***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: 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 BACKGROUND Epidemiologic data suggest that infection with herpes simplex virus type 2 ( HSV-2 ) is associated with increased genital shedding of human immunodeficiency virus type 1 ( HIV-1 ) RNA and HIV-1 transmissibility . METHODS We conducted a r and omized , double-blind , placebo-controlled trial of HSV suppressive therapy with valacyclovir ( at a dose of 500 mg twice daily ) in Burkina Faso among women who were seropositive for HIV-1 and HSV-2 ; all were ineligible for highly active antiretroviral therapy . The patients were followed for 24 weeks ( 12 weeks before and 12 weeks after r and omization ) . Regression models were used to assess the effect of valacyclovir on the presence and quantity of genital and plasma HIV-1 RNA and genital HSV-2 DNA during treatment , adjusting for baseline values , and to evaluate the effect over time . RESULTS A total of 140 women were r and omly assigned to treatment groups ; 136 were included in the analyses . At enrollment , the median CD4 cell count was 446 cells per cubic millimeter , and the mean plasma viral load was 4.44 log10 copies per milliliter . With the use of summary - measures analysis , valacyclovir therapy was found to be associated with a significant decrease in the frequency of genital HIV-1 RNA ( odds ratio , 0.41 ; 95 % confidence interval [ CI ] , 0.21 to 0.80 ) and in the mean quantity of the virus ( log(10 ) copies per milliliter , -0.29 ; 95 % CI , -0.44 to -0.15 ) . However , there was no significant decrease in detection of HIV ( risk ratio , 0.93 ; 95 % CI , 0.81 to 1.07 ) . HSV suppressive therapy also reduced the mean plasma HIV-1 RNA level by 0.53 log(10 ) copy per milliliter ( 95 % CI , -0.72 to -0.35 ) . Repeated- measures analysis showed that these effects became significantly stronger during the 3 months of follow-up . CONCLUSIONS HSV suppressive therapy significantly reduces genital and plasma HIV-1 RNA levels in dually infected women . This finding may have important implication s for HIV control . ( Clinical Trials.gov number , NCT00158509 [ Clinical Trials.gov ] . ) OBJECTIVE To evaluate the effectiveness of a community-based acquired immunologic deficiency syndrome ( AIDS ) educational intervention in young adults . METHODS A quasi-experimental design was used . Two townships in Kunshan county , matched by socioeconomic characteristics , were r and omly assigned to intervention or control groups . Eight hundred young adults aged 18 - 30 were recruited from the two townships as study subjects . A 12-month comprehensive educational intervention on AIDS prevention was conducted in the intervention group through local family planning services . RESULTS After intervention , subjects in intervention group significantly improved their knowledge on AIDS and attitudes related to AIDS prevention . Reported rate of condom use during the last episode of sexual intercourse increased from 8.5 % at baseline to 14.4 % after intervention ( chi 2 = 4.66 , P = 0.030 8) . No obvious change was observed among subjects in control group . CONCLUSION This study demonstrated the feasibility of integration of AIDS educational intervention into the existing family planning services . Integration of AIDS programs into family planning program should be considered as a realistic approach for AIDS control in China OBJECTIVES Women in impoverished inner-city neighborhoods are at high risk for contracting HIV . A r and omized , multisite community-level HIV prevention trial was undertaken with women living in 18 low-income housing developments in 5 US cities . METHODS Baseline and 12-month follow-up population risk characteristics were assessed by surveying 690 women at both time points . In the 9 intervention condition housing developments , a community-level intervention was undertaken that included HIV risk reduction workshops and community HIV prevention events implemented by women who were popular opinion leaders among their peers . RESULTS The proportion of women in the intervention developments who had any unprotected intercourse in the past 2 months declined from 50 % to 37.6 % , and the percentage of women 's acts of intercourse protected by condoms increased from 30.2 % to 47.2 % . Among women exposed to intervention activities , the mean frequency of unprotected acts of intercourse in the past 2 months tended to be lower at follow-up ( mean = 4.0 ) than at baseline ( mean = 6.0 ) . These changes were corroborated by changes in other risk indicators . CONCLUSIONS Community-level interventions that involve and engage women in neighborhood-based HIV prevention activities can bring about reductions in high-risk sexual behaviors BACKGROUND The ability of specific behaviour-change interventions to reduce HIV infection in young people remains question able . Since January 1999 , an adolescent sexual and reproductive health ( SRH ) intervention has been implemented in ten r and omly chosen intervention communities in rural Tanzania , within a community r and omised trial ( see below ; NCT00248469 ) . The intervention consisted of teacher-led , peer-assisted in-school education , youth-friendly health services , community activities , and youth condom promotion and distribution . Process evaluation in 1999 - 2002 showed high intervention quality and coverage . A 2001/2 intervention impact evaluation showed no impact on the primary outcomes of HIV seroincidence and herpes simplex virus type 2 ( HSV-2 ) seroprevalence but found substantial improvements in SRH knowledge , reported attitudes , and some reported sexual behaviours . It was postulated that the impact on " upstream " knowledge , attitude , and reported behaviour outcomes seen at the 3-year follow-up would , in the longer term , lead to a reduction in HIV and HSV-2 infection rates and other biological outcomes . A further impact evaluation survey in 2007/8 ( approximately 9 years post-intervention ) tested this hypothesis . METHODS AND FINDINGS This is a