervical cancer. Cochrane Database of Systematic Reviews. 2011;(4):CD001035.

Covey 2016 - Covey J, Rosenthal-Stott HES, Howell SJ. A synthesis of meta-analytic evidence of behavioral interventions to reduce HIV/STIs. Journal of Behavioral Medicine. 2016;39(3):371-385.

Crepaz 2007 - Crepaz N, Horn AK, Rama SM, 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. Sexually Transmitted Diseases. 2007;34(6):319-332.

Crepaz 2009 - Crepaz N, Marshall KJ, Aupont LW, et al. The efficacy of HIV/STI behavioral interventions for African American females in the United States: A meta-analysis. American Journal of Public Health. 2009;99(11):2069-78.

Crooks 2019* - Crooks N, Muehrer RJ. Are sexually transmitted infection/HIV behavioral interventions for women of color culturally grounded? A review of the literature. Journal of the Association of Nurses in AIDS Care. 2019;30(5):e64-e81.

Daniel-Ulloa 2016 - Daniel-Ulloa J, Ulibarri M, Baquero B, et al. Behavioral HIV prevention interventions among latinas in the U.S.: A systematic review of the rvidence. Journal of Immigrant and Minority Health. 2016;18(6):1498-1521.

Darbes 2008 - Darbes L, Crepaz N, Lyles C, Kennedy G, Rutherford G. The efficacy of behavioral interventions in reducing HIV risk behaviors and incident sexually transmitted diseases in heterosexual African Americans. AIDS. 2008;22(10):1177-94.

East 2012* - East L, Jackson D, O’Brien L, Peters K. Stigma and stereotypes: Women and sexually transmitted infections. Collegian. 2012;19(1):15-21.

Eaton 2012 - Eaton LA, Huedo-Medina TB, Kalichman SC, et al. Meta-analysis of single-session behavioral interventions to prevent sexually transmitted infections: Implications for bundling prevention packages. American Journal of Public Health. 2012;102(11):e34–44.

Evans 2020* - Evans R, Widman L, Stokes MN, et al. Association of sexual health interventions with sexual health outcomes in Black adolescents: A systematic review and meta-analysis. JAMA Pediatrics. 2020;174(7):676-689.

Gause 2018* - Gause NK, Brown JL, Welge J, Northern N. Meta-analyses of HIV prevention interventions targeting improved partner communication: effects on partner communication and condom use frequency outcomes. Journal of Behavioral Medicine. 2018;41(4):423-440.

Gilbert 2021 - Gilbert L, Goddard-Eckrich D, Chang M, et al. Effectiveness of a culturally tailored HIV and sexually transmitted infection prevention intervention for Black women in community supervision programs. JAMA Network Open. 2021;4(4):e215226.

Hemmige 2012 - Hemmige V, McFadden R, Cook S, Tang H, Schneider JA. HIV prevention interventions to reduce racial disparities in the United States: A systematic review. Journal of General Internal Medicine. 2012;27(8):1047-1067.

Henderson 2020* - Henderson JT, Senger CA, Henninger M, et al. Behavioral counseling interventions to prevent sexually transmitted infections: Updated evidence report and systematic review for the U.S. Preventive Services Task Force. JAMA - Journal of the American Medical Association. 2020;324(7):682-699.

Henny 2012* - Henny KD, Crepaz N, Lyles CM, et al. Efficacy of HIV/STI behavioral interventions for heterosexual African American men in the United States: A meta-analysis. AIDS and Behavior. 2012;16(5):1092–114.

Hergenrather 2016* - Hergenrather KC, Emmanuel D, Durant S, Rhodes SD. Enhancing HIV prevention among young men who have sex with men: A systematic review of HIV behavioral interventions for young gay and bisexual men. AIDS Education and Prevention. 2016;28(3):252-271.

HIV.gov - HIV.gov. HIV and AIDS timeline.

Johnson 2011 - Johnson BT, Scott-Sheldon LAJ, Huedo-Medina TB, Carey MP. Interventions to reduce sexual risk for human immunodeficiency virus in adolescents: A meta-analysis of trials, 1985-2008. Archives of Pediatrics & Adolescent Medicine. 2011;165(1):77–84.

Lorimer 2013* - Lorimer K, Lawrence M, McPherson K, Cayless S, Cornish F. Systematic review of reviews of behavioural HIV prevention interventions among men who have sex with men. AIDS Care. 2013;25(2):133-150.

McGough 2005 - McGough LG. HIV/AIDS stigma: Historical perspectives on sexually transmitted diseases. Virtual Mentor: Ethics Journal of the American Medical Association. 2005;7(10):710-715.

Mullen 2002 - 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. Journal of Acquired Immune Deficiency Syndromes. 2002;30(Suppl 1):S94-105.

NCSD-STD Funding - National Coalition of STD Directors (NCSD). As STD funding stagnates, rates rise to all-time highs.

NNCPTC-BPTC - National Network of STD Clinical Prevention Training Centers (NNCPTC). Behavioral Prevention Training Centers (BPTC): courses that teach the use of evidence-based STD/HIV prevention interventions at the individual, group, and community level.

Noar 2008* - Noar SM. Behavioral interventions to reduce HIV-related sexual risk behavior: Review and synthesis of meta-analytic evidence. AIDS and Behavior. 2008;12(3):335-353.

O'Donnell 2014* - O’Donnell L, Stueve A, Joseph HA, Flores S. Adapting the VOICES HIV behavioral intervention for Latino men who have sex with men. AIDS and Behavior. 2014;18:767-775.

Perez 2018 - Pérez A, Santamaria EK, Operario D. A systematic review of behavioral interventions to reduce condomless sex and increase HIV testing for Latino MSM. Journal of Immigrant and Minority Health. 2018;20(5):1261-1276.

Ruiz-Perez 2017 - Ruiz-Perez I, Murphy M, Pastor-Moreno G, Rojas-García A, Rodríguez-Barranco M. The effectiveness of HIV prevention interventions in socioeconomically disadvantaged ethnic minority women: A systematic review and meta-analysis. American Journal of Public Health. 2017;107(12):e13-e21.

Sagherian 2016 - Sagherian MJ. Single-session behavioral interventions for sexual risk reduction: A meta-analysis. Annals of Behavioral Medicine. 2016;50(6):920-934.

Scott-Sheldon 2011* - Scott-Sheldon LAJ, Huedo-Medina TB, Warren MR, Johnson BT, Carey MP. Efficacy of behavioral interventions to increase condom use and reduce sexually transmitted infections: A meta-analysis, 1991 to 2010. Journal of Acquired Immune Deficiency Syndromes. 2011;58(5):489-498.

Taggart 2021 - Taggart T, Ritchwood TD, Nyhan K, Ransome Y. Messaging matters: Achieving equity in the HIV response through public health communication. Lancet HIV. 2021;8(6):e376-e386.

Tobin 2022 - Tobin MJ. Fiftieth anniversary of uncovering the Tuskegee syphilis study: The story and timeless lessons. American Journal of Respiratory and Critical Care Medicine. 2022;205(10):1145-1158.

von Sadovszky 2014* - von Sadovszky V, Draudt B, Boch S. A systematic review of reviews of behavioral interventions to promote condom use. Worldviews on Evidence-Based Nursing. 2014;11(2):107–17.

Wetmore 2010 - Wetmore CM, Manhart LE, Wesserheit JN. Randomized controlled trials of interventions to prevent sexually transmitted infections: Learning from the past to plan for the future. Epidemiologic Reviews. 2010;32(1):121-36.