BMJ 2001;322:1451-1456 ( 16 June )

Papers

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

John Imrie, senior research fellow, a Judith M Stephenson, senior lecturer in epidemiology, a Frances M Cowan, senior lecturer in genitourinary medicine, a Shamil Wanigaratne, consultant clinical psychologist, b Andrew J P Billington, genitourinary medicine sexual health coordinator, b Andrew J Copas, lecturer in statistics, a Lesley French, head of health advising services, b Patrick D French, consultant physician, b Anne M Johnson, professor of epidemiology, a for the Behavioural Intervention in Gay Men Project Study Group.

a Department of Sexually Transmitted Diseases, Royal Free and University College Medical School, London WC1E 6AU, b Camden and Islington Community Health Services NHS Trust, London WC1E 6AU

Correspondence to: J Imrie jimrie{at}gum.ucl.ac.uk

Objective: To determine the effectiveness of a brief cognitive behavioural intervention in reducing the incidence of sexually transmitted infections among gay men.
Design: Randomised controlled trial with 12 months' follow up.
Setting: Sexual health clinic in London.
Participants: 343 gay men with an acute sexually transmitted infection or who reported having had unprotected anal intercourse in the past year.
Main outcome measures: Number of new sexually transmitted infections diagnosed during follow up and self reported incidence of unprotected anal intercourse.
Results: 72% (361/499) of men invited to enter the study did so. 90% (308/343) of participants returned at least one follow up questionnaire or re-attended the clinic and requested a check up for sexually transmitted infections during follow up. At baseline, 37% (63/172) of the intervention group and 30% (50/166) of the control group reported having had unprotected anal intercourse in the past month. At 12 months, the proportions were 27% (31/114) and 32% ( 39/124) respectively (P=0.56). However, 31% (38/123) of the intervention group and 21% (35/168) of controls had had at least one new infection diagnosed at the clinic (adjusted odds ratio 1.66, 95% confidence interval 1.00 to 2.74). Considering only men who requested a check up for sexually transmitted infections, the proportion diagnosed with a new infection was 58% (53/91) for men in the intervention group and 43% (35/81) for men in the control group (adjusted odds ratio 1.84, 0.99 to 3.40). Using a regional database that includes information from 23 sexual health clinics in London, we determined that few participants had attended other sexual health clinics.
Conclusions: This behavioural intervention was acceptable and feasible to deliver, but it did not reduce the risk of acquiring a new sexually transmitted infection among these gay men at high risk. Even carefully designed interventions should not be assumed to bring benefit. It is important to evaluate their effects in randomised trials with objective clinical end points.


What is already known on this topic
The need for effective HIV prevention strategies based on reducing sexual risk behaviour remains important

Few interventions to reduce sexual risk behaviour have been rigorously evaluated using randomised controlled trials

What this study adds
This is the first randomised controlled trial of an intervention addressing sexual behaviour in homosexual men that uses sexually transmitted infections and self reported behaviour as end points

The intervention was brief and feasible to use in a busy clinic, but it did not reduce the risk of participants acquiring new infections

The potential for behavioural interventions to do more harm than good needs to be taken seriously



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Behavioural interventions do work
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workshops don't work?
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Imrie et al.: The final word on cognitive behavioural interventions?
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