Abstract
Given the need of programme planners and policy makers 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 men who have sex with men (MSM) in Europe. The aim was 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. 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 from six controlled studies, involving a total of 4,111 participants at entry from four different European countries were summarised. 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 and to draw solid conclusions about unique gaps in the evaluation literature. Despite the maturity of the HIV epidemic, rigorous outcome evaluations of any form of behavioural HIV/STI intervention for MSM in Europe are scarce. 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 demonstrates the need for research in this area. 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.
Highlights
Across Europe, the HIV/AIDS epidemic has caused tremendous human suffering and financial loss as the number of new diagnoses of HIV infections has continued to increase: from 2000 to 2007, the annual rate of reported HIV infection increased from 39 to 75 per million [1]
The pooled effect estimate for the shortterm effects of the two randomised controlled trials (RCT) with least risk of bias suggested that men who have sex with men (MSM) participating in HIV/STI interventions were 34% less likely to report engaging in unprotected anal intercourse (UAI) (RR 0.66, 95%confidence interval (CI) 0.52-0.82)
The main finding of the review is the dearth of HIV/ STI prevention interventions for European MSM which have been evaluated in such a way as to enable reliable conclusions about effectiveness
Summary
Across Europe, the HIV/AIDS epidemic has caused tremendous human suffering and financial loss as the number of new diagnoses of HIV infections has continued to increase: from 2000 to 2007, the annual rate of reported HIV infection increased from 39 to 75 per million [1]. Continue to be the population most affected by HIV, and the rate of infections is increasing faster among MSM than among other populations [2,3]. In high-income European countries, MSM remain the group at highest risk for HIV [1], and unprotected sex remains the most frequent mode of transmission. There has been an increase in the rate of MSM who report unprotected anal intercourse (UAI). In London, between 1998 and 2002 there was a doubling in the percentage of MSM reporting UAI with a casual partner of unknown or discordant HIV status, increasing from 7% to 16% [4]. Recent outbreaks of syphilis and gonorrhoea in several major European cities suggest a trend for increased sexual risk taking among MSM [5,6,7]
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