It is unclear whether interventions to reduce sexually transmitted infections among heterosexual men reduce morbidity

Wilkinson, Professor David MBCHB, MD, PhD

University of South Australia, Adelaide, Australia

Abstracted from:Elwy R, Hart G, Hawkes S, Petticrew M. Effectiveness of interventions to prevent sexually transmitted infections and human immunodeficiency virus in heterosexual men. Arch Intern Med 2002; 162: 1818-1830 .

Source of funding: Anglia and Oxford Regional Research and Development grant.

Correspondence to: J Elwy, ICRF General Practice Research Group, Division of Public Health and Primary Care, Institute of Health Sciences, Oxford, UK.

Abstract prepared by Bazian Ltd, London

Evidence-based Healthcare 7(1):p 6-7, March 2003.

BACKGROUND

Despite widespread efforts to prevent HIV transmission, infection rates are increasing in heterosexual populations. Sexually transmitted infections are transferred most easily from men to women. Interventions for heterosexual men may therefore help control the spread of HIV and other sexually transmitted infections.

OBJECTIVE

To assess which interventions reduce sexually transmitted infections and HIV among heterosexual men.

METHOD

Systematic review.

SEARCH STRATEGY

Twenty-one databases were searched for interventions to reduce the spread of sexually transmitted infections (to 2000). Four key journals and reference lists from identified studies were hand searched. Authors were contacted for unpublished research or work in progress.

INCLUSION/EXCLUSION CRITERIA

Randomised or non-randomised controlled trials, cohort studies and retrospective studies were eligible if they assessed one of the main outcomes (see below); were of moderate or high methodological quality, and included separate data for heterosexual men older than 15 years. There were no language restrictions. Of 1157 studies identified, 27 met the inclusion criteria. Twenty of these were randomised trials; the rest were prospective observational studies, mostly without a comparison group. Most were based in North America (63%).

MAIN OUTCOMES

New infection or reinfection with sexually transmitted disease (morbidity); behavioural outcomes (such as condom use, number of sexual partners); social-psychological outcomes (such as intention to use condoms and attitudes towards HIV or condoms).

MAIN RESULTS

Most interventions targeted specific groups, such as people attending sexually transmitted infection clinics or drug users receiving treatment. Few included men only. Most studies were designed to assess changes in social-psychological and behavioural outcomes. Few focused on morbidity. Eight different types of interventions were identified. Of these, five reduced the incidence of sexually transmitted infections. These included individual counselling with HIV testing; mass health promotions, and skills and motivation training. One successful programme was conducted in the workplace, one in the military and three in sexually transmitted infection clinics.

AUTHORS' CONCLUSIONS

No single method was identified to change behaviours, increase knowledge or influence men's intent to change that worked in all situations. As most studies focus on social-psychological or behavioural outcomes, there is little evidence about whether these interventions reduce sexually transmitted infections.