CDC COMMUNITY GUIDE: Interventions to Reduce Sexual Risk Behaviors or Increase Protective Behaviors to Prevent Acquisition of HIV in Men Who Have Sex with Men: Individual-, Group-, and Community-Level Behavioral Interventions

Behavioral interventions to prevent acquisition of HIV in men who have sex with men (MSM) fall into three categories:
• Individual-level HIV behavioral interventions that provide relevant information, training, or support through a personal interaction between a deliverer and an MSM.
• Group-level HIV behavioral interventions that promote individual behavior change in situations where information and activities delivered by a trained counselor, educator, or other facilitator can be reinforced by peer pressure and support from other group members.
• Community-level HIV behavioral interventions that are designed to influence individual risk behavior by changing knowledge, attitudes, and beliefs in a defined community.

The Task Force on Community Preventive Services recommends implementation of the following HIV behavioral interventions for adult men who have sex with men based on evidence of their effectiveness in reducing unprotected anal intercourse:
• Individual-level interventions (strong evidence)
• Group-level interventions (strong evidence)
• Community-level interventions (sufficient evidence)

The goal of the HIV behavioral interventions program is to reduce unprotected anal intercourse among men who have sex with men.

The Community Preventive Services Task Force (CPSTF) recommends individual-level HIV behavioral interventions for adult men who have sex with men to reduce unprotected anal intercourse. Related findings recommend HIV behavioral interventions at the group level and community level.

Results of the Systematic Reviews:

Individual-level interventions:
Four studies qualified for the review and reported on six interventions:
• Unprotected anal intercourse (UAI): mean odds ratio = 0.57
-These effects were significant at both short-term (median 6 months) and long-term (median 12 months) follow-ups.
-Individual-level interventions also resulted in a 59% reduction in odds of having UAI with non-primary partners (3 interventions), and a 48% reduction in odds of having UAI with partners who don't have the same HIV status (serodiscordant partners) (4 interventions).

Group-level interventions:
Twelve studies qualified for the review and reported on 15 interventions:
• Unprotected anal intercourse (UAI): 27% reduction in odds
-These effects were significant at both short-term (median 3 months) and long-term (median 12 months) follow-ups.
• Receptive UAI: 44% reduction in odds (two studies)
• Condom use during anal intercourse: 81% increase in odds (five studies)
• The interventions that showed greater effectiveness in reducing UAI included multiple intervention sessions; delivery by other MSM; and skill building through role plays, live demonstrations, or practice.
• A systematic economic evaluation found that two group-level interventions were cost saving; the averted HIV medical care costs exceeded the program intervention costs.

Community-level interventions:
Three studies qualified for the review and reported on three interventions:
• Unprotected anal intercourse (UAI): 35% reduction in odds at follow-up intervals ranging from 4 months (two studies) to 1 year (one study)
• Condom use during anal intercourse: 59% increase in odds (two studies)
• A systematic economic evaluation of 3 community-level interventions found that potential savings in HIV-related medical costs exceeded the costs of implementing the intervention.