Sexual risk behaviour for transmission of HIV in men who have sex with men: recent findings and potential interventions.
OBJECTIVE
Men who have sex with men (MSM) remain one of the groups most at risk of HIV, particularly in countries with concentrated epidemics. Here, we review findings from behavioural research with MSM and discuss the potential of behavioural interventions.


RESULTS
Increasing sexual risk behaviour and HIV transmission among MSM is apparent. Although risk reduction strategies, including serosorting and strategic positioning, are being widely reported, these appear to offer limited protection to HIV-negative MSM. There are emerging HIV epidemics among MSM in low-income and middle-income countries, with reported high levels of HIV and sexual risk behaviour. Studies of African MSM report higher HIV prevalence than that in the adult male general population. Evidence of effective behavioural interventions is growing. However, further trials, incorporating biological endpoints, are required.


CONCLUSIONS
Reducing HIV transmission among MSM remains a significant challenge. Risk reduction strategies, other than condom use, could reduce the risk, but their efficacy is questionable, particularly when knowledge of HIV status may be inaccurate. Behaviour change alone is unlikely to produce the sustained reductions in HIV transmission necessary to change the course of the epidemic. 'Combination prevention', which incorporates biomedical, behavioural, social and structural interventions, should be explored further.
McDaid
Lisa M
LM
MRC/CSO Social and Public Health Sciences Unit, Glasgow, UK.
Hart
Graham J
GJ
D000328:Adult; D032763:Behavior Control / Q000379:methods*; D018562:Disease Transmission, Infectious / Q000517:prevention & control*; D015658:HIV Infections / Q000517:prevention & control* / Q000635:transmission*; D018451:Homosexuality, Male; D006801:Humans; D008297:Male; D012309:Risk-Taking