***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 Adolescents and young adults in sub-Saharan Africa ( SSA ) are particularly vulnerable to human immunodeficiency virus ( HIV ) and acquired immune deficiency syndrome ( AIDS ) infection . Adolescents orphaned as a direct result of HIV/AIDS are at an elevated risk of acquiring HIV/AIDS and other sexually transmitted infections . However , limited empirical evidence exists on HIV knowledge and prevention programs , especially those design ed to address HIV information gaps among adolescents . This study evaluates the effect of a peer mentorship program provided in addition to other supportive services on HIV/AIDS knowledge , beliefs , and prevention attitudes , among school-going orphaned adolescents in southern Ug and a. We utilize data from the Bridges to the Future Study , a 5-year longitudinal r and omized experimental study funded by the National Institute of Child Health and Human Development . Out of the 1410 adolescents enrolled in the study ( average age = 12.7 at study initiation ) , 855 of them participated in a nine-session , curriculum based peer mentorship program .  We analyzed data collected at baseline and 12-months post intervention initiation . The results from bivariate and regression analysis indicate that , controlling for socioeconomic characteristics , adolescents who participated in a peer mentorship program were more likely than non- participants to report increased scores on HIV/AIDS knowledge ; better scores on desired HIV/AIDS-related beliefs ; and better scores on HIV/AIDS prevention attitudes . Overall , the study findings point to the potential role of a peer mentorship program in promoting the much-desired HIV/AIDS knowledge , beliefs , and prevention attitudes among orphaned adolescents . Future programs and policies that support AIDS-orphaned adolescents in sub-Saharan Africa should consider incorporating peer mentoring programs that provide correct , age , and culturally appropriate HIV information to help protect orphaned adolescents and reduce the risk of HIV infections OBJECTIVES The purpose of this study was to test the effects of an  education program in Tanzania  design ed to reduce children 's risk of human immunodeficiency virus ( HIV ) infection and to improve their tolerance of and care for people with acquired immunodeficiency syndrome ( AIDS ) . METHODS A r and omized controlled community trial including baseline and 12-month follow-up surveys was employed . Public primary schools in the Arusha and Kilimanjaro regions of Tanzania were stratified according to location and r and omly assigned to intervention ( n = 6 ) or comparison ( n = 12 ) conditions . Of the 1063 sixth- grade students ( average age : 13.6 years ) who participated at baseline , 814 participated in the follow-up survey . RESULTS At follow-up , statistically significant effects favoring the intervention group were observed for exposure to AIDS information and communication , AIDS knowledge , attitudes toward people with AIDS , and subjective norms and behavioral intentions toward having sexual intercourse . A consistent positive but nonsignificant trend was seen for attitudes toward having sexual intercourse and for initiation of sexual intercourse during the previous year ( 7 % vs 17 % ) . CONCLUSIONS It is feasible and effective to train local teachers and health workers to provide HIV/AIDS education to Tanzanian primary school children BACKGROUND Intimate partner violence ( IPV ) is associated with HIV infection . We aim ed to assess whether provision of a combination of IPV prevention and HIV services would reduce IPV and HIV incidence  in individuals enrolled in the Rakai Community Cohort Study ( RCCS ) , Rakai , Ug and a. METHODS We used pre-existing clusters of communities r and omised as part of a previous family planning trial in this cohort . Four intervention group clusters from the previous trial were provided st and ard of care HIV services plus a community-level mobilisation intervention to change attitudes , social norms , and behaviours related to IPV , and a screening and brief intervention to promote safe HIV disclosure and risk reduction in women seeking HIV counselling and testing services ( the Safe Homes and Respect for Everyone [ SHARE ] Project ) . Seven control group clusters ( including two intervention groups from the original trial ) received only st and ard of care HIV services . Investigators for the RCCS did a baseline survey between February , 2005 , and June , 2006 , and two follow-up surveys between August , 2006 , and April , 2008 , and June , 2008 , and December , 2009 . Our primary endpoints were self-reported experience and perpetration of past year IPV ( emotional , physical , and sexual ) and laboratory-based diagnosis of HIV incidence in the study population . We used Poisson multivariable regression to estimate adjusted prevalence risk ratios ( aPRR ) of IPV , and adjusted incidence rate ratios ( aIRR ) of HIV acquisition . This study was registered with Clinical Trials.gov , number NCT02050763 . FINDINGS Between Feb 15 , 2005 , and June 30 , 2006 , we enrolled 11 448 individuals aged 15 - 49 years . 