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

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Abstract
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 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 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