The aims of this systematic review of reviews were to identify, appraise, synthesise and contextualise a range of guidance, guidelines, review-level evidence of effectiveness (or ineffectiveness) and pertinent evaluation evidence on prevention of HIV transmission in MSM. Specifically, the objectives of the review were to: • Use systematic review methods to identify, retrieve and critically appraise review-level evidence of effectiveness of HIV prevention among MSM. • Identify relevant aspects of published guidance and guidelines for inclusion in the synthesis. • Synthesise the review data and contextualise this for a Scottish perspective. There was consistent review-level evidence for group- and community-level interventions being effective in changing risky sexual behaviour associated with HIV acquisition. There was less consistent review-level evidence for individual-level interventions.
The interventions included within the behavioural-focused reviews are broadly similar in their attempts to provide information and reduce sexual risk behaviour; however, they also vary greatly in terms of the prominently reported mode of delivery. Absent from the reviews is consistent detail on the activity, settings in which the interventions were delivered and theoretical orientation, which renders it difficult for a review of such reviews to make a valid comparison.
The review-level evidence stems largely from pre-HAART data, which were collected in an era prior to the internet being an important factor in the HIV epidemic. The evidence also fails to address other behavioural strategies to UAI, including serosorting, negotiated safety, withdrawal before ejaculation and strategic positioning.
There is a bias towards USA-based studies, which has implications for transferability to a Scottish context, given the different cultural contexts within which interventions are delivered in the USA and in Scotland. It might be that significant reductions in UAI is achievable, but that overall effects could be lower than reported from the USA literature.
There remain broad questions about whether such intervention aspects will work under non-research and controlled conditions and also within the Scottish context; therefore, there is a need for this evidence to be tested in a Scottish context, perhaps drawing upon work from other areas (e.g. smoking cessation group work with MSM), in rigorous feasibility studies.
- systematic review,
- review of reviews,
- behavioural interventions,
Available at: http://works.bepress.com/lisa_kidd/20/