This letter is in response to the September 9, 2002, article entitled #1Effectiveness of Interventions to Prevent Sexually Transmitted Infections #1STIs] and Human Immunodeficiency Virus [HIV] in Heterosexual Men."1 While we commend the rigorous review conducted by the authors, we wish to rebut Elwy et al's assertion that "no systematic reviews have been conducted to determine the most effective social and behavioral means of preventing the spread of STIs and HIV among heterosexual men."1(p1818) We direct readers to a similar systematic review that we published in 1999 entitled "HIV Sexual Risk Reduction Interventions With Heterosexual Men: The Forgotten Group."2 Our review described and evaluated the effectiveness of HIV sexual risk reduction programs directed toward heterosexually active men in the United States that had been published through the fall of 1998. We included interventions that had a psychological, behavioral, or educational component designed specifically to address heterosexual risk reduction. A sexual behavior outcome or public health proxy of behavior change (eg, STI rate) had to be evaluated; we excluded studies that evaluated only changes in knowledge, attitudes, or behavior (KAB). We further excluded mixed-gender studies that did not provide analyses broken down separately for men and women and studies that did not provide analyses broken down separately by sexual identity if the sample was composed predominantly of nonheterosexual men. In sum, our inclusion criteria were similar to those of Elwy et al, although we acknowledge they conducted a much more global analysis. Other differences included their inclusion of KAB-only studies and their exclusion of studies that failed to meet specified methodological rigor. Nonetheless, both reviews similarly concluded that there has been an insufficient number of rigorously conducted and evaluated interventions directed toward heterosexual men to make definitive conclusions about the relative effectiveness of various prevention strategies for this population. Both reviews noted the need to systematically conduct and evaluate methodologically sound interventions specifically directed toward heterosexual men, including the conduct of the recruitment of large sample sizes based on a priori power calculations and the inclusion of biological outcomes in intervention studies. Both reviews also highlighted the importance of publishing data about interventions that do not demonstrate efficacy. We also noted a need for more detailed methodological and analytical description in published articles of intervention studies, including detailed description of the intervention content and the reporting of participation rates and outcome effect sizes. The Elwy et al review correctly pointed out the need for more international research. In closing, we commend Elwy et al's review effort, which extends our earlier work. Nonetheless, we wish to acknowledge the systematic review that we published 3 years earlier. It is reassuring that both reviews came to similar conclusions given the similarity of the respective inclusion criteria. At the same time, Elwy et al's review highlights the lack of progress that has been made over the 4 years since our review toward the systematic conduct and evaluation of sexual risk reduction programs directed toward heterosexually active men. References 1. Elwy ARHart GJHawkes SPetticrew M Effectiveness of interventions to prevent sexually transmitted infections and human immunodeficiency virus in heterosexual men. Arch Intern Med. 2002;1621818- 1830Google ScholarCrossref 2. Exner TMGardos SSeal DWEhrhardt AA HIV sexual risk reduction interventions with heterosexual men: the forgotten group. AIDS Behav. 1999;3347- 358Google ScholarCrossref
Archives of Internal Medicine – American Medical Association
Published: Mar 24, 2003
Keywords: hiv,heterosexuality,risk reduction
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