|
|
|
|
|
|
Effectiveness of behavioural and psychosocial HIV/STI prevention interventions for MSM in Europe
( 11.01.2012 )3-siders sammendrag
Executive summary
Background: In the absence of an effective and affordable vaccine and non-curative abilities of current antiretroviral therapies, behavioural and psychosocial prevention with the goal of limiting sexual risk behaviours remains central to the efforts to decrease sexual HIV/STI transmissions among men who have sex with men. (MSM). Given programme planners’ and policymakers’ need for descriptions of specific interventions and quantitative estimates of intervention effects to make informed decisions concerning prevention funding and research, there is a need for a systematic review that updates the current knowledge base about HIV/STI preventive interventions targeted at MSM in Europe.
Objectives: The aims were to summarise and assess the effectiveness of HIV/STI prevention interventions for MSM living in Europe and to identify intervention characteristics associated with effectiveness, as well as potential gaps, in the evidence base.
Methods: A systematic search for relevant literature in eight international databases and in reference lists of relevant reviews and included studies was performed. Studies were selected according to pre-specified criteria and appraised for risk of bias. We summarised results using tables and calculated effect estimates for sexual behaviour outcomes.
Results: Results were drawn from data of six controlled studies, involving a total of 4 111 participants at entry from four different European countries. The results showed that there was ‘high’ or ‘unclear’ risk of bias in one or more of the assessed domains in all studies. The pooled effect estimate of the four interventions for which data were available suggested that MSM who participate in HIV/STI prevention initiatives may be somewhat less likely to report unprotected anal intercourse (UAI). The evidence base was insufficient to examine characteristics of interventions most closely associated with magnitude of effect. Very few study participants had a non-white background and only one study used biological measurement of STI as an index of change.
Discussion: Despite the maturity of the HIV epidemic, rigorous outcome evaluations of any form of behavioural HIV/STI intervention for MSM in Europe are far and few between. The results point to possible short-term effects of interventions in terms of reductions in the proportion of MSM who engage in UAI, but the paucity of controlled studies indicates the need for research in this area. The scientific community should deliberate the potential for intervention transferability and ideally conduct extensive formative research prior to launching a new programme.
Conclusion: There is an overall deficit in outcome evaluations of interventions aimed at reducing HIV/STI risk behaviour among MSM in Europe. Designing behavioural HIV/STI preventive strategies to avert new infections, and the evaluation of such prevention programmes for MSM is an important component of a comprehensive HIV/STI containment strategy across the continuum of prevention and care.
