Abstract
An estimated 42% of all newly diagnosed HIV cases in Europe in 2013 were transmitted during sex between men. This review was performed to identify and describe studies evaluating the efficacy and effectiveness of HIV prevention interventions among men who have sex with men (MSM), in relation to implementation data from European settings. A systematic search was performed individually for 24 interventions.Data were extracted from studies including efficacy or implementation data from European settings,appraised for efficacy, implementation and plausibility, and assigned a grade (1-4) according to the Highest Attainable Standard of Evidence (HASTE)framework. Four interventions (condom use, peer outreach,peer-led groups, and using universal coverage of antiretroviral treatment and treatment as prevention)were assigned the highest HASTE grade, 1. Another four interventions were assigned 2a for probable recommendation, including voluntary counseling and testing for HIV, using condom-compatible lubricant,using post-exposure prophylaxis, and individual counselling for MSM living with HIV. In addition, seven interventions were assigned a grade of 2b, for possible recommendation. Encouragingly, 15 interventions were graded to be strongly, probably or possibly recommended.In the relatively resource-rich European setting, there is an opportunity to provide global leadership with regard to the regional scale-up of comprehensive HIV prevention interventions for MSM.
Highlights
In 2012 the global burden of HIV was estimated to include 35.3 million people living with the virus
We reviewed the search strategies performed between 8 June 2010 and 17 March 2011 to guide the WHO’s 2011 recommendations for ‘Prevention and treatment of HIV
antiretroviral treatment (ART): antiretroviral therapy; CI: confidence interval; EEA: European Economic Area; EMIS: European MSM Internet survey; EU: European Union; FTC–TDF: emtricitabine and tenofovir ; LGBTI: lesbian, gay, bisexual, transgender and intersex; MSM: men who have sex with men; NA: not available; OR: odds ratio; PEP: post-exposure prophylaxis; PrEP: pre-exposure prophylaxis; PLWH: people living with HIV; randomised controlled trials (RCTs): randomised controlled trial; RR: relative risk; UAI: unprotected anal intercourse; US: United States; VCT: voluntary testing and counselling
Summary
In 2012 the global burden of HIV was estimated to include 35.3 million people living with the virus (people living with HIV, PLWH). There is a declining trend in new infections, morbidity and mortality due to HIV/AIDS [2]. Bisexual and other men who have sex with men (MSM) are disproportionately affected by HIV in every setting where data are available [3]. HIV rates reported among MSM show an increasing trend, in contrast to the declining trends reported in the general population [4]. A 2013 systematic review of HIV epidemiology in 33 high-income countries where data were available estimated a total of 2.3 million PLWH [5] and a male– female median case ratio of 2.5: 1 [5,6], indicating male-predominant epidemics. High-income countries where antiretroviral treatment (ART) and prevention services are available show increasing trends in HIV prevalence among MSM [5,7]
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