If HIV Prevention Works, Why Are Rates of High-Risk Sexual Behavior Increasing among MSM?

Abstract

Systematic reviews of HIV prevention research provide clear evidence that behavioral interventions can influence the sexual behavior of men who have sex with men (MSM). However, if HIV prevention works, why are rates of high-risk sexual behavior increasing among MSM in major European, Australian, Canadian, and U.S. cities? The evidence generated by systematic reviews alone may not provide a clear answer to this question. This is because (a) it is uncertain whether experimental interventions shown to be effective in one setting, place, or moment in time can be repeated successfully in another; (b) we have limited understanding of the processes that underlie the interventions; (c) interventions shown to work in an experimental study may not necessarily be effective in everyday life. To answer the question, we need to be alert to the changing risk environment in which men have sex with other men. We also need to develop a new program of research addressing the transferability, sustainability, and effectiveness of sexual health promotion among MSM. Randomized controlled trials will remain one of the optimal means of evaluating behavioral interventions in such a program. By further strengthening the evidence base, we may identify opportunities for innovative as well as effective HIV prevention initiatives.

Increase in HIV sexual risk behaviour in homosexual men in Scotland, 1996-2002: prevention failure?

“…21 The increase in UAI with one or more and casual partners that we found in 2002 occurred regardless of whether men had been tested for HIV or not. There are limitations to these data.…”

Discordance between Sexual Behavior and Self-Reported Sexual Identity: A Population-Based Survey of New York City Men

“…Despite earlier declines in incidence rates of HIV infection among men who have sex with men (2,3), recent data show increases in high-risk sexual behaviors (4,5), sexually transmitted diseases (STDs) (6 -9), and HIV diagnoses (10) among these men.…”

Explanations for the Origins of Sexual Compulsivity Among Gay and Bisexual Men

“…Given that SC is more prevalent men, and apparently more prevalent in gay and bisexual men, this may contribute to the public health crisis of HIV transmission through increased opportunities for unsafe sexual encounters (Carnes, 1991;Centers for Disease Control, 2005). Despite an overall decline in new HIV/AIDS cases over the past decade, the number of new HIV/AIDS cases in MSM has continually increased (Beltrami, Shouse, & Blake, 2005;Elford & Hart, 2003). At the height of the HIV/AIDS epidemic, where unsafe sexual contact remains the primary route of new infection, particularly among MSM, efforts need to be focused on prevention and treatment of this condition (Centers for Disease Control, 2005).…”