What do we want to know?

Men who have sex with men (MSM) remain the group at greatest risk of acquiring HIV infection in the UK. Initial behaviour changes in this group to reduce the risk of HIV are not being maintained.  This review analyses and synthesises the findings from studies of the views and experiences of MSM concerning HIV-related sexual health, and integrate these with findings from studies which report the effectiveness of risk-reduction interventions.

Who wants to know?

Policy-makers, practitioners, MSM, researchers.

What did we find?  

• A meta-analysis revealed that counselling or workshops based on cognitive-behavioural techniques for MSM who are at high risk are effective compared with standard counselling in reducing the number of men reporting sero-discordant or unknown status unprotected anal intercourse (sdUAI).  However, there was some risk of increased incidence of sexually transmitted infections.
• No evidence of effect was found for any of the evaluated interventions on casual UAI; knowledge or awareness; attitudes or beliefs; HIV testing; or practical skills.
• No evidence of the effect of UK peer-delivered community-based interventions was found. The ‘diffusion of innovation’ that underpins some of these interventions may not always have occurred as planned.
• Themes which emerged from the views studies were: the value of sex; understandings of sexual health and HIV; sex as a social activity; perceptions of self at risk; assessing risk; communicating over risk; strategies for sex and risk; services and resources; informal support, advice and information. These nine themes fell into three broad categories: ‘perceptions of sex, self and others in a risky world’; ‘engaging with sex and HIV’; and ‘experiences of support, advice and information’.
• One theme that cut across the different groups of MSM was an experience of risk as having multiple layers.  Along with the risk of being infected by HIV or infecting others, men emphasised other physical risks such as rape and assault, but also psychological and social risks such as those involved with disclosing or not disclosing HIV status.  Another cross-cutting theme was the use of a variety of strategies other than explicit disclosure to make decisions about a potential partner's HIV status.

What are the implications?

• Policy-makers should consider implementing counselling based on cognitive-behavioural techniques, or workshops using these techniques, in place of standard counselling for MSM at high risk of engaging in UAI with partners of unknown or sero-discordant HIV status. These interventions should be combined with addressing the reduction of STIs and there should be sound evaluation of impact on sdUAI and STI incidence.
• There is no evidence to support discontinuing community peer-delivered interventions. Instead, further work on evaluation is strongly recommended.
• Further rigorously conducted and reported research is required on the views of all groups of MSM, in particular those who are vulnerable to reduced control over HIV-related sexual health.

How did we get these results?

Eight outcome evaluations and ten studies of views were synthesised; all were reported during or after 1996.  Four of these outcome evaluations were included in two meta-analyses. A key feature of the review was the active involvement of an Advisory Group representing a range of stakeholders.

This summary was prepared by the EPPI Centre

This report should be cited as:  Rees R, Kavanagh J, Burchett H, Shepherd J, Brunton G, Harden A, Thomas J, Oliver S, Oakley A (2004) HIV Health promotion and men who have sex with men (MSM): a systematic review of research relevant to the development and implementation of effective and appropriate interventions. London: EPPI Centre, Social Science Research Unit, Institute of Education, University of London.