Which interventions modify sexual risk behaviour and prevent HIV infection in men who have sex with men, and what is their effectiveness?

HEN summary of a report of the Cochrane Collaboration.

Copyright Cochrane Library, reproduced with permission.

The issue

Men who have sex with men (MSM) continue to be at great risk for human immunodeficiency virus (HIV) infection. They make up a large proportion of new acquired immunodeficiency syndrome (AIDS) cases and HIV infections every year in industrialized countries.

Previous reviews of HIV prevention efforts have examined the effects of behavioural interventions across a broad range of populations at risk. One of these reviews noted the lack of research on interventions for MSM of colour, young MSM and MSM who do not identify themselves as gay. The reviews of the research indicated that critical intervention components include information, motivation and skills training, with successful interventions having high attendance rates or including an extensive formative research component. One review found that effects of interventions diminish as the time from intervention to follow-up increased from 1 month to 6 months. An earlier review on MSM noted that community-level interventions have the capacity to reach people who would not participate in facility-based interventions and who may be at higher risk than those who enrol in small-group or individual interventions. Thus, several reviews have suggested hypotheses about characteristics of interventions. However, there is a need to summarize and analyse the lessons learned in HIV prevention for MSM. This systematic review examines and summarizes the behavioural effects of rigorously evaluated interventions for MSM.

Findings

An analysis of 12 rigorous controlled trials reported on the effects of interventions on risk reduction behaviour among MSM. The studies included for analysis examined small-group interventions and the effects of community-level approaches and individual-level interventions. Interventions to reduce unprotected sex included individual counselling, and social and behavioral support (such as peer education, assertiveness and relationship support, discussing attitudes and beliefs, and videos). Small-group and community interventions were also tried (such as group counselling or workshops, interventions in community areas, and training community leaders).

The results for the effectiveness of interventions for MSM show that HIV prevention efforts can reduce the risk of sexually transmitted infections. The summary effect of these diverse interventions indicates that 23% fewer men reported unprotected anal sex (one of the riskiest behaviours for transmission of HIV and other sexually transmitted infections) after receiving intervention. The risk reduction observed across the trials occurred after relatively short interventions: the weighted median duration of the small-group interventions was only 3 hours; the community-level interventions, although being active in the communities for weeks or months, did not require extended time commitments from the individual recipients of the interventions. Findings suggest that community-level interventions reached and influenced substantial proportions of the study population, whether through direct exposure to the formal intervention mechanisms or by informal social diffusion, and these interventions were at least as favourable as those of small-group and individual-level interventions. The present analysis also confirmed that interventions that promote personal skills yielded clearly favourable effects.

Policy considerations

Efforts to prevent HIV can reduce sexual risk behaviour, which can be achieved with relatively brief interventions among MSM. Further reductions in unprotected anal sex and sexually transmitted diseases can have an important public health impact. Among interventions, community-level interventions, those that served populations in their twenties (rather than their thirties) and those that promoted interpersonal skills have yielded slightly more favourable results.

The reduction in risk would likely be even greater if intervention efforts could be guided towards the most effective strategies. There are a small number of rigorous controlled trials for MSM, which are not compensated by a large number of study group participants. Thus, more research is needed to ascertain the effects of specific intervention components, population characteristics and methodological features and to identify the best intervention strategies.

Type of evidence

This report is a review of randomized controlled trials, as well as certain strong quasi-experimental designs.

The views expressed in this summary are based on a publication of the Cochrane Collaboration and do not necessarily represent the decisions or stated policy of WHO/Europe.

Source

This systematic review was prepared by The Cochrane Collaboration.