Low uptake of behavioural interventions in GUM

An audit carried out at 15 of the larger sexual health clinics in England suggests that only a limited number of gay men are offered and accept a structured behavioural intervention.

The National Institute for Health and Clinical Excellence (NICE) recommends that health professionals should offer a structured discussion on risk reduction to people who are at high risk of having a sexually transmitted infection (STI), including gay and bisexual men. These one-to-one discussions should be structured on the basis of behaviour change theories and should last at least 15 to 20 minutes.

The British Association for Sexual Health and HIV (BASHH) and the British HIV Association (BHIVA) make similar recommendations.

A case-note review found that four-in-ten patients received a behavioural intervention, but frequently this was just advice. Fewer than one-in-ten received a structured intervention, as recommended. Although men who reported recent unprotected anal intercourse were more likely to be offered and to accept an intervention than other men, uptake remained low.

Interventions delivered were mostly counselling and motivational interviewing; a handful of men received cognitive behavioural therapy or peer education.

The authors recommend that the reasons why such interventions are not offered to men at higher risk of HIV infection be investigated and addressed. Moreover, practitioners need a better understanding of how acceptable such interventions are to potential participants.

Young people’s safer sex knowledge

Research from France suggests that young people, aged 18 to 29, have poorer safer sex knowledge now than in the mid-1990s.

The data come from six surveys conducted with representative samples of the French population between 1992 and 2010. It is unusual to have comparative data on public attitudes over such a long period of time.

While 99% of young people know that you can get HIV from unprotected sexual intercourse, the proportion who believe that condoms can reliably prevent infection is now much lower than in previous years.

Across the whole sample, condom use is down. But more encouragingly, it hasn’t declined among young people who have had two or more partners in the past year.

Beliefs that HIV could be transmitted in unlikely ways were high in the first survey, went down following public awareness campaigns, but are now back at pre-campaign levels. In 2010, 21% of young men thought they could get HIV from public toilets and 31% from mosquito bites.

And fewer young people now say that they know someone who has HIV, although the number of people living with HIV in France has increased significantly in recent years.

In the UK, surveys conducted for the National AIDS Trust (NAT) also suggest that awareness and understanding of HIV are declining in the general public. Moreover, poor knowledge was associated with stigmatising attitudes.

NAT argues that, as well as targeted prevention campaigns aimed at the communities most at risk of HIV, there is a need for better sex and relationships education in schools and for HIV to be explicitly mentioned in safer-sex campaigns aimed at the general public.

Communications about PEP

Gay men’s awareness of HIV post-exposure prophylaxis (PEP) significantly improved in Western Australia, following implementation of a communications strategy, according to a recent study.

In response to data showing low awareness of non-occupational PEP in the gay community and prescription of PEP outside the guidelines, a basic communications campaign was provided from 2005 onwards. Whereas in two community surveys before implementation, only 17% and 23% of gay men were aware of PEP, this then rose to 45% and 55%.

But awareness has since dropped. The authors suggest that this may be because the materials and techniques used have changed little in recent years.

The study is of interest as research on the impact of communication campaigns is relatively rare. The data imply that communications can have a positive impact on awareness (especially when providing novel information), but that communication strategies need to be periodically revised if awareness is to be maintained.

Sigma Research's role in HIV Prevention England

Sigma Research, a social research group at the London School of Hygiene and Tropical Medicine, is one of six partners making up HIV Prevention England, the new national HIV prevention programme.

The group specialises in the behavioural and policy aspects of HIV. It is known particularly for the Gay Men's Sex Survey and Bass Line, which are large surveys of the HIV prevention needs of gay men and African communities respectively. Moreover, it led the development of Making It Count and The Knowledge, the Will and the Power – these frameworks have guided UK HIV prevention work with gay men and African communities in recent years.

Within HIV Prevention England, Sigma's focus will shift from this developmental work to monitoring and evaluation.

It will monitor what activities are carried out within the partnership in order to clarify whether plans are implemented. Sigma intends to monitor the full range of programme activities, from condom distribution and the placement of advertising to lobbying and engagement.

Evaluation work will shed light on whether these activities are having the effects they are intended to. In some cases, it will be possible to analyse existing data sets (for example, the number of HIV tests performed in sexual health clinics) from before and after campaigns. At other times, behavioural surveys will give an insight into people's self-reported behaviour, knowledge and attitudes.