Skip to main content
Log in

A Systematic Review to Identify Challenges of Demonstrating Efficacy of HIV Behavioral Interventions for Gay, Bisexual, and Other Men Who Have Sex with Men (MSM)

AIDS and Behavior Aims and scope Submit manuscript

Abstract

Gay, bisexual, and other men who have sex with men (MSM) are disproportionately affected by HIV but few MSM-specific evidence-based interventions (EBIs) have been identified for this vulnerable group. We conducted a systematic review to identify reasons for the small number of EBIs for MSM. We also compared study, intervention and sample characteristics of EBIs versus non-EBIs to better understand the challenges of demonstrating efficacy evidence. Thirty-three MSM-specific studies were evaluated: Nine (27 %) were considered EBIs while 24 (73 %) were non-EBIs. Non-EBIs had multiple methodological limitations; the most common was not finding a significant positive effect. Compared to EBIs, non-EBIs were less likely to use peer intervention deliverers, include sexual communication in their interventions, and intervene at the community level. Incorporating characteristics associated with EBIs may strengthen behavioral interventions for MSM. More EBIs are needed for substance-using MSM, MSM of color, MSM residing in the south and MSM in couples.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. CDC. CDC factsheet: HIV among gay and bisexual men. Published May 2012. http://www.cdc.gov/hiv/topics/msm/pdf/msm.pdf. Accessed 1 Feb 2013.

  2. Purcell DW, Johnson CH, Lansky A, et al. Estimating the population size of men who have sex with men in the United States to obtain HIV and syphilis rates. Open AIDS J. 2012;6:98–107.

    Article  PubMed  Google Scholar 

  3. Prejean J, Song R, Hernandez A, et al. Estimated HIV incidence in the United States, 2006–2009. PLoS ONE. 2011;6(8):e17502.

    Article  PubMed  CAS  Google Scholar 

  4. Hall HI, Song R, Rhodes P, et al. Estimation of HIV incidence in the United States. JAMA. 2008;300(5):520–9.

    Article  PubMed  CAS  Google Scholar 

  5. Hankins CA, de Zalduondo BO. Combination prevention: a deeper understanding of effective HIV prevention. AIDS. 2010;24(Suppl 4):S70–80.

    Article  PubMed  Google Scholar 

  6. Mansergh G, Higa D. HIV/AIDS in lesbian, gay, bisexual, and transgender communities. In: Hall JC, Hall BJ, Cockerell CJ, editors. HIV/AIDS in the post-HAART era: manifestations, treatment, and epidemiology. Shelton: People’s Medical Publishing House; 2011. p. 709–21.

    Google Scholar 

  7. Kelly JA, Kalichman SC. Behavioral research in HIV/AIDS primary and secondary prevention: recent advances and future directions. J Consult Clin Psychol. 2002;70(3):626–39.

    Article  PubMed  Google Scholar 

  8. Kegeles SM, Hays RB, Coates TJ. The Mpowerment Project: a community-level HIV prevention intervention for young gay men. Am J Public Health. 1996;86(8):1129–36.

    Article  PubMed  CAS  Google Scholar 

  9. Kelly JA, St Lawrence JS, Stevenson LY, et al. Community AIDS/HIV risk reduction: the effects of endorsements by popular people in three cities. Am J Public Health. 1992;82(11):1483–9.

    Article  PubMed  CAS  Google Scholar 

  10. Noar SM. Behavioral interventions to reduce HIV-related sexual risk behavior: review and synthesis of meta-analytic evidence. AIDS Behav. 2008;12(3):335–53.

    Article  PubMed  Google Scholar 

  11. Herbst JH, Sherba RT, Crepaz N, et al. A meta-analytic review of HIV behavioral interventions for reducing sexual risk behavior of men who have sex with men. J Acquir Immune Defic Syndr. 2005;39(2):228–41.

    PubMed  Google Scholar 

  12. Herbst JH, Beeker C, Mathew A, et al. The effectiveness of individual-, group- and community-level HIV behavioral risk-reduction interventions for adult men who have sex with men: a systematic review. Am J Prev Med. 2007;32(Suppl 4):S38–67.

    Article  PubMed  Google Scholar 

  13. Johnson WD, Hedges LV, Ramirez G, et al. HIV prevention research for men who have sex with men: a systematic review and meta-analysis. J Acquir Immune Defic Syndr. 2002;30(Suppl 1):S118–29.

    PubMed  Google Scholar 

  14. Johnson WD, Holtgrave DR, McClellan WM, Flanders WD, Hill AN, Goodman M. HIV intervention research for men who have sex with men: a 7-year update. AIDS Educ Prev. 2005;17(6):568–89.

    Article  PubMed  Google Scholar 

  15. Johnson WD, Diaz RM, Flanders WD, et al. Behavioral interventions to reduce risk for sexual transmission of HIV among men who have sex with men. Cochrane Database Syst Rev. 2008;3:CD001230.

