We included eight studies with 11,164 participants but one study did not provide enough data to be useful. One study from Africa found a strong increase in uptake of Voluntary Counseling and Testing (VCT) to 51% when delivered on-site which was 14 times more compared to a voucher for off-site testing. However, VCT did not change HIV incidence in one study among African factory workers. In another study among HongKong truck drivers, VCTdecreased self-reported sexually transmitted diseases (STD) but VCT did not decrease unprotected sex significantly. Education was studied among soldiers in Nigeria, Angola and the US, truck drivers in India and factory workers in Thailand.. Education that was modelled after a motivational theory reduced STDs with 32%, decreased unprotected sex with a small amount, reduced sex with a commercial sex worker with 12% but did not decrease the number of partners or the habit of using alcohol before sex.
We concluded that workplace interventions for preventing HIV are feasible and that it is possible to study them in a randomised controlled trial. Peer influence has a positive effect on VCT uptake and workplace interventions can change risky sexual behaviour to a moderate degree. More randomised trials are needed in high risk groups or in areas with high HIV prevalence to find more effective interventions.
Workplace interventions to prevent HIV are feasible. There is moderate quality evidence that VCT offered at the work site increases the uptake of testing. Even though this did no lower HIV-incidence, there was a decrease in self-reported sexual transmitted diseases and a decrease in risky sexual behaviour. There is low quality evidence that educational interventions decrease sexually transmitted diseases, unprotected sex and sex with commercial sex workers but not sex with multiple partners and the use of alcohol before sex.
More and better randomised trials are needed directed at high risk groups such as truck drivers or workers in areas with a very high HIV prevalence such as Southern Africa. Risky sexual behaviour should be measured in a standardised way.
The workplace provides an important avenue to prevent HIV.
To evaluate the effect of behavioral interventions for reducing HIV on high risk sexual behavior when delivered in an occupational setting.
We searched the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE and PsycINFO up until March 2011 and CINAHL, LILACS, DARE, OSH Update, and EPPI database up until October 2010.
Randomised control trials (RCTs) in occupational settings or among workers at high risk for HIV that measured HIV, sexual transmitted diseases (STD), Voluntary Counseling and Testing (VCT), or risky sexual behaviour.
Two reviewers independently selected studies for inclusion, extracted data and assessed risk of bias. We pooled studies that were similar.
We found 8 RCTs with 11,164 participants but one study did not provide enough data. Studies compared VCT to no VCT and education to no intervention and to alternative education.
VCT uptake increased to 51% when provided at the workplace compared to a voucher for VCT (RR=14.0 (95% CI 11.8 to16.7)). After VCT, self-reported STD decreased (RR = 0.10 (95% CI 0.01 to 0.73)) but HIV incidence (RR=1.4 (95% CI 0.7 to 2.7)) and unprotected sex (RR=0.71 (0.48 to 1.06)) did not decrease significantly. .
Education reduced STDs (RR = 0.68 (95%CI 0.48 to 0.96)), unprotected sex (Standardised Mean Difference (SMD)= -0.17 (95% CI -0.29 to -0.05), sex with a commercial sex worker (RR = 0.88 (95% CI 0.81 to 0.96) but not multiple sexual partners (Mean Difference (MD) = -0.22 (95% CI -0.52 to 0.08) nor use of alcohol before sex (MD = -0.01 (95% CI of -0.11 to 0.08).