mental health AIDS

Spring 2006 Newsletter / Volume 7, Issue 3

HIV Prevention News

About Men Who Have Sex with Men

Updating earlier meta-analytic studies, Johnson et al. (2005)

conducted a systematic review and meta-analysis to locate, characterize, and summarize effects of behavioral HIV prevention interventions for men who have sex with men (MSM) ... [that were identified as of May 2005. The investigators] found 54 interventions with 16,224 participants that were evaluated in 40 randomized trials and controlled observational studies with independent comparison groups. Formats included 26 small group interventions, 18 individual-level interventions, and 10 community-level interventions. Fifteen interventions focused on HIV-positive individuals including MSM. (p. 568)

Johnson and colleagues report that "[i]n studies with strong research designs, behavioral interventions for MSM reduced unprotected sex by 27% compared with minimal or no intervention and reduced the proportion of men reporting any unprotected sex by 16%. These statistically significant effects were also evident in subgroup analyses of small-group and community-level interventions" (p. 582). The investigators also point out that "limited information on biological outcomes suggests that the highest risk clients may be better served by individual-level interventions than by small-group interventions that introduce them to potential new partners who are themselves at particularly high risk" (p. 584).

A study involving MSM comes from Heintz and Melendez (2006), who surveyed a convenience sample of 58 lesbian, gay, bisexual, and transgender individuals who had experienced intimate partner violence (IPV) and were receiving counseling from a community-based agency. "A large percentage of participants reported being forced by their partners to have sex (41%). Many stated that they felt unsafe to ask their abusive partners to use safer sex protection or that they feared their partners' response to safer sex (28%). In addition, many participants experienced sexual (19%), physical (21%), and/or verbal abuse (32%) as a direct consequence of asking their partner to use safer sex protection" (p. 193).

Drawing needed attention to this interface of IPV and HIV/sexually transmitted disease (STD) risk within same-sex relationships, Heintz and Melendez stress that "all [domestic violence] service providers [should] screen and provide assistance for issues relating to safer sex. Similarly, all HIV/STD service providers should screen for [domestic violence] and discuss safety within the context of abusive relationships when making safer sex plans with their clients" (p. 206).

By asking clients if they engage in safer sex with their partners and if they are forced to engage in sex with their partners or with others, service providers ... [can begin to] address the crucial and common nexus between IPV and STD risk in a way that gives voice to the victims ... [and] allow[s for] a more accurate, effective and safe plan for reducing the risk of violence and STD transmission ... . ... Counselors need to discuss with their clients the importance of safer sex and to discuss the possible risks that come from requesting safer sex. ... [Those who have experienced domestic violence] should learn techniques for ... staying physically safe and sexually safe. They should be given concrete guidelines for having a safer sex discussion with their partner including deciding beforehand where and when to request safer sex (making sure it happens before engaging in foreplay). Such negotiations will necessarily differ from individual to individual, much as general ... safety plans do. (pp. 205-206)

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