Low-income groups and behaviour change interventions: a review of intervention content, effectiveness and theoretical frameworks.

BACKGROUND: Interventions to change health-related behaviours have potential to increase health inequalities. METHODS: This review investigated the effectiveness of interventions targeting low-income groups to reduce smoking or increase physical activity and/or healthy eating. Of 9766 papers identified by the search strategy, 13 met the inclusion criteria. Intervention content was coded into component technique and theoretical basis, and examined as a potential source of effect heterogeneity. RESULTS: Interventions were heterogeneous, comprising 4-19 techniques. Nine interventions had positive effects, seven resulted in no change and one had an adverse effect. Effective interventions had a tendency to have fewer techniques than ineffective interventions, with no evidence for any technique being generally effective or ineffective. Only six studies cited theory relative to intervention development, with little information about how theory was used and no obvious association with intervention content or effect. CONCLUSION: This review shows that behaviour change interventions, particularly those with fewer techniques, can be effective in low-income groups, but highlights the lack of evidence to draw on in informing the design of interventions for disadvantaged groups.

Human immunodeficiency virus and migrant labor in South Africa.

The authors investigate the impact of the migrant labor system on heterosexual relationships on South African mines and assess the implications for the future transmission of human immunodeficiency virus (HIV) infection. The migrant labor system has created a market for prostitution in mining towns and geographic networks of relationships within and between urban and rural communities. A section of the migrant workforce and a group of women dependent on prostitution for economic support appear especially vulnerable to contracting HIV infection since they are involved in multiple sexual encounters with different, changing partners, usually without condom protection. Furthermore, sexually transmitted disease morbidity is extensive in the general and mineworker populations. Historically, migration facilitated the transmission of sexually transmitted diseases and may act similarly for HIV. Problems of combating the HIV epidemic in South Africa are discussed.

PIP: The impact of the migrant mine labor system in South Africa on transmission of human immunodeficiency virus (HIV) was assessed by reviewing the literature on epidemiology of sexually transmitted diseases (STDs) and HIV, and interviewing at length 20 male miners and 24 women supporting themselves near the mines as prostitutes or mistresses. Interview subjects were selected by "strategic informant snowball sampling," a type of purpose sampling used in anthropological studies, best for collecting descriptive data. Interviews focused on familial, marital, sexual experiences and perceptions of migrant mine workers and their wives and female partners. While official reports from mine management states that there is little likelihood that HIV will spread among migrant workers and their contracts, STD morbidity rates in these groups have almost doubled between the mid-1970s and mid-1980s, and reports of HIV infection are high in some areas, notably Malawi and Botswana. The HIV prevalence among Malawian migrants rose from 3.8% in 1986 to 21% in 1989, with an African pattern of transmission. The migrant labor system is based on "hostels" where male mine workers live in barracks for long periods or indefinitely, separated from wives and families. Men pass the time drinking and seeking female companionship and sex, either as long-term sexual partners, casual short-term partners, or cash clients. The system takes a toll on marriages, with high rates of divorce and abandonment, leaving many women, who are then rejected by their families, with prostitution as their only subsistence option. People viewed AIDS education messages from mine management with suspicion, often blamed AIDS on the mines or other ethnic groups, and neither sex used or expressed interest in using condoms. Thus this population fits the description in the epidemiology of STDs of a high-risk core group with multiple partners and frequent partner change, and the mobility to be major carriers to urban, suburban and rural areas. It is suggested that AIDS education be initiated by empathetic groups such as trade unions and the African National Congress, by prevent suspicion of racism or genocide as motivation for the campaign.