***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Women who exchange sex for money or other goods , that is , female sex workers , are at increased risk of experiencing physical and sexual violence from both paying and intimate partners . Exposure to violence can be exacerbated by alcohol use and HIV/STI risk . The purpose of this study is to examine the efficacy of a HIV/STI risk reduction and enhanced HIV/STI risk reduction intervention at decreasing paying and intimate partner violence against Mongolian women who exchange sex and engage in harmful alcohol use . Women are recruited and r and omized to either ( a ) four sessions of a relationship-based HIV/STI risk reduction intervention ( n = 49 ) , ( b ) the same HIV/STI risk reduction intervention plus two additional motivational interviewing sessions ( n = 58 ) , or ( c ) a four session control condition focused on wellness promotion ( n = 59 ) . All the respondents complete assessment s at baseline ( preintervention ) as well as at immediate posttest , 3 and 6 months postintervention . A multilevel logistic model finds that women who participated in the HIV/STI risk reduction group ( OR = 0.14 , p < .00 ) , HIV/STI risk reduction and motivational interview group ( OR = 0.46 , p = .02 ) , and wellness ( OR = 0.20 , p < .00 ) group reduced their exposure to physical and sexual violence in the past 90 days . No significant differences in effects are observed between conditions . This study demonstrates the efficacy of a  relationship-based HIV/STI risk reduction intervention , a relationship-based HIV/STI risk reduction intervention combined with motivational interviewing , and a wellness promotion intervention in reducing intimate and paying partner violence against women who exchange sex in Mongolia . The findings have significant implication s for the impact of minimal intervention and the potential role of peer networks and social support in reducing women ’s experiences of violence in re source poor setting Objective We evaluate the effect of clinic-based support by HIV-positive Peer Mentors , in addition to st and ard clinic care , on  maternal and infant well-being among Women Living with HIV ( WLH ) from pregnancy through the infant 's first year of life . Methods In a cluster r and omized controlled trial in KwaZulu-Natal , South Africa , eight clinics were r and omized for pregnant WLH to receive either : a St and ard Care condition ( SC ; 4 clinics ; n = 656 WLH ) ; or an Enhanced Intervention ( EI ; 4 clinics ; n = 544 WLH ) . WLH in the EI were invited to attend four antenatal and four postnatal meetings led by HIV-positive Peer Mentors , in addition to SC . WLH were recruited during pregnancy , and at least two post-birth assessment interviews were completed by 57 % of WLH at 1.5 , 6 or 12 months . EI 's effect was ascertained on 19 measures of maternal and infant well-being using r and om effects regressions to control for clinic clustering . A binomial test for correlated outcomes evaluated EI 's overall efficacy . Findings WLH attended an average of 4.1 sessions ( SD = 2.0 ) ; 13 % did not attend any sessions . Significant overall benefits were found in EI compared to SC using the binomial test . Secondarily , over time , WLH in the EI reported significantly fewer depressive symptoms and fewer underweight infants than WLH in the SC condition . EI WLH were significantly more likely to use one feeding method for six months and exclusively breastfeed their infants for at least 6 months . Conclusions WLH benefit by support from HIV-positive Peer Mentors , even though EI participation was partial , with incomplete follow-up rates from 6–12 months . Trial Registration Clinical Trials.gov Objective : To assess effects of a combined microfinance and training intervention on HIV risk behavior  among young female participants in rural South Africa . Design : Secondary analysis of quantitative and qualitative data from a cluster r and omized trial , the Intervention with Microfinance for AIDS and Gender Equity study . Methods : Eight villages were pair-matched and r and omly allocated to receive the intervention . At baseline and after 2 years , HIV risk behavior was assessed among female participants aged 14–35 years . Their responses were compared with women of the same age and poverty group from control villages . Intervention effects were calculated using adjusted risk ratios employing village level summaries . Qualitative data collected during the study explored participants ' responses to the intervention including HIV risk behavior . Results : After 2 years of follow-up , when compared with controls , young participants had higher levels of HIV-related communication ( adjusted risk ratio 1.46 , 95 % confidence interval 1.01–2.12 ) , were more likely to have accessed voluntary counseling and testing ( adjusted risk ratio 1.64 , 95 % confidence interval 