    PubMed  Google Scholar 

  16. Padian NS, McCoy SI, Balkus JE, Wasserheit JN. Weighing the gold in the gold standard: challenges in HIV prevention research. AIDS. 2010;24(5):621–35.

    Article  PubMed  Google Scholar 

  17. Ross DA. Behavioural interventions to reduce HIV risk: what works? AIDS. 2010;24(Suppl 4):S4–14.

    Article  PubMed  Google Scholar 

  18. Coates TJ, Richter L, Caceres C. Behavioural strategies to reduce HIV transmission: how to make them work better. Lancet. 2008;372(9639):669–84.

    Article  PubMed  Google Scholar 

  19. Grant RM, Lama JR, Anderson PL, et al. Preexposure chemoprophylaxis for HIV prevention in men who have sex with men. N Engl J Med. 2010;363(27):2587–99.

    Article  PubMed  CAS  Google Scholar 

  20. de Wit JB, Aggleton P, Myers T, Crewe M. The rapidly changing paradigm of HIV prevention: time to strengthen social and behavioural approaches. Health Educ Res. 2011;26(3):381–92.

    Article  PubMed  Google Scholar 

  21. Mei S, Quax R, van de Vijver D, Zhu Y, Sloot PM. Increasing risk behaviour can outweigh the benefits of antiretroviral drug treatment on the HIV incidence among men-having-sex-with-men in Amsterdam. BMC Infect Dis. 2011;11:118.

    Article  PubMed  Google Scholar 

  22. Office of National AIDS Policy. National HIV/AIDS strategy for the United States. Washington, DC: Office of National AIDS Policy. Published July 2010. http://www.whitehouse.gov/sites/default/files/uploads/NHAS.pdf. Accessed 8 Jun 2012.

  23. Lyles CM, Crepaz N, Herbst JH, Kay LS. Evidence-based HIV behavioral prevention from the perspective of the CDC’s HIV/AIDS Prevention Research Synthesis Team. AIDS Educ Prev. 2006;18(4 Suppl A):21–31.

    Article  PubMed  Google Scholar 

  24. De Luca JB, Mullins MM, Lyles CM, Crepaz N, Kay L, Thadiparthi S. Developing a comprehensive search strategy for evidence-based systematic review. Evid Based Libr Inf Pract. 2011;3(1):3–32.

    Google Scholar 

  25. Antoni MH, Cruess DG, Klimas N, et al. Stress management and immune system reconstitution in symptomatic HIV-infected gay men over time: effects on tranisitional naive T cells (CD4+ CD45RA+ CD29+). Am J Psychiat. 2002;159(1):143–4.

    Article  PubMed  Google Scholar 

  26. Carrico AW, Antoni MH, Pereira DB, et al. Cognitive behavioral stress management effects on mood, social support and a marker of antiviral immunity are maintained up to 1 year in HIV-infected gay men. Int J Behav Med. 2005;12(4):218–26.

    Article  PubMed  Google Scholar 

  27. Cosio D, Heckman TG, Anderson T, Heckman BD, Garske J, McCarthy J. Telephone-administered motivational interviewing to reduce risky sexual behavior in HIV-infected rural persons: a pilot randomized clinical trial. Sex Transm Dis. 2010;37(3):140–6.

    Article  PubMed  Google Scholar 

  28. Gilbert P, Ciccarone D, Gansky SA, et al. Interactive “Video Doctor” counseling reduces drug and sexual risk behaviors among HIV-positive patients in diverse outpatient settings. PLoS ONE. 2008;3(4):e1988.

    Article  PubMed  Google Scholar 

  29. Ironson G, Antoni MH, Schneiderman N, et al. Stress management and psychosocial predictors of disease course in HIV-1 infection. In: Goodkin K, Visser AP, editors. Psychoneuroimmunology: stress, mental disorders and health. Washington, DC: American Psychiatric; 2000. p. 317–56.

    Google Scholar 

  30. Kalichman SC, Rompa D, Cage M, et al. Effectiveness of an intervention to reduce HIV transmission risks in HIV-positive people. Am J Prev Med. 2001;21(2):84–92.

    Article  PubMed  CAS  Google Scholar 

  31. Kelly JA, Murphy DA, Bahr GR, et al. Outcome of cognitive-behavioral and support group brief therapies for depressed, HIV-infected persons. Am J Psychiatry. 1993;150(11):1679–86.

    PubMed  CAS  Google Scholar 

  32. Lightfoot M, Tevendale H, Comulada WS, Rotheram-Borus MJ. Who benefited from an efficacious intervention for youth living with HIV: a moderator analysis. AIDS Behav. 2007;11(1):61–70.

