The effectiveness of community interventions targeting HIV and AIDS prevention at young people in developing countries

Objective To identify successful HIV/AIDS prevention interventions targeting youths and delivered in geographically bounded communities (for example, rural villages, urban settlements or neighbourhoods) in developing countries. Methods A systematic review and synthesis of studies evaluating interventions that were published between January 1990 and December 2004 was conducted. Using predetermined criteria, all interventions were summarized into multiple tables to facilitate comparison. Results of the evaluations of each of four types of intervention were reviewed using predetermined thresholds of evidence. The four types of interventions were classified as follows. Type 1 interventions were those targeting youths and delivered through existing organizations or centres that served youths. Type 2 were those targeting youths but not affiliated with existing organizations or centres. Type 3 were those targeting all community members and delivered through traditional kinship networks. Type 4 were those targeting communities as a whole and delivered through community-wide events. Findings Evaluations of 22 interventions were reviewed. Type 1 interventions produced primarily positive results at the required threshold of evidence. They are recommended for use in scaling-up projects but should be subject to continued rigorous evaluations. Studies of all other intervention types produced primarily positive results, but the evaluations were less rigorous so clear conclusions could not be drawn about their effectiveness. It is recommended that these interventions be continued and that priority should be given to implementing rigorous evaluations of these interventions. Conclusions Considerable creativity, ingenuity and commitment is demonstrated in designing and delivering HIV interventions but there is a paucity of adequate evidence of their effectiveness. This precludes identification of the types of interventions that actually produce the targeted changes. It is essential that governments and donor agencies invest in high quality process and outcome evaluations and cost-benefit analyses so that effective interventions can be identified and promoted.