5337 individuals ( in four intervention clusters ) were allocated into the SHARE plus HIV services group and 6111 individuals ( in seven control clusters ) were allocated into the HIV services only group . Compared with control groups , individuals in the SHARE intervention groups had fewer self-reports of past-year physical IPV ( 346 [ 16 % ] of 2127 responders in control groups vs 217 [ 12 % ] of 1812 responders in intervention groups ; aPRR 0·79 , 95 % CI 0·67 - 0·92 ) and sexual IPV ( 261 [ 13 % ] of 2038 vs 167 [ 10 % ] of 1737 ; 0·80 , 0·67 - 0·97 ) . Incidence of emotional IPV did not differ ( 409 [ 20 % ] of 2039 vs 311 [ 18 % ] of 1737 ; 0·91 , 0·79 - 1·04 ) . SHARE had no effect on male-reported IPV perpetration . At follow-up 2 ( after about 35 months ) the intervention was associated with a reduction in HIV incidence ( 1·15 cases per 100 person-years in control vs 0·87 cases per 100 person-years in intervention group ; aIRR 0·67 , 95 % CI 0·46 - 0·97 , p=0·0362 ) . INTERPRETATION SHARE could reduce some forms of IPV towards women and overall HIV incidence , possibly through a reduction in forced sex and increased disclosure of HIV results . Findings from this study should inform future work toward HIV prevention , treatment , and care , and SHARE 's ecological approach could be adopted , at least partly , as a st and ard of care for other HIV programmes in sub-Saharan Africa . FUNDING Bill & Melinda Gates Foundation , US National Institutes of Health , WHO , President 's Emergency Plan for AIDS Relief , Fogarty International Center Background While the HIV epidemic is levelling off in sub-Saharan Africa , it remains at an unacceptably high level . Young people aged 15 - 24 years remain particularly vulnerable , result ing in a regional HIV prevalence of 1.4 % in young men and 3.3 % in young women . This study assesses the effectiveness of a peer-led HIV prevention intervention in secondary schools in Rw and a on young people ’s sexual behavior , HIV knowledge and attitudes . Methods In a non-r and omized longitudinal controlled trial , fourteen schools were selected in two neighboring districts in Rw and a Bugesera ( intervention ) and Rwamagana ( control ) . Students ( n = 1950 ) in eight intervention and six control schools participated in three surveys ( baseline , six and twelve months in the intervention ) . Analysis was done using linear and logistic regression using generalized estimation equations adjusted for propensity score . Results The overall retention rate was 72 % . Time trends in sexual risk behavior ( being sexually active , sex in last six months , condom use at last sex ) were not significantly different in students from intervention and control schools , nor was the intervention associated with increased knowledge , perceived severity or perceived susceptibility . It did significantly reduce reported stigma . Conclusions Analyzing this and other interventions , we identified several reasons for the observed limited effectiveness of peer education : 1 ) intervention activities ( spreading information ) are not tuned to objectives ( changing behavior ) ; 2 ) young people prefer receiving HIV information from other sources than peers ; 3 ) outcome indicators are not adequate and the context of the relationship in which sex occurs and the context in which sex occurs is ignored . Effectiveness of peer education may increase through integration in holistic interventions and redefining peer educators ’ role as focal points for sensitization and referral to experts and services . Finally , we argue that a narrow focus on sexual risks will never significantly turn the tide Objective To assess the impact of Stepping Stones , a HIV prevention programme , on incidence of HIV and herpes simplex type 2 ( HSV-2 ) and sexual behaviour . Design Cluster r and omised controlled trial . Setting 70 villages ( clusters ) in the Eastern Cape province of South Africa . Participants 1360 men and 1416 women aged 15 - 26 years , who were mostly attending schools . Intervention Stepping Stones , a 50 hour programme , aims to improve sexual health by using participatory learning approaches to build knowledge , risk awareness , and communication skills and to stimulate critical reflection . Villages were r and omised to receive either this or a three hour intervention on HIV and safer sex . Interviewers administered question naires at baseline and 12 and 24 months and blood was tested for HIV and HSV-2 . Main outcome measures Primary outcome measure : incidence of HIV . Other outcomes : incidence of HSV-2 , unwanted pregnancy , reported sexual practice s , depression , and substance misuse . Results There was no evidence that Stepping Stones lowered the incidence of HIV ( adjusted incidence rate ratio 0.95 , 95 % confidence interval 0.67 to 1.35 ) . The programme was associated with a reduction of about 33 % in the incidence of HSV-2 ( 0.67 , 0.46 to 0.97 ; P=0.036)—that is , Stepping Stones reduced the number of new HSV-2 infections over a two year period by 34.9 ( 1.6 to 68.2 ) per 1000 people exposed . Stepping Stones significantly improved a number of reported risk behaviours in men , with a lower proportion of men reporting perpetration of intimate partner violence across two years of follow-up and less transactional sex and problem drinking at 12 months . In women desired behaviour changes were not reported and those in the Stepping Stones programme reported more transactional sex at 12 months . Conclusion Stepping Stones did not reduce incidence of HIV but had an impact on several risk factors for HIV — notably , HSV-2 and perpetration of intimate partner violence . Trial Registration Clinical Trials NCT00332878 Background HIV-1 control in sub-Saharan Africa requires cost-effective and sustainable programmes that promote behaviour change and reduce cofactor sexually transmitted infections ( STIs ) at the population and individual levels . Methods and Findings We measured the feasibility of community-based peer education , free condom distribution , income-generating projects , and clinic-based STI treatment and counselling services and evaluated their impact on the incidence of HIV-1 measured over a 3-y period in a cluster-r and omised controlled trial in eastern Zimbabwe . Analysis of primary outcomes was on an intention-to-treat basis . The income-generating projects proved impossible to implement in the prevailing economic climate . Despite greater programme activity and knowledge in the intervention communities , the incidence rate ratio of HIV-1 was 1.27 ( 95 % confidence interval [ CI ] 0.92–1.75 ) compared to the control communities . No evidence was found for reduced 
    Output:
    
Conclusion Peer-education-based interventions appear to be particularly effective in facilitating the uptake of HIV-related knowledge , particularly pertaining to transmission routes .