As we enter the third decade of the HIV pandemic, there is yet no cure or vaccine. At this time, our principal means for deterring the further spread of HIV remain behavioral risk prevention interventions. Behavioral interventions have directly contributed to decreases in HIV infections throughout the world. For example, in 1982 there were 8,000 new HIV infections in San Francisco, California. In 1992, the number had dropped to 1,000, and as of 1998 infections had dropped still further to less than 500 per year. There is strong evidence that the decrease in infection rates was due to an enormous decline in the levels of unprotected anal intercourse among men who have sex with men (Coates, 1998). Both Uganda and Thailand have demonstrated similar decreases in infection rates. In Uganda, surveys found that people made significant behavioral changes between 1989 and 1995. For example, young people delayed their initiation of sexual activity (e.g., the percentage of 15 year old boys reporting they had never had sex rose from 20% to 50%) and adults increased their condom use (for men from 15% to 55%; for women from 6% to 39%) (UNAIDS, 2001). Concurrently, HIV incidence declined, and behavioral change contributed to this decline (UNAIDS, 2001). In Thailand a rapid escalation of the HIV epidemic was met with prompt behavioral changes encouraged by national prevention programs. For example, visits to sex workers decreased, and condom use increased with both sex workers and casual partners. Similar to Uganda sharp decreases in risk behavior were found as well as a rapid decline in new HIV infections (UNAIDS, 2001). UNAIDS has stated that the experience of Thailand is one of the clearest examples of behavioral changes having a direct link to decreases in HIV infection (UNAIDS, 2001). As these behavioral changes were the result of interventions undertaken on both individual and community levels, developing and implementing effective interventions that focus on behavioral prevention are of utmost importance.

Recent statistics have demonstrated that there is a significant over‐representation of new HIV infections among population sub‐groups characterized by both non‐European racial/ethnic origin and by lower socioeconomic status in high‐income economies. For example, in the United States recent statistics show that over 50% of newly diagnosed HIV infections are occurring among African Americans (FN1) (CDC, 2000) although they only comprise approximately 12% of the U.S. population (U.S. Census, 2000). In Europe, over 50% of heterosexually acquired HIV infections (newly diagnosed between 1997‐2000) are in people from countries with a generalized HIV epidemic (e.g., Sub‐Saharan Africa) (WHO, 2000). Though the WHO estimates that approximately 64% of those newly diagnosed may have been infected prior to their migration (WHO, 2000), migrants new to their country who are not yet infected may be at heightened risk. Thus, although overall prevalence rates of HIV infection may be relatively low in countries such as the U.S., Great Britain and Canada, there are sub‐groups of the population (e.g., in the U.S., African‐American men who have sex with men) who have prevalence rates of HIV infection that rival parts of Sub‐Saharan Africa (Valleroy, 2000).

Specifically, in North America and Europe high prevalence rates of HIV infection among racial and ethnic minorities are present in the following sub‐groups: men who have sex with men (MSM), injection drug users (IDU), heterosexuals and youth/adolescents. For example, prevalence rates by race for HIV infection in participants in a national study of young MSM in the U.S. were 33% for African‐American, 14% for Latino, 2% for Caucasian, and 0% for Asian Americans (Valleroy, 2000). In Canada, Aboriginal persons are over‐represented among HIV‐infected IDU, and persons of African or Afro‐Caribbean origin are over‐represented among HIV infected heterosexuals. In Europe, certain risk groups, such as IDU and heterosexuals, have over‐representation from people of non‐European origin (WHO, 2000). Thus, though some high‐income economies (FN2) may have relatively low prevalence rates of HIV infection they also have certain sub‐groups at increased risk, and these sub‐groups demonstrate prevalence rates close to that of countries more universally impacted by the HIV epidemic.

Although other sociological issues such as socioeconomic status, racism and education are important factors to consider when examining the context in which HIV infection occurs, this review is focused on individually‐focused behavioral interventions. The figures presented above underscore the necessity for examining the results of behaviorally‐focused primary prevention interventions aimed at sub‐groups of racial and ethnic minorities in high‐income economies, focusing on the primary risk groups.

In this systematic review we examine evidence of the effectiveness of prevention interventions for persons of African of Afro‐Caribbean origin, Asian origin and Latin American origin living in high‐income economies. Previous literature reviews have been conducted on racial and ethnic minorities living in the U.S. (e.g. Marin, 1995, for African Americans and Latinos) and a Cochrane review is in progress addressing behavioral prevention interventions for HIV (Cochrane 1998b), but no prior review has systematically reviewed behavioral prevention interventions for all racial and ethnic minorities living in high‐income economies.

Footnotes:
(1) African American is the term used to describe persons of African or Caribbean ancestry living in the United States. It does not usually imply recent migration status.
(2) High‐income economies are defined by the World Bank by gross national income and are: Andorra, Germany, New Caledonia, Aruba, Greece, New Zealand, Australia, Greenland, Northern Mariana Islands, Austria, Guam, Norway, Bahamas, Hong Kong, China, Portugal, Barbados, Iceland, Qatar, Belgium, Ireland, San Marino, Bermuda, Israel, Singapore, Brunei, Italy, Slovenia, Canada, Japan, Spain, Cayman Islands, Kuwait, Sweden, Channel Islands, Liechtenstein, Switzerland, Cyprus, Luxembourg, United Arab Emirates, Denmark, Macao, China, United Kingdom, Faeroe Islands, Malta, United States, Finland, Monaco, Virgin Islands (U.S.), France, Netherlands, French Polynesia, Netherlands, Antilles.