Karen Lorimer

Systematic review of reviews of behavioural HIV prevention interventions among men who have sex with men

Abstract Men who have sex with men (MSM) remain one of the groups most at risk of HIV. The growing evidence-base on behavioural HIV prevention interventions includes systematic review-level evidence, including reviews specific to MSM populations. Here, we provide an up-to-date review of these systematic reviews in which we examined the effectiveness of behavioural HIV prevention interventions among MSM. A systematic search of electronic databases, including MEDLINE, EMBASE, Cochrane Database of Systematic Reviews, PsycInfo, from January 2000 to October 2010, along with hand searches of the reference lists of retrieved documents were conducted. Inclusion criteria included: study design limited to systematic reviews and meta-analyses; methodological quality; and review to focus on MSM and behavioural interventions. A narrative synthesis was conducted. Across the four included meta-analyses (102 studies; 52 independent studies), there was strong and consistent evidence for group- and community-level interventions being associated with reductions in UAI (27–30% and 30%, respectively) and increases in condom use amongst MSM, but inconsistent evidence for the effectiveness of individual-level interventions. Skills-building, trained professionals delivering the training and theory-based interventions were also consistently effective. The inherent limitations of the review of review method within a changing health domain meant it was difficult to develop contemporary and directly transferable guidance to HIV prevention policy development. However, the analysis does demonstrate a need for a step change in the kinds of data that are collated in the development of future systematic reviews of HIV prevention interventions among MSM.

It has to speak to people's everyday life... : qualitative study of men and women's willingness to participate in a non-medical approach to Chlamydia trachomatis screening

Objective: To explore the factors associated with men and women’s willingness to provide a urine sample for Chlamydia trachomatis screening in various non-medical settings. Methods: Men and women aged 16–24 years attending non-medical settings were invited to participate in urine-based screening and later to participate in a follow-up in-depth interview. Participant observation techniques were also used to collect data on young people’s response to the offer of screening. Results: The views of 24 men and women revealed three themes in relation to willingness to participate, particularly among men: their raised awareness of chlamydia, particularly its asymptomatic nature; the convenience of the offer; and the “non-medical” nature of the screening. In contrast, women more often felt the public nature of the settings inhibited them from agreeing to take the test and, thus, acted as a barrier to their willingness to participate in screening. Conclusions: The gender difference in willingness to participate in non-medical screening suggests that extending the reach of screening could certainly assist in bringing more young men into screening but may not necessarily destigmatise screening for women. As such, the potential benefits to men must be considered in the context of the potential psychosocial harms to women.

The home as an appropriate setting for women undertaking cervical ripening before the induction of labour.

OBJECTIVES to explore womens experiences of cervical ripening using isosorbide mononitrate (IMN) in the home as part of the main randomised controlled trial. DESIGN qualitative study with semi-structured interviews carried out at three weeks post partum. Interview transcripts were analysed to identify recurrent themes, focusing on why women became involved in the study, their views about both the self-medication and the home setting, and whether they would repeat the experience. SETTING the home. PARTICIPANTS twenty women enrolled in the main randomised controlled trial. INTERVENTION the study is part of a double-blind randomised controlled trial with 350 patients investigating whether a nitric oxide donor (IMN) used in cervical ripening improves the process of induction of labour. FINDINGS women liked the opportunity to remain at home during the cervical ripening process. Timing and setting were central issues; women hoped that it would hasten labour, while the home was seen as a setting offering freedom, security and reassurance, as opposed to the hospital, seen as constraining. Two women reported problems with IMN but the remainder reported that they would repeat the experience. IMPLICATIONS FOR PRACTICE women were very positive about the opportunity to undertake cervical ripening at home. It is important to explore this setting further for appropriate interventions.

