https://www.thecommunityguide.org/sites/default/files/assets/Evidence_review.pdf

The effectiveness of individual-, group-, and community-level HIV behavioral risk-reduction interventions for adult men who have sex with men: a systematic review.

Sexually transmitted infections (STIs) are a major health problem in most countries of the world, but especially in developing countries where the resources and technology to diagnose and treat them are limited.1 Currently, many countries, including China, are experiencing a resurgence of STIs, because of limited control efforts.2,3

In many of these countries, the major strategy for control of STIs has been through sexually transmitted disease clinics for the management of symptomatic genitourinary infections for individuals seeking treatment. However, an emphasis on this strategy has several limitations. First, because of the stigma associated with STIs, a high proportion (often 60 + %) of individuals with symptomatic STIs are reluctant to seek treatment from government clinics.4 Second, these symptomatic individuals often seek treatment in pharmacies and from indigenous providers, where treatment is often inadequate, partner treatment is not offered, and no record of their treatment is kept.5,6 Third, this strategy relies on individuals seeking treatment. Those who are asymptomatic are unlikely to seek any kind of treatment, and may have a long duration of infection, repeatedly exposing their regular partners and/or new partners to infection. For these reasons, studies of asymptomatic STIs require investigation of populations who do not seek care on the basis of symptoms. Several studies have reported high proportions of laboratory-confirmed Chlamydia trachomatis- and Neisseria gonorrhoeae-infected individuals who are asymptomatic, especially in women.7–13 However, the proportions of asymptomatic C. trachomatis and N. gonorrhoeae infections may differ between different countries and groups.

The National Institute of Mental Health sponsored a trial of a community-level intervention based on the “popular opinion leader model” to prevent HIV/STIs among selected populations in 5 countries, China, India, Peru, Russia, and Zimbabwe.14,15 The populations in this study were selected on the basis of reported sexual risk behaviors and/or prevalence of STIs in their respective countries, and therefore, the ages are not comparable. In some countries, the individuals at highest risk for STIs were young, whereas in other country settings, were older and had more discretionary income. As part of the assessment of the trial, a baseline and 2 follow-up surveys at 12 and 24 months were conducted, in which symptoms of STIs were solicited, and participants were tested for the presence of several STIs, including C. trachomatis and N. gonorrhoeae, using sensitive nucleic acid amplification tests. Because of the large sample size, this study provided an excellent opportunity to study the prevalence and incidence of both symptomatic and asymptomatic infections in community settings among individuals not selected on the basis of symptoms or high-risk activities. We report herein the prevalence and incidence of laboratory-confirmed C. trachomatis and N. gonorrhoeae in these 5 diverse populations, the proportions of those reporting symptoms by several demographic characteristics, and predictors of symptomatic and asymptomatic infection. This information should be useful for decision makers in these countries attempting to control the epidemics of STIs in their populations. The study was approved by the institutional review boards of the institutions in each of the 5 countries, and by those at each of the American academic institutions.

The incidence and correlates of symptomatic and asymptomatic Chlamydia trachomatis and Neisseria gonorrhoeae infections in selected populations in five countries.

Background: Studies of condom use to reduce risk of most sexually transmitted infection provide inconsistent results. This inconsistency is often attributed to methodologic limitations yet has not been assessed systematically. Objectives: The objectives of this study were to review studies of condom use and risk of gonorrhea and chlamydia, and to evaluate the importance of 4 key design and measurement factors on condom effectiveness estimates. Design: We reviewed studies published 1966 –2004 to assess risk reduction for gonorrhea and/or chlamydia associated with male condom use. Results: Of 45 studies identified, most found reduced risk of infection associated with condom use. All studies reviewed had methodologic limitations: only 28 (62%) distinguished consistent from inconsistent use; 2 (4%) reported on correct use or use problems; 13 (29%) distinguished incident from prevalent infection; and one (2%) included a population with documented exposure to infection. Eight of 10 studies with 2 or more of these attributes reported statistically significant protective effects for condom use versus 15 of 35 studies with zero or one attribute (80% vs. 43%, P 0.04). Conclusions: Condom use was associated with reduced risk of gonorrhea and chlamydia in men and women in most studies, despite methodologic limitations that likely underestimate condom effectiveness. Epidemiologic studies that better address these factors are needed to provide more accurate assessment of condom effectiveness. APPROXIMATELY 19 MILLION CASES of sexually transmitted infection (STI) occur in the United States each year. 1 For sexually active persons, male latex condoms are the most commonly used contraceptive method to prevent STIs. 2 When properly

Condom use and risk of gonorrhea and Chlamydia: a systematic review of design and measurement factors assessed in epidemiologic studies.

