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A Systematic Review to Quantitatively Evaluate ‘Stepping Stones’: A Participatory Community-based HIV/AIDS Prevention Intervention

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Abstract

This first independent systematic review examined evidence for the effectiveness of the stepping stones intervention in HIV prevention. To reduce HIV transmission it addresses gender roles and promotes equitable relationships. Biomedical, behavioural and psychosocial outcomes extracted from six databases and ‘grey’ literature identified eight reports of seven studies (n = 14,630) from India, Gambia, S. Africa, Ethiopia, Angola, Tanzania, Uganda and Fiji. Infection incidence tested in the only RCT showed no significant reduction in HIV, although HSV-2 decreased. Condom use increased (two countries out of eight). Risk reduction results were mixed for declining alcohol misuse (two studies in three) and multiple partners (one in two). Communicating HIV information to partners, family or community improved (three studies from seven). Gender inequity was reduced in India (one in five), but stigma decreased in four studies. Future investigations of diverse cultures and older adults should select high quality biomedical and quality of life measures.

Resumen

La primera revisión sistemática independiente de evidencia cuantitativa, examina la efectividad de la intervención “stepping stones (SS)” la cual intenta reducir la propagación del VIH abordando los roles de genero y promoviendo relaciones equitativas dentro de las comunidades de países en desarrollo. Los resultados biomédicos, psicosociales y de comportamiento fueron extraídos de seis bases de datos y de literatura ¨gris¨. Ocho reportes de siete estudios (uno ECA) contenían 14,630 participantes viviendo en India, Gambia, Sur África, Etiopía, Angola, Tanzania, Uganda y Fiji. No se demostró cambio en la incidencia del VIH a pesar del incremento en el uso del condón, sin embargo HSV-2 disminuyo en el ECA. La información sobre VIH y la comunicación entre parejas, familias y comunidades mejoró. Cambios en la desigualdad de género y la violencia contra la mujer variaban entre culturas. El alto riesgo en el abuso de alcohol, sustancias y estigmatización ha disminuido pero los índices de parejas múltiples y sexo transaccional fueron mixtos. Se necesitan estudios de calidad con más culturas y adultos mayores medidos según ciertos estándares biomédicos y sujetos a medidas de calidad de vida subjetiva.

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Acknowledgments

The authors are very grateful to SS researchers/administrators who assisted us in finding information and Dr Lydia Ruprecht at UNESCO for her comments and support. The authors thank Lilly Barrera for translating the abstract. This research was presented as part fulfillment of a Masters in Health Psychology awarded to Dr Elena Sovetkina by University of Bath, Bath, UK.

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Authors and Affiliations

  1. WHO Centre for the Study of Quality of Life, Department of Psychology, University of Bath, Bath, BA27AY, UK

    Suzanne M. Skevington & Elena C. Sovetkina

  2. Department for Health, University of Bath, Bath, BA27AY, UK

    Fiona B. Gillison

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  1. Suzanne M. Skevington
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  3. Fiona B. Gillison
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Correspondence to Suzanne M. Skevington.

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Skevington, S.M., Sovetkina, E.C. & Gillison, F.B. A Systematic Review to Quantitatively Evaluate ‘Stepping Stones’: A Participatory Community-based HIV/AIDS Prevention Intervention. AIDS Behav 17, 1025–1039 (2013). https://doi.org/10.1007/s10461-012-0327-6

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