A cognitive behavioural intervention to reduce sexually transmitted infections among gay men: randomised trial

Abstract

Objective To determine the effectiveness of a brief cognitive behavioural intervention in reducing the incidence of sexually transmitted infections among gay men. Design Randomised controlled trial with 12 months' follow up. Setting Sexual health clinic in London. Participants 343 gay men with an acute sexually transmitted infection or who reported having had unprotected anal intercourse in the past year. Main outcome measures Number of new sexually transmitted infections diagnosed during follow up and self reported incidence of unprotected anal intercourse. Results 72% (361/499) of men invited to enter the study did so. 90% (308/343) of participants returned at least one follow up questionnaire or re-attended the clinic and requested a check up for sexually transmitted infections during follow up. At baseline, 37% (63/172) of the intervention group and 30% (50/166) of the control group reported having had unprotected anal intercourse in the past month. At 12 months, the proportions were 27% (31/114) and 32% ( 39/124) respectively (P = 0.56). However, 31% (38/123) of the intervention group and 21% (35/168) of controls had had at least one new infection diagnosed at the clinic (adjusted odds ratio 1.66, 95% confidence interval 1.00 to 2.74). Considering only men who requested a check up for sexually transmitted infections, the proportion diagnosed with a new infection was 58% (53/91) for men in the intervention group and 43% (35/81) for men in the control group (adjusted odds ratio 1.84, 0.99 to 3.40). Using a regional database that includes information from 23 sexual health clinics in London, we determined that few participants had attended other sexual health clinics. Conclusions This behavioural intervention was acceptable and feasible to deliver, but it did not reduce the risk of acquiring a new sexually transmitted infection among these gay men at high risk. Even carefully designed interventions should not be assumed to bring benefit. It is important to evaluate their effects in randomised trials with objective clinical end points.

MSM in HIV-Prevention Trials are Sexual Partners With Each Other: An Ancillary Study to the EXPLORE Intervention

“…In light of the present study's findings, data from another behavioral risk-reduction trial also points to the importance of examining sexual behavior within trial participants in HIV-prevention studies (Imrie et al, 2001). This study to reduce sexual risk among MSM used a one-day group workshop as a cognitive behavioral intervention to reduce STIs.…”

“…This intervention, like many others, brought participants together for the intervention itself; a same-time intervention may be less financially and temporally burdensome than individual treatment. Imrie et al (2001) however, found that the individuals who received the group intervention actually had more new STIs post-study enrollment than those who did not. This study, however, did not report on whether men randomized to the intervention arm became sexually active with each other as a result of meeting during the group workshop.…”

Is use of antiretroviral therapy among homosexual men associated with increased risk of transmission of HIV infection?

“…Comparison with two studies of HIV negative homosexual men shows that sexual risk behaviour in this HIV population is particularly high. In a study of HIV negative homosexual men conducted in the same clinic 11 the risk of acquiring a bacterial STI in a 12 month period was 10% compared with 23% in this study, and a community survey of homosexual men in London has shown higher rates of STI and unprotected anal intercourse in HIV positive men compared with HIV negative men. 12 Concerning the link between HAART and treatment optimism, [4][5][6] we found that, in a population of HIV positive homosexual men who mostly rate their health as good, men on HAART are no more likely to have unprotected anal intercourse than those not on HAART.…”

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

“…Articles were excluded for not being a RCT or other suitable study, as specified in our inclusion criteria; not having the sufficient percentage of MSM in the study population; [137][138][139][140][141][142][143][144][145] not including a sufficient percentage of HIV-negative participants; [146][147][148][149][150][151][152][153][154][155][156] or not being an individually focused intervention, instead focusing on groups or structural factors. [157][158][159][160][161][162][163][164][165][166][167] Other reasons for exclusion, such as interventions not being brief, reporting a pilot trial, reporting non-HIV-specific data (e.g. if only alcohol-related outcomes were provided in a study assessing alcohol as well as HIV risk-related behaviours) or data were unobtainable despite our attempts to gain information from authors, were captured in our 'other' category.…”