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Interventions to Reduce Sexual Risk Behaviors or Increase Protective Behaviors to Prevent Acquisition of HIV in Men Who Have Sex with Men: Individual-, Group-, and Community-Level Behavioral Interventions

Behavioral interventions to prevent acquisition of HIV in men who have sex with men (MSM) fall into three categories:

  • Individual-level HIV behavioral interventions that provide relevant information, training, or support through a personal interaction between a deliverer and an MSM
  • Group-level HIV behavioral interventions that promote individual behavior change in situations where information and activities delivered by a trained counselor, educator, or other facilitator can be reinforced by peer pressure and support from other group members
  • Community-level HIV behavioral interventions that are designed to influence individual risk behavior by changing knowledge, attitudes, and beliefs in a defined community

Summary of Task Force Recommendations and Findings

The Community Preventive Services Task Force recommends implementation of the following HIV behavioral interventions for adult men who have sex with men based on evidence of their effectiveness in reducing unprotected anal intercourse:

  • Individual-level interventions (strong evidence)
  • Group-level interventions (strong evidence)
  • Community-level interventions (sufficient evidence)

Task Force Finding

About the Interventions

  • Individual-level HIV behavioral interventions:
    • Seek to modify knowledge, attitudes, beliefs, self-efficacy, and emotional well-being
    • Can involve individualized risk-reduction counseling or motivational interviewing delivered by a trained counselor, educator, peer, or other professional
  • Group-level HIV behavioral interventions:
    • Are designed to influence individual risk behavior by changing knowledge, attitudes, beliefs, and self-efficacy in a small group setting
    • Focus on the development of skills through live demonstrations, role plays, or practice
    • Teach skills that may include learning how to use condoms correctly, how to implement personal decisions to reduce risk, and how to negotiate safer sex effectively with partners
  • Community-level HIV behavioral interventions:
    • Can motivate and reinforce behavior change in individuals who do not participate directly in the intervention by promoting norms that support safer sex—through popular opinion leaders, community mobilization, or social networks
    • May have several components, requiring complex coordination and several years or longer to implement

Results of the Systematic Reviews

Individual-level interventions

  • Four studies qualified for the review and reported on six interventions.
    • Unprotected anal intercourse (UAI): mean (not median) odds ratio = 0.57
      • These effects were significant at both short-term (median 6 months) and long-term (median 12 months) follow-ups.
      • Individual-level interventions also resulted in a 59% reduction in odds of having UAI with non-primary partners (3 interventions), and a 48% reduction in odds of having UAI with partners who don’t have the same HIV status (serodiscordant partners) (4 interventions).

Group-level interventions

  • Twelve studies qualified for the review and reported on 15 interventions.
    • Unprotected anal intercourse (UAI): 27% reduction in odds
      • These effects were significant at both short-term (median 3 months) and long-term (median 12 months) follow-ups.
    • Receptive UAI: 44% reduction in odds (two studies)
    • Condom use during anal intercourse: 81% increase in odds (five studies)
    • The interventions that showed greater effectiveness in reducing UAI included multiple intervention sessions; delivery by other MSM; and skill building through role plays, live demonstrations, or practice.
    • A systematic economic evaluation found that two group-level interventions were cost saving; the averted HIV medical care costs exceeded the program intervention costs.

Community-level interventions

  • Three studies qualified for the review and reported on three interventions.
    • Unprotected anal intercourse (UAI): 35% reduction in odds at follow-up intervals ranging from 4 months (two studies) to 1 year (one study)
    • Condom use during anal intercourse: 59% increase in odds (two studies)
    • A systematic economic evaluation of 3 community-level interventions found that potential savings in HIV-related medical costs exceeded the costs of implementing the intervention.

These results were based on a systematic review of all available studies, conducted on behalf of the Task Force by a team of specialists in systematic review methods, and in research, practice and policy related to the prevention of HIV and AIDs.

Supporting Materials

Publications

Herbst JH, Beeker C, Mathew A, et al. The effectiveness of individual-, group-, and community-level HIV behavioral risk reduction interventions for adult men who have sex with men: a systematic review. Adobe PDF File [PDF - 868 kB] Am J Prev Med 2007;32(4S):S38-67.

Task Force on Community Preventive Services. Recommendations for use of behavioral interventions to reduce the risk of sexual transmission of HIV among men who have sex with men. Adobe PDF File [PDF - 48 kB] Am J Prev Med 2007;32(4S):S36-7.

Read other Community Guide publications about Preventing HIV/AIDS, Other STIs, and Teen Pregnancy in our library.




Disclaimer

The findings and conclusions on this page are those of the Community Preventive Services Task Force and do not necessarily represent those of CDC. Task Force evidence-based recommendations are not mandates for compliance or spending. Instead, they provide information and options for decision makers and stakeholders to consider when determining which programs, services, and policies best meet the needs, preferences, available resources, and constraints of their constituents.

Sample Citation

The content of publications of the Guide to Community Preventive Services is in the public domain. Citation as to source, however, is appreciated. Sample citation: Guide to Community Preventive Services. Interventions to reduce sexual risk behaviors or increase protective behaviors to prevent acquisition of HIV in men who have sex with men: individual-, group-, and community-level behavioral interventions. www.thecommunityguide.org/hiv/mensexmen.html. Last updated: MM/DD/YYYY.

Review completed: June 2005