UK review of reviews

As can be seen above, the vast majority of research into the effectiveness of behaviour-change interventions as a means of preventing HIV has taken place in the US, though there are exceptions. Remarkably, although the UK has good surveillance of HIV and a long history of research into sexual-risk and other HIV-risk behaviour, there has been very little accompanying research into the efficacy of HIV-prevention programmes, and major decisions, as cited above, on the direction of HIV-prevention programmes have been taken on the basis of very little research or research conducted outside the UK. 

A 2003 meta-review¹ (a review of reviews) by the Health Development Agency (now part of NICE, the National Institute for Health and Clinical Excellence) assessed the effectiveness of interventions relevant to the UK. The reviews the agency looked at were primarily US-based, but it critically appraised the relevance of these findings for the UK. The meta-review came up with a considerably slimmer body of evidence than the largely US-based reviews above. This may in part be due to different inclusion criteria.

The meta-review found no research on which specific modifying factors produced better outcomes, no studies of cost-effectiveness and no studies of whether theory-based interventions were more effective.

Among its list of ‘key evidence gaps’, it found:

• very little review-level evidence relevant to UK gay men
• very little review-level evidence relevant to UK commercial sex workers
• no review-level evidence relevant to UK African communities
• no review-level evidence about interventions with people with HIV
• very little review-level evidence about the vast majority of interventions and none on condom-distribution schemes, small media (leaflets) and community development work.

What did it find?

• It found that cognitive-behavioural, group-work interventions that concentrate on role-playing, communication skills and sexual negotiation can be effective for gay men.
• It found that community-level interventions involving peers and popular opinion leaders could be effective in influencing gay men’s sexual-risk behaviour.
• It found that community level, especially peer-led, interventions can be effective in influencing the sexual-risk behaviour of commercial sex workers.
• It found that small-group interventions delivered at the community level can be effective in influencing the sexual-risk behaviour of black and minority ethnic women.
• And it found that a positive HIV diagnosis positively influenced sexual-risk behaviour, but no evidence that a negative one did.

This was the total amount of statistically significant evidence it was able to cull from the studies.

The Health Development Agency  was at pains to point out that, for the many different HIV-prevention programmes that have been carried out in the UK since the beginning of the epidemic, lack of evidence of effectiveness was not the same as evidence of lack of effectiveness. However, the lack of scientifically rigorous research into HIV prevention, especially into the difference in effectiveness between methods, does not serve as a good foundation for future programmes.