According to the authors, heterosexual men may be key to controlling the spread of STDs and HIV. STDs, including HIV, are more easily transmitted from men to women than from women to men. Women are twice as likely as men to become infected with STDs and the efficiency of transmission from male-to-female is four times higher than female-to-male transmission. In addition, women may be at higher risk due to social and cultural norms that make them vulnerable in their sexual practices. Moreover, these same norms often allow men to seek sexual activity outside the home, increasing the risk of acquiring and transmitting STDs and HIV.
No systematic reviews have been conducted to determine the most effective social and behavioral means of preventing the spread of STDs and HIV among heterosexual men. In a review of 68 behavioral interventions, the authors rated only 18 of these as being of high methodological quality. Meta-analysis of 27 specific programs based on providing information on HIV status found that counseling and testing was not an effective primary prevention strategy for uninfected participants, but it did provide an effective means of secondary prevention for HIV-positive individuals. The authors found reviews of other specific population-based interventions not generalizable to adult men who have sex with women. Other review limitations consisted in reliance only on North American populations and a failure to assess the effectiveness of interventions of STDs, along with HIV in heterosexual men.
The authors undertook a systematic review to evaluate the evidence for the effectiveness of social and behavioral interventions to promote men's sexual and reproductive health, focusing on the prevention of STDs, including HIV. Studies were selected for review according to five criteria that included focus upon heterosexual males; analyzed male data separate from other data or at least 80 percent of study participants were heterosexual men; study designs were coded (randomized or nonrandomized; prospective; retrospective); outcomes assessed included one of the following: morbidity, behavioral outcome; social psychological outcome; and study was coded as being moderate to high quality.
Of 1157 studies identified, 27 met the inclusion criteria. Most interventions targeted specific groups of men (e.g., those attending STD clinics) rather than general populations. Few were conducted with men alone, and most focused on behavioral and social psychological rather than morbidity outcomes. Of 8 interventions designed to reduce STD incidence (including HIV), 5 were successful, 2 were unsuccessful, and 1 had equivocal results. Of the 5 successful interventions, 1 was carried out in the workplace, 1 in the military and 3 in STD clinics. They included onsite counseling and HIV testing, mass communications and multiple-component motivation and skills education in STD clinics.
In an extensive discussion section of the article, the authors indicated the following other findings:
- Only a minority of studies was designed to evaluate the effectiveness of reducing the incidence of STDs or HIV.
- There is no single intervention that can be identified as being more effective than others. Moreover, achieving and recording the success of an intervention is a resource-intensive undertaking.
- As with the studies that aimed to decrease the incidence of STDs, there was no single method that could be identified as being effective in all situations aimed to change behaviors, increase knowledge, or measure an intention to change.
- However, studies of interventions with men in the workplace all reported significant effects on the men's sexual behavior and knowledge of STDs and HIV. The use of peer educators in interventions of longer duration seems to have been effective. Similar results were found in studies among men in other settings -- students, homeless men, and prisoners.
The authors suggest research needs to focus on morbidity outcomes rather than behavioral change. Interventions need to target heterosexual men so that evaluations can identify approaches that are more appropriate. More research needs to be carried out in regions of the world where STDs and HIV are high among heterosexual men. Studies should have the statistical power to demonstrate effectiveness prior to being funded and implemented.
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This article was provided by CDC National Prevention Information Network.
It is a part of the publication CDC HIV/Hepatitis/STD/TB Prevention News Update.