***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: BACKGROUND Effective interventions are needed to prevent acquisition of HIV infection in men who have sex with men . To date , no behavioural interventions specifically for this risk group have been tested with HIV infection as the primary outcome . METHODS This multisite two-group r and omised controlled phase IIb trial tested the efficacy of a behavioural intervention in preventing HIV infection among 4295 men who have sex with men . The experimental intervention consisted of ten one-on-one counselling sessions followed by maintenance sessions every 3 months . The st and ard condition was twice-yearly Project RESPECT individual counselling . Twice-yearly follow-up visits included testing for HIV antibody and assessment of behavioural outcomes . FINDINGS The rate of acquisition of HIV infection was 18.2 % ( 95 % CI -4.7 to 36.0 ) lower in the intervention group than the st and ard group . Adjustment for baseline covariates attenuated the intervention effect to 15.7 % ( -8.4 to 34.4 ) . The effect was more favourable in the first 12 - 18 months of follow-up . The occurrence of unprotected receptive anal intercourse with HIV-positive and unknown-status partners was 20.5 % ( 10.9 to 29.0 ) lower in the intervention than in the st and ard group . INTERPRETATION The results from the primary analyses allow us to rule out that the experimental intervention is associated with a 35 % lower rate of HIV acquisition than in the st and ard group . The overall estimate of a difference of 18.2 % , more favourable estimates of effect in the first 12 - 18 months , and similar effects on risk behaviours suggest that prevention of HIV infection among men who have sex with men by a behavioural intervention is feasible . Further work should be done to develop more effective interventions Objective : Evaluate a computerized intervention supporting  antiretroviral therapy ( ART ) adherence and HIV transmission  prevention . Design : Longitudinal r and omized controlled trial . Setting s : An academic HIV clinic and a community-based organization in Seattle . Subjects : In a total of 240 HIV-positive adults on ART , 209 completed 9-month follow-up ( 87 % retention ) . Intervention : R and omization to computerized counseling or assessment only , 4 sessions over 9 months . Main Outcome Measures : HIV-1 viral suppression , and self-reported ART adherence and transmission risks , compared using generalized estimating equations . Results : Overall , intervention participants had reduced viral load : mean 0.17 log10 decline , versus 0.13 increase in controls , P = 0.053 , and significant difference in ART adherence baseline to 9 months ( P = 0.046 ) . Their sexual transmission risk behaviors decreased ( odds ratio = 0.55 , P = 0.020 ) , a reduction not seen among controls ( odds ratio = 1.1 , P = 0.664 ) , and a significant difference in change ( P = 0.040 ) . Intervention effect was driven by those most in need ; among those with detectable virus at baseline ( > 30 copies/mL , n = 89 ) , intervention effect was mean 0.60 log10 viral load decline versus 0.15 increase in controls , P = 0.034 . ART adherence at the final follow-up was 13 points higher among intervention participants versus controls , P = 0.038 . Conclusions : Computerized counseling is promising for integrated ART adherence and safer sex , especially for individuals with problems in these areas . This is the first intervention to report improved ART adherence , viral suppression , and reduced secondary sexual transmission risk behavior Objective : To evaluate the effectiveness of a clinician-delivered intervention , implemented during routine clinical care , in reducing unprotected sexual behavior  of HIV-infected patients . Design : A prospect i ve clinical trial comparing the impact of a clinician-delivered intervention arm vs. a st and ard-of-care control arm on unprotected sexual behavior  of HIV-infected patients . Setting : The 2 largest HIV clinics in Connecticut . Participants : A total of 497 HIV-infected patients , aged ≥18 years , receiving HIV clinical care . Intervention : HIV clinical care providers conducted brief client-centered interventions at each clinical encounter that were design ed to help HIV-infected patients reduce unprotected sexual behavior . Main Outcome Measures : Unprotected insertive and receptive vaginal and anal intercourse and unprotected insertive oral sex ; unprotected insertive and receptive vaginal and anal intercourse only . Results : HIV-infected patients who received the clinician-delivered intervention showed significantly reduced unprotected insertive and receptive vaginal and anal intercourse and insertive oral sex over a follow-up interval of 18 months ( P < 0.05 ) . These behaviors increased across the study interval for patients in the st and ard-of-care control arm ( P < 0.01 ) . For the measure of unprotected insertive and receptive vaginal and anal sex only , there was a trend toward a reduction in unprotected sex among intervention arm participants over time ( P < 0.09 ) , and a significant increase in unprotected sex in the st and ard-of-care control arm ( P < 0.01 ) . Conclusions : A clinician-delivered HIV prevention intervention targeting HIV-infected patients result ed in reductions in unprotected sex . Interventions of this kind should be integrated into routine HIV clinical care Background Reducing substance use and unprotected sex by HIV-positive persons improves individual health status while decreasing the risk of HIV transmission . Despite recommendations that health care providers screen and counsel their HIV-positive patients for ongoing behavioral risks , it is unknown how to best provide “ prevention with positives ” in clinical setting s. Positive Choice , an interactive , patient-tailored computer program , was developed in the United States to improve clinic-based assessment and counseling for risky behaviors . Methodology and Findings We conducted a parallel groups r and omized controlled trial ( December 2003–September 2006 ) at 5 San Francisco area outpatient HIV clinics . Eligible patients ( HIV-positive English-speaking adults ) completed an in-depth computerized risk assessment . Participants reporting substance use or sexual risks ( n = 476 ) were r and omized