A Systematic Review to Identify Challenges of Demonstrating Efficacy of HIV Behavioral Interventions for Gay, Bisexual, and Other Men Who Have Sex with Men (MSM)

Abstract

Gay, bisexual, and other men who have sex with men (MSM) are disproportionately affected by HIV but few MSM-specific evidence-based interventions (EBIs) have been identified for this vulnerable group. We conducted a systematic review to identify reasons for the small number of EBIs for MSM. We also compared study, intervention and sample characteristics of EBIs versus non-EBIs to better understand the challenges of demonstrating efficacy evidence. Thirty-three MSM-specific studies were evaluated: Nine (27 %) were considered EBIs while 24 (73 %) were non-EBIs. Non-EBIs had multiple methodological limitations; the most common was not finding a significant positive effect. Compared to EBIs, non-EBIs were less likely to use peer intervention deliverers, include sexual communication in their interventions, and intervene at the community level. Incorporating characteristics associated with EBIs may strengthen behavioral interventions for MSM. More EBIs are needed for substance-using MSM, MSM of color, MSM residing in the south and MSM in couples.

The clinical effectiveness of individual behaviour change interventions to reduce risky sexual behaviour after a negative human immunodeficiency virus test in men who have sex with men: systematic and realist reviews and intervention development

“…46,47,50,53,57 These studies mix knowledge concerning behaviour change interventions, designed to reduce HIV infection risks with high perceived severity, with those that are designed to reduce HIV infection risks with lower perceived severity. Equally, systematic reviews of behavioural interventions exist for a range of populations, but do not solely focus on MSM 42,45,48,49,51,54 and this limits the direct translation of findings to this specific population. Table 1 also shows the ongoing methodological problems associated with the existing evidence.…”

“…These relate to issues such as conflicting and limited evidence: 43 on the one hand, the heterogeneity of populations included in studies and, on the other hand, where population criteria is more tightly specified, the small number of studies available for review. 48,62 Many of the studies available suffer from high or unclear risk of bias. 62 Primary studies often suffer from high attrition, 48,53 a lack of statistical power, 48 limited follow-up periods, 48 heterogeneity of intervention content, 54 heterogeneity of cultural context regarding implementation, 49 differential attrition between intervention and control, a lack of information regarding cost-effectiveness, 34 a lack of focus relating to theories of behaviour change, 34 a lack of focus regarding the complexity and changing nature of HIV risk-related behaviours, 34,55 a lack of inclusion of qualitative and mixed-methods studies, 55 and the heterogeneity of outcome measures.…”

The Present and Future Tread of MSM Intervention: A Qualitative Study in Hubei Province, China

“…Before the final interview, the revised guide was pilot tested with two volunteers---one from the CDC, and another from the NGO. Apart from the basic demographic questions, the final guide mainly explored the four aspects of questions, including: (1) what is the reasons for the inconsistent of knowledge and behaviors among MSM; (2) what is the primary problems in complementing the MSM intervention; (3) what are the advantages and disadvantages about MSM intervention in the CDCs and NGOs; and (4) what are suggestions for MSM intervention in the future.…”

“…The rate of new HIV infection for MSM is 44 times than the general, and it still has a tendency to rise up [2]. Evidence-based HIV intervention measures have been developed and disseminated typically to meet the prevention and control needs among MSM [3]. In the developed countries, the Internet and new media had been used with HIV/AIDS prevention and care initiatives [2,4,5] including sending health promotion messages, improving HIV/AIDS medication adherence, promoting test result notification and facilitating attendance at clinic appointments.…”

Behavioral interventions to reduce HIV risk behavior for MSM and transwomen in Southeast Asia: a systematic review

“…To increase program coverage and ensure the effectiveness of interventions, it is essential to employ insights from the behavioral sciences in developing intervention approaches (Bartholomew, Parcel, Kok, Gottlieb, & Fernández, 2011). Previous reviews have synthesized literature on behavioral HIV interventions (Higa et al, 2013;Johnson et al, 2008;Lu et al, 2013), and nearly all of these reviews are from the upper-middleincome countries. Therefore, our systematic review examines the effectiveness of behavioral interventions at reducing risky sexual behavior specifically among MSM and transwomen in Southeast Asia.…”