1.06–2.56 ) , and less likely to have had unprotected sex at last intercourse with a nonspousal partner ( adjusted risk ratio 0.76 , 95 % confidence interval 0.60–0.96 ) . Qualitative data suggest a greater acceptance of intrahousehold communication about HIV and sexuality . Although women noted challenges associated with acceptance of condoms by men , increased confidence and skills associated with participation in the intervention supported their introduction in sexual relationships . Conclusions : In addition to impacts on economic well being , women 's empowerment and intimate partner violence , interventions addressing the economic and social vulnerability of women may contribute to reductions in HIV risk behavior OBJECTIVES We examined the effect of a peer-delivered educational intervention , the Malawi Male Motivator intervention , on  couples '  contraceptive uptake . We based the intervention design on the information-motivation-behavioral skills ( IMB ) model . METHODS In 2008 we recruited 400 men from Malawi 's Mangochi province who reported not using any method of contraception . We r and omized them into an intervention arm and a control arm , and administered surveys on contraceptive use at baseline and after the intervention . We also conducted in-depth interviews with a subset of intervention participants . RESULTS After the intervention , contraceptive use increased significantly within both arms ( P < .01 ) , and this increase was significantly greater in the intervention arm than it was in the control arm ( P < .01 ) . Quantitative and qualitative data indicated that increased ease and frequency of communication within couples were the only significant predictors of uptake ( P < .01 ) . CONCLUSIONS Our findings indicate that men facilitated contraceptive use for their partners . Although the IMB model does not fully explain our findings , our results show that the intervention 's content and its training in communication skills are essential mechanisms for successfully enabling men to help couples use a contraceptive Background Violence against female sex workers ( FSWs ) can impede HIV prevention efforts and contravenes their human rights . We developed a multi-layered violence intervention targeting policy makers , secondary stakeholders ( police , lawyers , media ) , and primary stakeholders ( FSWs ) , as part of wider HIV prevention programming involving > 60,000 FSWs in Karnataka state . This study examined if violence against FSWs is associated with reduced condom use and increased STI/HIV risk , and if addressing violence against FSWs within a large-scale HIV prevention program can reduce levels of violence against them . Methods FSWs were r and omly selected to participate in polling booth surveys ( PBS 2006 - 2008 ; short behavioural question naires administered anonymously ) and integrated behavioural-biological assessment s ( IBBAs 2005 - 2009 ; administered face-to-face ) . Results 3,852 FSWs participated in the IBBAs and 7,638 FSWs participated in the PBS . Overall , 11.0 % of FSWs in the IBBAs and 26.4 % of FSWs in the PBS reported being beaten or raped in the past year . FSWs who reported violence in the past year were significantly less likely to report condom use with clients ( zero unprotected sex acts in previous month , 55.4 % vs. 75.5 % , adjusted odds ratio ( AOR ) 0.4 , 95 % confidence interval ( CI ) 0.3 to 0.5 , p < 0.001 ) ; to have accessed the HIV intervention program ( ever contacted by peer educator , 84.9 % vs. 89.6 % , AOR 0.7 , 95 % CI 0.4 to 1.0 , p = 0.04 ) ; or to have ever visited the project sexual health clinic ( 59.0 % vs. 68.1 % , AOR 0.7 , 95 % CI 0.6 to 1.0 , p = 0.02 ) ; and were significantly more likely to be infected with gonorrhea ( 5.0 % vs. 2.6 % , AOR 1.9 , 95 % CI 1.1 to 3.3 , p = 0.02 ) . By the follow-up surveys , significant reductions were seen in the proportions of FSWs reporting violence compared with baseline ( IBBA 13.0 % vs. 9.0 % , AOR 0.7 , 95 % CI 0.5 to 0.9 p = 0.01 ; PBS 27.3 % vs. 18.9 % , crude OR 0.5 , 95 % CI 0.4 to 0.5 , p < 0.001 ) . Conclusions This program demonstrates that a structural approach to addressing violence can be effectively delivered at scale . Addressing violence against FSWs is important for the success of HIV prevention programs , and for protecting their basic human rights The aim of this study is to assess whether the Government of Kenya 's Cash Transfer for Orphans and Vulnerable Children ( Kenya CT-OVC ) can reduce the risk of HIV among young people by postponing sexual debut . The program provides an unconditional transfer of US$ 20 per month directly to the main caregiver in the household . An evaluation of the program was implemented in 2007–2009 in seven districts . Fourteen Locations were r and omly assigned to receive the program and fourteen were assigned to a control arm . A sample of households was enrolled