Sex Transm Infect 89:620-627 doi:10.1136/sextrans-2013-051135
  • Review

Behavioural interventions to reduce sexual risk for HIV in heterosexual couples: a meta-analysis

  1. Blair T Johnson
  1. Department of Psychology, Center for Health, Intervention, and Prevention, University of Connecticut, Storrs, Connecticut, USA
  1. Correspondence to Jessica M LaCroix, Department of Psychology, Center for Health, Intervention, and Prevention, 2006 Hillside Road, Unit 1248, University of Connecticut, Storrs, CT 06269-1248, USA; jessica.lacroix{at}
  • Received 19 March 2013
  • Revised 5 July 2013
  • Accepted 14 July 2013
  • Published Online First 5 August 2013


Objectives The current study was conducted to synthesise evaluations of couple-based HIV prevention interventions, assess the efficacy of these interventions in reducing sexual risk, and identify moderators of intervention efficacy.

Methods A comprehensive literature search identified 29 interventions (22 reports; N=5168 couples) that met the inclusion criteria, including enrolment of both members of a heterosexual couple, measurement of condom use at baseline and follow-up, and sufficient statistical information to calculate effect sizes. Effect sizes were analysed using fixed-effects and random-effects assumptions; factors related to intervention efficacy were identified using metaregression.

Results Overall, there were significant increases in condom use from baseline to follow-up (d+=0.78, 95% CI 0.48 to 1.09) and significant decreases in partner concurrency (d+=0.37, 95% CI 0.13 to 0.60). Condom use increased to a greater extent when studies were conducted toward the beginning of the epidemic, were located in countries scoring lower on the Human Development Index, enrolled serodiscordant couples, and delivered intervention content in multiple contexts. Couples who had been together longer, reported higher incidence of sexually transmitted infection, were provided voluntary counselling and testing, and provided outcome measures during face-to-face interviews also reported larger increases in condom use.

Conclusions Couple-based interventions are efficacious in reducing unprotected sex within the context of romantic relationships. Future research should continue to improve risk reduction for couples.