This page contains the findings of systematic reviews undertaken by review groups linked to the EPPI Centre and the EPPI Centre Health Promotion and Public Health Reviews Facility

Men who have sex with men
Young men who have sex with men
HIV positive men
Men who sell sex with men
References

Men who have sex with men

• One review found that there was no evidence of the effect of UK peer-delivered community-based interventions for any of the outcomes it prioritised. The ‘diffusion of innovation’ that underpins some of these interventions may not always have occurred as planned. It is also possible that structural and cultural barriers exist to such interventions in some situations in the UK.[3]  
• One meta-analysis of two studies, one conducted in the UK, the other in the USA, found that counselling or workshops based on cognitive-behavioural techniques for MSM who are at high risk appear to be effective in reducing the number of men reporting sero-discordant or unknown status unprotected anal intercourse (sdUAI) when compared with standard counselling. However, one study from this meta-analysis found a potentially harmful effect on the incidence of sexually transmitted infections.[3]
• In a second meta-analysis of two studies conducted in the USA of counselling or workshops that contextualised sexual risks, no evidence of effect was found on casual unprotected anal intercourse.[3]
• A behavioural intervention which included AIDS education, cognitive-behavioural self-management, sexual assertion training and the affirmation of social support, was found to be effective on the AIDS-related knowledge and risk practices of high-risk gay and bisexual men in a US metropolitan area. The intervention was only shown to be effective for white men.[1]
• One intervention used opinion leaders to endorse HIV/AIDS risk reduction behaviour change among gay men in one city in the USA.  This resulted in short-term reduction in risk behaviour, but there was no evidence of long-term change.[1]
• A community-based approach to increasing condom use took place in three gay bars in Anchorage, Alaska, and involved placing a large sign directly above a container of free condoms. The sign gave statistics for the number of people who had died from AIDS in the state and pointed out that condoms can reduce the spread of AIDS. Additional signs were placed in the bar lavatories. The presence of the signs increased the taking of condoms by 47%.[1]

Young men who have sex with men

• A peer-delivered health promotion using a ‘community mobilisation’ approach has been successfully used with young gay men in the USA. To what extent this can be transferred to other countries and to other groups of young people was not determined.[2]
• Young MSM expressed the view that informal conversations led to more opportunities for raised awareness than did more formal interactions with services.[3]
• A Rapid Evidence Assessment[2] looked at risk and protective factors for poor outcomes for young people. These included risk and protective factors for HIV/AIDS and the findings of systematic reviews of preventative measures. Full details can be found in the report.[4]

HIV positive men

• HIV positive MSM noted that: variation in, and multiple sources for advice on the risks of viral load and re-infection caused confusion; lack of time for consultations with health professionals and use of confusing terminology meant that some men left clinic sessions without finding out what they needed; drop-in centres could provide resources in useful formats (workshops) but could also be ‘cliquey, sources of inaccurate, speculative information and anti-sex’. Some complementary therapies were particularly valued. While gay doctors were highly regarded as sources of advice and practical information, some men talked of their experience of homophobic and hostile attitudes with some non-HIV specialists. Social networks were considered useful for advice and support on practical and personal issues but had limitations as sources of accurate information and support.[3]

Men who sell sex with men

Men who sell sex said that they needed accessible and non-judgemental places to go for information, advice and social support that were not necessarily linked to sexual health services. They expressed the need for outreach and counselling services and a befriending network. Men who sold sex on the streets identified an immediate need for free condoms. Some men expressed the need for places to go to meet other gay men. Some of the men said that they needed their work to be legalised and/or unionised as a means of creating a safer work environment.[3]

References

1. Review of effectiveness of health promotion interventions for men who have sex with men  (1996)

2. A review of the effectiveness and appropriateness of peer-delivered health promotion interventions for young people  (1999)

3. 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 (2004)

4. Targeted youth support: Rapid Evidence Assessment of effective early interventions for youth at risk of future poor outcomes (2008)