Strategies to cut risky sexual behaviour may do more harm than good

(A cognitive behavioural intervention to reduce sexually transmitted infections among gay men: randomised trial)

Strategies aimed at changing sexual behaviour to prevent the transmission of HIV should not be assumed to bring benefit and potentially may even do more harm than good, finds a study in this week’s BMJ. More rigorous evaluation of such interventions is needed, report the authors.

To determine the effectiveness of a brief behavioural intervention in reducing sexual risk behaviour among gay men, researchers at a sexual health clinic in London recruited 343 gay men with an acute sexually transmitted infection or who reported having had unprotected anal intercourse in the past year.

All men received standard management consisting of a brief (20 minute) one to one counselling session about sexual risk behaviour. Additionally, a randomly selected group of 175 men were invited to a one day workshop (intervention group). For the following 12 months, the number of new infections diagnosed at the clinic were recorded and self-reported changes in sexual behaviour were assessed using postal questionnaires.

Although this intervention was acceptable and feasible to use in a busy clinic, it failed to reduce the risk of these men acquiring new infections. In fact, a larger proportion of the intervention group (31%) had at least one new sexually transmitted infection diagnosed at the clinic compared with the control group (21%) during the 12 month follow up.

The higher risk of acquiring a sexually transmitted infection among men in the intervention group was unexpected, and clearly a cause for concern, say the authors. Even carefully designed interventions should not be assumed to bring benefit and the potential for such interventions to do more harm than good needs to be taken seriously, they conclude.

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