in stratified blocks . The intervention group received tailored risk-reduction counseling from a “ Video Doctor ” via laptop computer and a printed Educational Worksheet ; providers received a Cueing Sheet on reported risks . Compared with control , fewer intervention participants reported continuing illicit drug use ( RR 0.81 , 95 % CI : 0.689 , 0.957 , p = 0.014 at 3 months ; and RR 0.65 , 95 % CI : 0.540 , 0.785 , p<0.001 at 6 months ) and unprotected sex ( RR 0.88 , 95 % CI : 0.773 , 0.993 , p = 0.039 at 3 months ; and RR 0.80 , 95 % CI : 0.686 , 0.941 , p = 0.007 at 6 months ) . Intervention participants reported fewer mean days of ongoing illicit drug use ( -4.0 days vs. -1.3 days , p = 0.346 , at 3 months ; and -4.7 days vs. -0.7 days , p = 0.130 , at 6 months ) than did controls , and had fewer casual sex partners at ( −2.3 vs. −1.4 , p = 0.461 , at 3 months ; and −2.7 vs. −0.6 , p = 0.042 , at 6 months ) . Conclusions The Positive Choice intervention achieved significant cessation of illicit drug use and unprotected sex at the group-level , and modest individual-level reductions in days of ongoing drug use and number of casual sex partners compared with the control group . Positive Choice , including Video Doctor counseling , is an efficacious and appropriate adjunct to risk-reduction efforts in outpatient setting s , and holds promise as a public health HIV intervention . Trial Registration Clinical trials.gov To support exp and ed prevention services for people living with HIV , the US Health Re sources and Services Administration ( HRSA ) sponsored a 5-year initiative to test whether interventions delivered in clinical setting s were effective in reducing HIV transmission risk among HIV-infected patients . Across 13 demonstration sites , patients were r and omized to one of four conditions . All interventions were associated with reduced unprotected vaginal and /or anal intercourse with persons of HIV-uninfected or unknown status among the 3,556 participating patients . Compared to the st and ard of care , patients assigned to receive interventions from medical care providers reported a significant decrease in risk after 12 months of participation . Patients receiving prevention services from health educators , social workers or paraprofessional HIV-infected peers reported significant reduction in risk at 6 months , but not at 12 months . While clinics have a choice of effective models for implementing prevention programs for their HIV-infected patients , medical provider-delivered methods are comparatively robust OBJECTIVE Men who have sex with men ( MSM ) are the largest group of individuals in the U.S. living with HIV and have the greatest number of new infections . This study was design ed to test a brief , culturally relevant prevention intervention for HIV-infected MSM , which could be integrated into HIV care . METHOD HIV-infected MSM who received HIV care in a community health center ( N = 201 ) , and who reported HIV sexual transmission-risk behavior ( TRB ) in the prior 6 months , were r and omized to receive the intervention or treatment as usual . The intervention , provided by a medical social worker , included proactive case management for psychosocial problems , counseling about living with HIV , and HIV TRB risk reduction . Participants were followed every 3 months for one year . RESULTS Participants , regardless of study condition , reported reductions in HIV TRB , with no significant differential effect by condition in primary intent-to-treat analyses . When examining moderators , the intervention was differentially effective in reducing HIV TRB for those who screened in for baseline depression , but this was not the case for those who did not screen in for depression . CONCLUSIONS The similar level of reduction in HIV TRB in the intervention and control groups , consistent with other recent secondary prevention interventions , speaks to the need for new , creative design s , or more potent interventions in secondary HIV prevention trials , as the control group seemed to benefit from risk assessment , study contact , and referrals provided by study staff . The differential finding for those with depression may suggest that those without depression could reap benefits from limited interventions , but those with a comorbid psychiatric diagnosis may require additional interventions to modify their sexual risk behaviors Objective : To evaluate the feasibility , fidelity , and effectiveness of a human immunodeficiency virus ( HIV ) prevention intervention delivered to HIV-infected patients by counselors during routine clinical care in KwaZulu-Natal , South Africa . Methods : A total of 152 HIV-infected patients , aged 18 years and older , receiving clinical care at an urban hospital in South Africa , were r and omly assigned to intervention or st and ard-of-care control counselors . Intervention counselors implemented a brief risk reduction intervention at each clinical encounter to help patients reduce their unprotected sexual behavior . Self-report question naires were administered at baseline and 6 months to assess number of unprotected sex events in previous 3 months . Results : Intervention was delivered in 99 % of routine patient visits and included a modal 8 of 8 intervention steps . Although HIV-infected patients in both conditions reported more vaginal and anal sex events at 6-month follow-up than at baseline , patients who received the counselor-delivered intervention reported a significant decrease over time in number of unprotected sexual events . There was a marginally significant increase in these events among patients in the st and ard-of-care control condition . Conclusions : A counselor-delivered HIV prevention intervention targeting HIV-infected patients seems to be feasible to implement with fidelity in the South African clinical care setting and effective at reducing unprotected sexual behavior 
    Output:
    
We found limited evidence that sexual risk reduction interventions increase condom use consistency in HIV transmission risk acts , and reduce the number of ( casual ) sexual partners .
We still believe that regular interactions between HIV care providers and PLWHA provide valuable opportunities for theory-based sexual risk reduction interventions to restrain the spread of HIV