There is always a question of how effective are programs intended to reduce the number of people with sexually transmitted infections, including HIV. That is the question researchers from Scotland set out to answer in a study reported in this month's Archives of Internal Medicine. The answer they come up with is, essentially, that it'sdiifficult to say.
More than 1,500 studies were gathered from a database. Of those, only 30 met the researchers criteria for the study. Among the specific criteria were that the study had to single out heterosexual men in some way, had to include heterosexual men over age 15, and it had to be methodologically sound.After analyzing the 30 studies, a number of conclusions were reached. For one, they determined that few studies are conducted on men alone and few target the general population. Instead, most studies tend to be targeted to specific groups and most are done in the United States, despite the most rapid spread of HIV being in other parts of the world including the former Soviet Union and Asia. Researchers say, "Interventions targeting North American populations, while important, will not substantially reduce the global threat of [sexually transmitted infections] and HIV.
Eight of the interventions reviewed set out to reduce the incidence of STI. Of those, researchers determined only five were successful. These five included on-site individual counseling and HIV testing, mass communications regarding risk reduction, and multiple-component motivation and skills education in STI clinics. The rest of the 30 studies were designed more to focus on behavioral and social psychological outcomes as opposed to morbidity outcomes.
Following the review, researchers reached five major conclusions. First, more research is needed to focus on morbidity outcomes as opposed to behavior. Also, more interventions need to target heterosexual men, or at least ensure that heterosexual men participate in single-sex interventions. Additionally, more research needs to be carried out in regions of the world where STI and HIV are high among heterosexual men and interventions require more rigorous evaluation before widespread implementation. Finally, studies should have the statistical power to demonstrate effectiveness and this should be calculated before being funded and implemented.
