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Behaviour change interventions in HIV prevention: is there still a place for them?
Gus Cairns, 2017-04-12 07:40:00
A meta-analysis of studies of brief interventions to reduce
HIV risk behaviour in HIV-negative gay men has concluded that there is evidence
that such techniques did have a significant impact on the behaviours they were
designed to change.
It also found evidence that the best way to conduct such
interventions was face-to-face, i.e. not via the internet, telephone or phone
apps, and that immediately or shortly after HIV testing was an ideal “learning
moment” to conduct them.
Interventions that helped participants set goals for
themselves, and ones that helped them understand and restructure
self-justifying or contradictory thinking, were the ones most likely to result
in behaviour change. Programmes worked better if they involved participants feeling
differently about themselves and their behavioural risk, rather than receiving
new information. Interventions worked better if they were based explicitly on a
theory of behaviour change.
However, while the analysis did find positive evidence for
such interventions producing behaviour change, the writers also conclude that
the HIV prevention “landscape” has changed radically in the last few years. The
studies were published between 2002 and 2014 and probably gathered their data
at least two years before their publication date. None included as measurable outcomes
serosorting or seropositioning (i.e. basing condom use or sex role on a
partner’s perceived status), pre-exposure prophylaxis (PrEP) use, decisions based on partners’ viral load,
or the use of negotiated safety arrangements, even though the authors tried to
find studies that measured these.
There was just one outcome measure that was sufficiently
universal across the studies for the authors to make a statistical
generalisation about study effectiveness: whether the interventions reduced
condomless anal sex. Even though this was measured in various ways (number of
condomless acts, number of condomless sex partners, whether they occurred with
primary or casual partners, the HIV status or assumed status of the partner,
and so on) and was measured over different time periods, the general reduction
in condomless sex acts after the eleven interventions was 25%.