Towards preparedness for PrEP: PrEP awareness and acceptability among MSM at high risk of HIV transmission who use sociosexual media in four Celtic nations: Scotland, Wales, Northern Ireland and The Republic of Ireland: an online survey

Objective To assess the awareness and acceptability of pre-exposure prophylaxis (PrEP) among men who have sex with men (MSM) and use sociosexual media at high risk of HIV infection in four Celtic nations. Design Cross-sectional study. Methods Online self-complete survey of 386 HIV-negative/status unknown MSM who reported condomless anal intercourse (CAI) with ≥2 men in the last year, recruited from gay sociosexual media. Results One-third (34.5%, 132/386) of the participants were aware of PrEP but over half (58.5%, 226/356) reported that they would be willing to use PrEP if it were available to them. Only men who regularly tested for HIV every 6 months (adjusted OR 2.89, 95% CI 1.54 to 5.42) were more likely to be aware of PrEP. PrEP acceptability was only associated with reporting ≥5 CAI partners (OR 2.04, 95% CI 1.2 to 3.46) in the last year. Conclusions Low levels of PrEP awareness were reported across these Celtic nations. Only one-third of high-risk MSM had heard of PrEP but over one-half would be willing to take a daily pill to prevent HIV infection. Sociodemographic factors, commercial gay scene proximity and social network use were unrelated to considering PrEP use. However, those reporting most CAI partners were more likely to consider PrEP use.

Sexual health risk reduction interventions for people with severe mental illness: a systematic review

BackgroundDespite variability in sexual activity among people with severe mental illness, high-risk sexual behavior (e.g. unprotected intercourse, multiple partners, sex trade and illicit drug use) is common. Sexual health risk reduction interventions (such as educational and behavioral interventions, motivational exercises, counselling and service delivery), developed and implemented for people with severe mental illness, may improve participants’ knowledge, attitudes, beliefs behaviors or practices (including assertiveness skills) and could lead to a reduction in risky sexual behavior. This systematic review evaluates the effectiveness of sexual health risk reduction interventions for people with severe mental illness.MethodsThirteen electronic databases (including MEDLINE, EMBASE and PsycINFO) were searched to August 2014, and supplemented by hand-searching relevant articles and contacting experts. All controlled trials (randomized or non-randomized) comparing the effectiveness of sexual health risk reduction interventions with usual care for individuals living in the community with severe mental illness were included. Outcomes included a range of biological, behavioral and proxy endpoints. Narrative synthesis was used to combine the evidence.ResultsThirteen controlled trials (all from the USA) were included. Although there was no clear and consistent evidence that interventions reduce the total number of sex partners or improved behavioral intentions in sexual risk behavior, positive effects were generally observed in condom use, condom protected intercourse and on measures of HIV knowledge, attitudes to condom use and sexual behaviors and practices. However, the robustness of these findings is low due to the large between study variability, small sample sizes and low-to-moderate quality of included studies.ConclusionsThere is insufficient evidence at present to fully support or reject the identified sexual health risk reduction interventions for people with severe mental illness. Given the serious consequences of high-risk sexual behaviors, there is an urgent need for well-designed UK based trials, as well as training and support for staff implementing sexual health risk reduction interventions.Trial registrationPROSPERO CRD42013003674.

Knowledge of Chlamydia trachomatis among men and women approached to participate in community-based screening, Scotland, UK

BackgroundPoor awareness and knowledge of Chlamydia trachomatis could be a barrier to uptake of screening. This study aimed to determine the level of awareness and knowledge of chlamydia among young people who were being approached in a variety of community settings and offered opportunistic screening.MethodsMen and women aged 16-24 years were approached in education, health and fitness, and workplace settings and invited to complete a self-administered questionnaire then provide a urine sample for chlamydia testing. Follow-up semi-structured interviews with 24 respondents were carried out after test results were received.Results363 questionnaires were completed (43.5% from men). Whilst awareness of chlamydia was high, knowledge decreased as questions became increasingly focussed so that around half of respondents were unaware of the asymptomatic nature of chlamydia infections. Mens knowledge of symptoms was consistently lower than womens, with most men failing to identify unusual discharge as a symptom in men (men 58.3%, female 45.8%, p = 0.019); fewer men knew unusual discharge was a symptom among women (men 65.3% female 21.4%, p < 0.001). The asymptomatic nature of the infection resonated with respondents and was the commonest piece of information they picked up from their participation in the study.ConclusionsDespite scientific gains in understanding chlamydia infection, public understanding remains limited. Greater efforts are required to translate scientific evidence to the public. An improvement in knowledge may maximise gains from interventions to improve detection.

