Combined HIV prevention encompasses structural, behavioral, and biomedical means to reduce HIV infection risk, with prevention focus especially warranted for vulnerable groups such as Indigenous peoples. This study aimed to evaluate the efficacy and effectiveness of HIV prevention strategies implemented among Indigenous populations between 2000 and 2025. Following PRISMA guidelines, 17 studies were included, covering biomedical interventions (e.g., pre-exposure prophylaxis and antiretroviral therapy), behavioral interventions (e.g., condom promotion and health education), and structural approaches (e.g., stigma reduction and access expansion). Analysis revealed significant protective effects, particularly for biomedical strategies, with pre-exposure prophylaxis reducing HIV infection risk by 58% (OR = 0.42, 95% CI: 0.30–0.59) and testing campaigns increasing early-diagnosis rates (RR = 1.58, 95% CI: 1.32–1.90). Behavioral and structural approaches also showed moderate but significant impact. The forest plot confirmed consistency of effect sizes across studies, with moderate heterogeneity (I² = 42%). Methodological quality varied, with seven studies rated high quality. Overall, culturally sensitive interventions featuring Indigenous leadership, bilingual communication, and integration of traditional knowledge were more effective at promoting adherence and reducing stigma. The results underscore the importance of intercultural, community-led strategies for addressing HIV among Indigenous peoples and highlight the need for greater methodological rigor and equity-oriented public policies.
Silva et al. (Sun,) studied this question.