***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 : Sexually transmitted disease ( STD ) , including AIDS , disproportionately affects African-American and Hispanic women . Goal : To evaluate efficacy of st and ard and enhanced ( addition of optional support groups ) gender- and culture-specific , small-group behavioral interventions , compared to interactive STD counseling , in high risk minority women for two years . Methods : Women with a non-viral STD were treated and enrolled in a r and omized trial . Follow-up screens and interviews occurred at 6 months , 1 year , 18 months ( short interview , optional exam ) and 2 years . The primary outcome was subsequent infection with chlamydia and /or gonorrhea . Secondary outcomes included risky sexual behaviors . We employed logistic regression based on intention-to-treat . Results : Data from 775 women were included ; the retention rate was 91 % . Adjusted infection rates were higher in the controls in Year 1 ( 26.8 % ) , Year 2 ( 23.1 % ) , and cumulatively ( 39.8 % ) than in the enhanced ( 15.4 % , P = 0.004 ; 14.8 % , P < 0.03 ; 23.7 % , P < 0.001 , respectively ) and st and ard ( 15.7 % , P = 0.006 ; 14.7 % , P = 0.03 ; 26.2 % , P < 0.008 , respectively ) intervention arms at these time points . Enhanced-intervention women who opted to attend support groups ( attendees ) had the lowest adjusted infection rates in Year 1 ( 12.0 % ) and cumulatively ( 21.8 % ) . Intervention women in general , but particularly attendees , were significantly less likely than controls to have repeat infections . Multiple partners and unprotected sex with an untreated or incompletely treated partner helped explain group differences in infection . Conclusions : Risk-reduction interventions significantly decreased both single and multiple infective episodes with chlamydia and /or gonorrhea and risky sexual behaviors in the two-year study period . Support-group attendance appeared to contribute additional risk reduction in Year 1 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 A r and omised trial was done to evaluate the impact of improved sexually transmitted disease ( STD ) case management at primary health care level on the  incidence of HIV infection in the rural Mwanza region of Tanzania .  HIV incidence was compared in six intervention communities and six pair-matched comparison communities . A r and om cohort of about 1000 adults aged 15 - 54 years from each community was surveyed at baseline and at follow-up 2 years later . Intervention consisted of establishment of an STD reference clinic , staff training , regular supply of drugs , regular supervisory visits to health facilities , and health education about STDs .  12,537 individuals were recruited .  Baseline HIV prevalences were 3.8 % and 4.4 % in the intervention and comparison communities , respectively . At follow-up , 8845 ( 71 % ) of the cohort were seen . Of those initially seronegative , the proportions seroconverting over 2 years were 48 of 4149 ( 1.2 % ) in the intervention communities and 82 of 4400 ( 1.9 % ) in the comparison communities . HIV incidence was consistently lower in the intervention communities in all six matched pairs . Allowing for the community-r and omised design and the effects of confounding factors , the estimated risk ratio was 0.58 ( 95 % CI 0.42 - 0.79 , p = 0.007 ) . No change in reported sexual behaviour was observed in either group . We conclude that improved STD treatment reduced HIV incidence by about 40 % in this rural population . This is the first r and omised trial to demonstrate an impact of a preventive intervention on HIV incidence in a general population 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 Objectives A community level r and omised controlled trial of a Community Popular Opinion Leader ( C-POL ) intervention to reduce bacterial and viral sexually transmitted infections ( STIs ) and unprotected extramarital sex was carried out over 2 years in five countries . The main study results did not find significant intervention effects . This paper presents a sub- analysis examining the differential intervention impacts among high-risk and low-risk participants in the China site . Methods From 2002 –2006 , 3912 migrant market vendors aged 18 and 49 years were recruited at an urban site in China . Markets were r and omly assigned to the C-POL intervention ( N=20 markets ; n=1979 ) or st and ard-care control condition ( N=20 ; n=1933 ) . Both study condition venues received HIV/STI education , free condoms , STI testing and treatment , and training for pharmacists in antibiotic treatments . In