in the evaluation in 2007 . We revisited these households in 2011 and collected information on sexual activity among individuals between 15–25 years of age . We used logistic regression , adjusted for the respondent 's age , sex and relationship to caregiver , the age , sex and schooling of the caregiver and whether or not the household lived in Nairobi at baseline , to compare rates of sexual debut among young people living in program households with those living in control households who had not yet entered the program . Our results , adjusted for these covariates , show that the program reduced the odds of sexual debut by 31 percent . There were no statistically significant effects on secondary outcomes of behavioral risk such as condom use , number of partners and transactional sex . Since the CT-OVC provides cash to the caregiver and not to the child , and there are no explicit conditions associated with receipt , these impacts are indirect , and may have been achieved by keeping young people in school . Our results suggest that large-scale national social cash transfer programs with poverty alleviation objectives may have potential positive spillover benefits in terms of reducing HIV risk among young people in Eastern and Southern Africa This article presents the results of a r and omized trial in South Africa of an adapted  evidence -based Woman-Focused intervention  on condom use with primary sex partners . The preliminary findings show that regardless of HIV status , condom negotiation was significantly associated with condom use at the 3- and 6-month follow-ups . By intervention group , significant intervention effects were found at 6-month follow-up for HIV-positive and HIV-unknown status women in the Woman-Focused intervention who were more likely than women in the St and ard intervention to report condom use with a primary male partner . Among HIV-positive women , those in the Woman-Focused group and those with greater sexual control were more likely to report condom use at the 6-month follow-up . The findings indicate that gender-based interventions for women may result in increased condom negotiation skills This cost-effectiveness study analyzes the cost per quality -adjusted life year ( QALY ) gained in a r and omized controlled trial that tested school support as a structural intervention to prevent HIV risk factors among Zimbabwe orphan girl adolescents . The intervention significantly reduced early marriage , increased years of schooling completed , and increased health-related quality of life . By reducing early marriage , the literature suggests the intervention reduced HIV infection . The intervention yielded an estimated US$ 1,472 in societal benefits and an estimated gain of 0.36 QALYs per orphan supported . It cost an estimated US$ 6/QALY gained , about 1 % of annual per capita income in Zimbabwe . That is well below the maximum price that the World Health Organization ( WHO ) Commission on Macroeconomics and Health recommends paying for health gains in low and middle income countries . About half the girls in the intervention condition were boarded when they reached high school . For non-boarders , the intervention ’s financial benefits exceeded its costs , yielding an estimated net cost savings of $ 502 per pupil . Without boarding , the intervention would yield net savings even if it were 34 % less effective in replication . Boarding was not cost-effective . It cost an additional $ 1,234 per girl boarded ( over the 3 years of the study , discounted to present value at a 3 % discount rate ) but had no effect on any of the outcome measures relative to girls in the treatment group who did not board . For girls who did not board , the average cost of approximately 3 years of school support was US$ 973 BACKGROUND Measurement of the global burden of disease with disability-adjusted life-years ( DALYs ) requires disability weights that quantify health losses for all non-fatal consequences of disease and injury 
    Output:
    
The findings suggest that couple counselling for the prevention of vertical transmission ; gender empowerment , community mobilization , and female condom promotion for female sex workers ; exp and ed female condom distribution for the general population ; and post-exposure HIV prophylaxis for rape survivors are cost-effective HIV interventions .
Cash transfers for schoolgirls and school support for orphan girls may also be cost-effective in generalized epidemic setting s. CONCLUSIONS There has been limited research to assess the cost-effectiveness of interventions that seek to address women 's needs and transform harmful gender norms .
Our review identified several promising , cost-effective interventions that merit consideration as critical enablers in HIV investment approaches , as well as highlight that broader gender and development interventions can have positive HIV impacts .