cross-sectional survey ( June 2007 through July 2008 ) of 13,814 young people aged 15 - 30 y who had attended trial schools during the first phase of the MEMA kwa Vijana intervention trial ( 1999 - 2002 ) . Prevalences of the primary outcomes HIV and HSV-2 were 1.8 % and 25.9 % in males and 4.0 % and 41.4 % in females , respectively . The intervention did not significantly reduce risk of HIV ( males adjusted prevalence ratio [ aPR ] 0.91 , 95%CI 0.50 - 1.65 ; females aPR 1.07 , 95%CI 0.68 - 1.67 ) or HSV-2 ( males aPR 0.94 , 95%CI 0.77 - 1.15 ; females aPR 0.96 , 95%CI 0.87 - 1.06 ) . The intervention was associated with a reduction in the proportion of males reporting more than four sexual partners in their lifetime ( aPR 0.87 , 95%CI 0.78 - 0.97 ) and an increase in reported condom use at last sex with a non-regular partner among females ( aPR 1.34 , 95%CI 1.07 - 1.69 ) . There was a clear and consistent beneficial impact on knowledge , but no significant impact on reported attitudes to sexual risk , reported pregnancies , or other reported sexual behaviours . The study population was likely to have been , on average , at lower risk of HIV and other sexually transmitted infections compared to other rural population s , as only youth who had reached year five of primary school were eligible . CONCLUSIONS SRH knowledge can be improved and retained long-term , but this intervention had only a limited effect on reported behaviour and no significant effect on HIV/STI prevalence .  Youth interventions integrated within intensive , community-wide risk reduction programmes may be more successful and should be evaluated . TRIAL REGISTRATION Clinical Trials.gov BACKGROUND Male circumcision could provide substantial protection against acquisition of HIV-1 infection . Our aim was to determine whether male circumcision had a protective effect against HIV infection , and to assess safety and changes in sexual behaviour related to this intervention . METHODS We did a r and omised controlled trial of 2784 men aged 18 - 24 years in Kisumu , Kenya . Men were r and omly assigned to an intervention group ( circumcision ; n=1391 ) or a control group ( delayed circumcision , 1393 ) , and assessed by  HIV testing , medical examinations , and behavioural interviews during follow-ups at 1 , 3 , 6 , 12 , 18 , and 24 months . HIV seroincidence was estimated in an intention-to-treat analysis . This trial is registered with Clinical Trials.gov , with the number NCT00059371 . FINDINGS The trial was stopped early on December 12 , 2006 , after a third interim analysis review ed by the data and safety monitoring board . The median length of follow-up was 24 months . Follow-up for HIV status was incomplete for 240 ( 8.6 % ) participants . 22 men in the intervention group and 47 in the control group had tested positive for HIV when the study was stopped . The 2-year HIV incidence was 2.1 % ( 95 % CI 1.2 - 3.0 ) in the circumcision group and 4.2 % ( 3.0 - 5.4 ) in the control group ( p=0.0065 ) ; the relative risk of HIV infection in circumcised men was 0.47 ( 0.28 - 0.78 ) , which corresponds to a reduction in the risk of acquiring an HIV infection of 53 % ( 22 - 72 ) . Adjusting for non-adherence to treatment and excluding four men found to be seropositive at enrollment , the protective effect of circumcision was 60 % ( 32 - 77 ) . Adverse events related to the intervention ( 21 events in 1.5 % of those circumcised ) resolved quickly . No behavioural risk compensation after circumcision was observed . INTERPRETATION Male circumcision significantly reduces the risk of HIV acquisition in young men in Africa . Where appropriate , voluntary , safe , and affordable circumcision services should be integrated with other HIV preventive interventions and provided as expeditiously as possible BACKGROUND R and omized intervention trials in which the community is the unit of r and omization are increasingly being used to evaluate the impact of public health interventions . In the design of community r and omized trials ( CRT ) , the power of the study is likely to be affected by two issues : the matching or stratification of communities , and the number and size of the communities to be r and omized . METHODS Data from three East African community intervention trials , design ed to evaluate the impact of interventions to reduce human immunodeficiency virus ( HIV ) incidence , are used to compare the efficiency of different trial design s. RESULTS Compared with an unmatched design , stratification reduced the between-community variation in the Mwanza trial ( from 0.51 to 0.24 ) and in the Masaka trial ( from 0.38 to 0.28 ) . The reduction was smaller in the Rakai trial where the selected communities were more homogeneous ( from 0.15 to 0.11 ) . For all trials , individual matching of communities produced estimates of between-community variation similar to those from the stratified design s. The linear association between HIV prevalence and incidence was strong in the Mwanza trial ( correlation coefficient R = 0.83 ) and the Masaka trial ( R = 0.83 ) , but weak in the Rakai trial ( R = 0.28 ) . Unmatched study design s that use smaller communities tend to increase between-community variation , but reduce the design effect and improve study power . CONCLUSIONS These empir 
    Output:
    
We failed to confirm the hypothesis that STI control is an effective HIV prevention strategy .
Improved STI treatment services were shown in one study to reduce HIV incidence in an environment characterised by an emerging HIV epidemic ( low and slowly rising prevalence ) , where STI treatment services were poor and where STIs were highly prevalent ; Incidence was not reduced in two other setting s. There is no evidence for substantial benefit from a presumptive treatment intervention for all community members .
There are , however , other compelling reasons why STI treatment services should be strengthened , and the available evidence suggests that when an intervention is accepted it can substantially improve quality of services provided