intervention markets , C-POLs were identified and trained to diffuse messages regarding safer sex , STI treatment and partner discussion s of sex . The primary biological outcome was incidence of new STIs ( chlamydia , gonorrhoea , syphilis , trichomonas , herpes or HIV ) . The primary sexual behaviour risk outcome was any unprotected extramarital sex in the prior 3 months . Results In unadjusted analyses , women had significantly lower rates of STI infection at 24 months in the C-POL intervention ( 5.7 % ) compared to controls ( 8.3 % ; p=0.043 ) . In mixed-effects regression models , intervention participants with STIs at previous assessment s were about half as likely to have STIs at 24 months ( OR 0.47 , 95 % CI 0.25 to 0.90 ) compared to controls . Conclusions The C-POL intervention lowers HIV risk among those at highest risk ( ie , with a STI or engaging in high-risk sexual activities ) rather than the general population . Trial registration http:// Clinical trials.gov/ identifier NCT 00710060 The Zimbabwe AIDS Prevention Project ( ZAPP ) conducted a r and omized trial to investigate the effectiveness of peer education in preventing  HIV infection . Initial research revealed that if health education could successfully promote a reduction in the number of sex partners and condom use , HIV risk could be greatly reduced . In 1993 , ZAPP began enrolling men working at 40 factories in a study . The men were tested for sexually transmitted diseases ( STD ) and HIV every six months and had access to a ZAPP clinic for counseling , testing , and STD treatment . In June 1994 , ZAPP r and omly chose 20 factories to receive an additional peer education intervention .  Educators were trained for a week and were given refresher courses every six months . Comparison of the incidence of HIV between the control and intervention groups was measured by determining incidence for all individuals and by comparing overall incidence at each factory . Of the 2219 men who were HIV negative after the introduction of peer education  , 78 % completed one follow-up , and HIV incidence  was 2.52%/year . Controlling for time enrolled in the program revealed that the peer education result ed in significantly fewer new HIV infections . Because the voluntary testing and counseling were available at factories with control and intervention programs , this study exposed the independent impact of  peer education .  It is concluded that  peer education , condom distribution , and treatment of STDs should be the cornerstone of HIV prevention policies OBJECTIVE To explore whether adding a gender and HIV training programme to microfinance initiatives can lead to health and social benefits beyond those achieved by microfinance alone . METHODS Cross-sectional data were derived from three r and omly selected matched clusters in rural South Africa : ( i ) four villages with 2-year exposure to the Intervention with Microfinance for AIDS and Gender Equity ( IMAGE ) , a combined microfinance-health training intervention ; ( ii ) four villages with 2-year exposure to microfinance services alone ; and ( iii ) four control villages not targeted by any intervention .  Adjusted risk ratios ( aRRs ) employing village-level summaries compared associations between groups in relation to indicators of economic well-being , empowerment , intimate partner violence ( IPV ) and HIV risk behaviour . The magnitude and consistency of aRRs allowed for an estimate of incremental effects . FINDINGS A total of 1409 participants were enrolled , all female , with a median age of 45 . After 2 years , both the microfinance-only group and the IMAGE group showed economic improvements relative to the control group . However , only the IMAGE group demonstrated consistent associations across all domains with regard to women 's empowerment , intimate partner violence and HIV risk behaviour . CONCLUSION The addition of a training component to group-based microfinance programmes may be critical for achieving broader health benefits . Donor agencies should encourage intersectoral partnerships that can foster synergy and broaden the health and social effects of economic interventions such as microfinance BACKGROUND South African alcohol-serving establishments ( i.e. , shebeens ) offer unique opportunities to reduce HIV risks among men who drink . PURPOSE To test an individual- and a social structural-level HIV prevention intervention for men who drink in shebeens . M 
    Output:
    
There is no clear evidence that structural interventions at the community level to increase condom use prevent the transmission of HIV and other STIs .