Location, safety and (non) strangers in gay men’s narratives on ‘hook-up’ apps

Hook-up websites and apps are said to be transforming the sexual lives of gay men and have been linked with the apparent erosion of gay publics as the basis for identity politics and social action. This article examines these dynamics in the interview and focus-group talk of gay men living on the economic and geographical margins of metropolitan gay culture. It offers perspectives on the importance of location – class, generation and space – for the experience of digital media, the negotiation of safety, and the new codifications and elaborations on sex with the (non) stranger; a figure who is not alien, yet not familiar, in sexual sociality. Reflecting on these situated perspectives in connection with debates on the erosion of gay publics, this article argues against monolithic framings of gay men’s sexual lives after digital media.

Psychosocial factors influencing risk-taking in middle age for STIs

Objectives To increase the knowledge of the psychosocial factors influencing sexual risk-taking for STIs among adults in late middle age. Methods Individual interviews were conducted either face to face or by telephone with 31 heterosexual men and women aged between 45 and 65. They were recruited from NHS sexual health services (n=16) and council run culture and leisure facilities (n=15) in a large Scottish city. A total of 18 women and 13 men were interviewed. All interviews were transcribed in full and thematically analysed. Results Analysis detailed important psychosocial and sociocultural factors; the prioritisation of intimacy above and beyond concerns about risks for STI in sexual partnerships; the importance of unwanted pregnancy in shaping risk perceptions throughout the life course; vulnerability associated with periods of relationship transition (eg, bereavement, divorce or separation); social norms and cultural expectations relating to age-appropriate sexual and health-seeking behaviours. Conclusions This is the first qualitative study to examine the factors associated with sexual risk-taking among heterosexual adults in late middle age in the UK. Many factors associated with sexual risk-taking are similar to those reported within other populations. However, we also detail population-specific factors, which should be considered in terms of the development of interventions for ‘at risk’ older adults, or the tailoring of wider behaviour change interventions to this specific age group.

Young men who have sex with men's use of social and sexual media and sex-risk associations: cross-sectional, online survey across four countries

Objective There has been an increase in new HIV diagnoses among young men who have sex with men (YMSM) over the past decade in both UK and US contexts, with online sex-seeking implicated in driving this development. This study sought to examine YMSMs use of a variety of social and sexual networking websites and ‘apps’, and assess sexual risk behaviours. Design YMSM were recruited from across four countries in Britain and Ireland, via an online survey using convenience sampling. Data were collected from 2668 men, of whom 702 were aged 18–25 years. Results Facebook use was almost ubiquitous and for largely social reasons; sexual media use was common with 52% using gay sexual networking (GSN) websites frequently and 44% using similar apps frequently. We found increased odds of high-risk condomless anal intercourse associated with the length of time users had been using GSN websites and lower levels of education. We found no significant differences across the four countries in sexual risk behaviours. Conclusions YMSM are a heterogeneous population with varied sexual health needs. For young men with digital literacy, individual-level online interventions, targeted and tailored, could be directed towards frequent users with lower levels of education. Variation in demographic characteristics of GSN websites and app users may affect who interventions are likely to reach, depending on where they are targeted. However, interventions, which may catch young men earlier, also provide a major opportunity for reducing sexual health inequalities.

Interventions to increase condom use among middle-aged and older adults: A systematic review of theoretical bases, behaviour change techniques, modes of delivery and treatment fidelity

This systematic review collates, examines and syntheses condom use interventions for middle-aged and older adults. Associations between effectiveness and theoretical basis, behaviour change techniques, mode of delivery and treatment fidelity were explored. Five interventions were included; one was effective. Compared to interventions with non-significant findings, the effective telephone-administered intervention used theory to a greater extent, had a higher number of behaviour change techniques and employed more treatment fidelity strategies. There is a need to develop theory-based interventions targeting condom use among this population and evaluate these in randomised controlled trials that are rigorously designed and reported. Health psychologists have a key role in this endeavour.