Background: Two risk-reduction counseling sessions can prevent sexually transmitted diseases (STDs); however, return rates for test results are low. Study: A randomized, controlled trial compared rapid HIV testing and counseling in 1 visit with standard HIV testing and counseling in 2 visits. Main outcomes were STDs (gonorrhea, chlamydia, trichomoniasis, syphilis, HIV) within 12 months. Participants were 15- to 39year-old STD clinic patients in Denver, Long Beach, and Newark. STD screening and questionnaires were administered every 3 months. Results: Counseling was completed by 1632 of 1648 (99.0%) of the rapid-test group and 1144 of 1649 (69.4%) of the standard-test group. By 12 months, STD was acquired by 19.1% of the rapid group and 17.1% of the standard group (relative risk [RR], 1.11; confidence interval [CI], 0.96‐1.29). STD incidence was higher in the rapid-test group than in the standard-test group among men (RR, 1.34; CI, 1.06‐1.70), men who had sex with men (RR, 1.86; 95% CI, 0.92‐3.76), and persons with no STDs at enrollment (RR, 1.21; 95% CI, 0.99‐ 1.48). Behavior was similar in both groups. Conclusions: Counseling with either test had similar effects on STD incidence. For some persons, counseling with standard testing may be more effective than counseling with rapid testing. IN THE UNITED STATES, in 1998, there were 621,150 human immunodeficiency (HIV) tests done in sexually transmitted disease (STD) clinics and 7731 were positive. 1 HIV-negative persons visiting STD clinics are at a relatively high risk of becoming infected with HIV 2 and of having subsequent STDs. 3 It is thus important that STD clinics provide effective interventions to prevent HIV and other STDs. Project RESPECT showed that for STD clinic clients, 2 20-minute sessions of prevention counseling with HIV testing, given a week apart, decreased the risk of acquiring an STD during the following year 20% more than HIV testing with 2 sessions of information alone. 3 In practice, however, it is often not

Relative efficacy of prevention counseling with rapid and standard HIV testing: a randomized, controlled trial (RESPECT-2).

Background: Two risk-reduction counseling sessions can prevent sexually-transmitted diseases (STDs); however, return rates for test results are low Study: A randomized, controlled trial compared rapid HIV testing and counseling in 1 visit with standard HIV testing and counseling in 2 visits Main outcomes were STDs (gonorrhea, chlamydia, trichomoniasis, syphilis, HIV) within 12 months Participants were 15- to 39- year old STD clinic patients in Denver, Long Beach, and Newark STD screening and questionnaires were administered every 3 months Results: Counseling was completed by 1632 of 1648 (990%) of the rapid-test group and 1144 of 1649 (694%) of the standard-test group By 12 months, STD was acquired by 191% of the rapid group and 171% of the standard group (relative risk [RR], 111; confidence interval [CI], 096-129) STD incidence was higher in the rapid-test group among men (RR, 134; CI, 106-170), men who had sex with men (RR, 186; CI, 092-376), and persons with no STDs at enrollment (RR, 121; CI, 099-148) Behavior was similar in both groups Conclusions: Counseling with either test had similar effects on STD incidence For some persons, counselling with standard testing may be more effective than counselling with rapid testing

Relative Efficacy of Prevention Counseling With Rapid and Standard HIV Testing: A Randomized, Controlled Trial (RESPECT-2)

NIMH/APPC workgroup on behavioral and biological outcomes in HIV/STD prevention studies: a position statement.

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NIMH/APPC workgroup on behavioral and biological outcomes in HIV/STD prevention studies: a position statement.