Goal oriented interventions reduce condomless sex likelihood among people living with HIV in network meta-analysisSexual Health Interventions Reduce Condomless Sex Among People With HIV

IntroductionNumerous sexual health interventions have been employed to promote safer sexual practices among people living with HIV (PLWH). However, their effectiveness remains uncertain.ObjectivesThis review aimed to assess and rank the effectiveness of different sexual health interventions targeting risky sexual behaviors in PLWH.MethodsWe systematically searched PubMed, Elsevier, the Web of Science, CINAHL, and the Cochrane Library for studies published between January 2010 and June 2025. Randomized controlled trials (RCTs) were included if they recruited PLWH aged ≥18 years and reported original quantitative data on condomless sex and multiple sexual partners across different groups. The network meta-analysis (NMA) was conducted within a Bayesian framework. We used a random effects model to calculate odds ratios (ORs) or standardized mean differences (SMDs) with 95% confidence intervals (CIs). Study quality was assessed using the Cochrane Risk of Bias (RoB) 2.0 tool, and the strength of the body of evidence was evaluated using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) framework.ResultsA total of 34 eligible trials involving 12,967 PLWH and covering four types of sexual health interventions were included. In total, six trials reported outcomes on multiple sexual partners, but no significant effects were observed. A total of 33 trials reporting condomless sex were included in the network meta-analysis. Goal-oriented interventions ranked highest, with surface under the cumulative ranking curve (SUCRA) values of 0.903 and 0.828. Compared to standard care, goal-oriented interventions (OR: 0.54, 95%CI: 0.39 to 0.76) and safe sex skills training (OR: 0.65, 95%CI: 0.43 to 0.99) significantly reduced the likelihood of engaging in condomless sex. However, only goal-oriented interventions showed statistically significant superiority over control conditions in most subgroup analyses, including those stratified by country income level, intervention format and delivery mode, recruitment setting, and participant type.ConclusionThis review highlights the effectiveness of goal-oriented interventions in substantially reducing condomless sexual behaviors among PLWH. Such interventions should be prioritized to address the persistently high prevalence of risky sexual behaviors in this population, with important implications for preventing potential HIV recombination and other sexually transmitted infection (STI) co-infections, thereby reducing the overall health burden in this vulnerable group.Systematic review registrationIdentifier CRD42023414692.