This study identifies and critically reviews health promotion interventions in HIV prevention and sexual health for men who have sex with men (MWHSWM), in order to inform future prevention strategy in the UK.
MWHSWM are the largest group of people affected by HIV/AIDS in the industrialised west. There are indications that the behavioural changes of the early 1980s in the direction of safer sexual behaviour have not been maintained.
A total of 320 references to studies concerned with MWHSWM were retrieved from the EPI-Centre's bibliographic database. Twenty four of these were evaluations assessing the impact of one or more HIV prevention interventions on attitudes, knowledge or behavioural outcomes. A methodological review was undertaken to identify the subgroup of studies with sufficient methodological strengths to generate reliable conclusions as to effectiveness. Five of the outcome evaluations were judged to be methodologically adequate according to the criteria of using an equivalent control or comparison group, providing pre- and post-intervention data and reporting on all relevant outcomes. All five studies were carried out in North America and all reported effective or partially effective interventions. The evidence of the five studies taken together is that relatively brief interventions consisting of small group sessions with some individual counselling, and which have some credibility in the gay community, are an effective way to reduce risk behaviour, at least in the short term.
The major finding in this study is that there is very little well-evaluated HIV prevention intervention work with MWHSWM. Although there is considerable intervention for this group in the UK, particularly at the community and local level, much of it is service-led, and research and evaluation are at best an afterthought and at worse absent.
Our main recommendation is that interventions aimed at influencing behavioural factors relevant to HIV/AIDS transmission targeted at MWHSWM should be evaluated. Where feasible the best evaluation approach, the randomised controlled trial, should be employed. We also suggest that future interventions should be targeted at particular groups within MWHSWM, particularly young, working class and ethnic minority men, and should be tailor-made for those groups. Prior ethnographic research should be undertaken to identify the cultural context, values, beliefs, social mores and community norms of the targeted group, in order to provide the basis for the content and design of the intervention. We highlight the importance of not isolating HIV/AIDS prevention strategies from the broader context of knowledge and understanding about health and the social and material context in which MWHSWM live. There should be greater co-ordination between researchers, programme developers and practitioners in producing interventions for MWHSWM. Finally, we suggest that a demonstration project should be initiated, drawing on the suggestions in this report, to establish the ground rules for developing and evaluating interventions for MWHSWM and provide an example of good practice.
This report should be cited as: Oakley A, Oliver S, Peersman G, Mauthner M (1996) Review of effectiveness of health promotion interventions for men who have sex with men. London: EPPI Centre, Social Science Research Unit, Institute of Education, University of London.