    Article  PubMed  Google Scholar 

  33. Morin SF, Shade SB, Steward WT, et al. A behavioral intervention reduces HIV transmission risk by promoting sustained serosorting practices among HIV-infected men who have sex with men. J Acquir Immune Defic Syndr. 2008;49(5):544–51.

    Article  PubMed  Google Scholar 

  34. Richardson JL, Milam J, McCutchan A, et al. Effect of brief safer-sex counseling by medical providers to HIV-1 seropositive patients: a multi-clinic assessment. AIDS. 2004;18(8):1179–86.

    Article  PubMed  Google Scholar 

  35. Rotheram-Borus MJ, Swendeman D, Comulada WS, Weiss RE, Lee M, Lightfoot M. Prevention for substance-using HIV-positive young people: telephone and in-person delivery. J Acquir Immune Defic Syndr. 2004;37(Suppl 2):S68–77.

    Article  PubMed  Google Scholar 

  36. Kelly JA, Murphy DA, Sikkema KJ, et al. Randomised, controlled, community-level HIV-prevention intervention for sexual-risk behaviour among homosexual men in US cities. Community HIV Prevention Research Collaborative. Lancet. 1997;350(9090):1500–5.

    Article  PubMed  CAS  Google Scholar 

  37. Goldbaum GM, Johnson W, Wolitski RJ et al. Sexual behavior change among non-gay-identified men who have sex with men: response to a community-level intervention. Unpublished manuscript.

  38. Picciano J, Roffman R, Kalichman S, Rutledge S, Berghuis J. A telephone based brief intervention using motivational enhancement to facilitate HIV risk reduction among MSM: a pilot study. AIDS Behav. 2001;5(3):251–62.

    Article  Google Scholar 

  39. Carpenter KM, Stoner SA, Mikko AN, Dhanak LP, Parsons JT. Efficacy of a web-based intervention to reduce sexual risk in men who have sex with men. AIDS Behav. 2010;14(3):549–57.

    Article  PubMed  Google Scholar 

  40. Rosser BR, Oakes JM, Konstan J, et al. Reducing HIV risk behavior of men who have sex with men through persuasive computing: results of the Men’s INTernet Study-II. AIDS. 2010;24(13):2099–107.

    Article  PubMed  Google Scholar 

  41. Roffman RA, Picciano JF, Ryan R, et al. HIV-prevention group counseling delivered by telephone: an efficacy trial with gay and bisexual men. AIDS Behav. 1997;1(2):137–54.

    Article  Google Scholar 

  42. Coleman JD, Lindley LL, Annang L, Saunders RP, Gaddist B. Development of a framework for HIV/AIDS prevention programs in African American churches. AIDS Patient Care STDS. 2012;26(2):116–24.

    Article  PubMed  Google Scholar 

  43. Dilley JW, Woods WJ, Sabatino J, et al. Changing sexual behavior among gay male repeat testers for HIV: a randomized, controlled trial of a single-session intervention. J Acquir Immune Defic Syndr. 2002;30(2):177–86.

    PubMed  Google Scholar 

  44. Dilley JW, Woods WJ, Loeb L, et al. Brief cognitive counseling with HIV testing to reduce sexual risk among men who have sex with men: results from a randomized controlled trial using paraprofessional counselors. J Acquir Immune Defic Syndr. 2007;44(5):569–77.

    Article  PubMed  Google Scholar 

  45. Koblin B, Chesney M, Coates T. Effects of a behavioural intervention to reduce acquisition of HIV infection among men who have sex with men: the EXPLORE randomised controlled study. Lancet. 2004;364(9428):41–50.

    Article  PubMed  CAS  Google Scholar 

  46. Mansergh G, Koblin BA, McKirnan DJ, et al. An intervention to reduce HIV risk behavior of substance-using men who have sex with men: a two-group randomized trial with a nonrandomized third group. PLoS Med. 2010;7(8):e1000329.

    Article  PubMed  Google Scholar 

  47. Picciano JF, Roffman RA, Kalichman SC, Walker DD. Lowering obstacles to HIV prevention services: effects of a brief, telephone-based intervention using motivational enhancement therapy. Ann Behav Med. 2007;34(2):177–87.

    Article  PubMed  Google Scholar 

  48. Read SJ, Miller LC, Appleby PR, et al. Socially optimized learning in a virtual environment: reducing risky sexual behavior among men who have sex with men. Health Commun Res. 2006;32(1):1–34.

    Article  Google Scholar 

  49. Velasquez MM, von Sternberg K, Johnson DH, Green C, Carbonari JP, Parsons JT. Reducing sexual risk behaviors and alcohol use among HIV-positive men who have sex with men: a randomized clinical trial. J Consult Clin Psychol. 2009;77(4):657–67.

    Article  PubMed  Google Scholar 

  50. Wolitski RJ, Gomez CA, Parsons JT. Effects of a peer-led behavioral intervention to reduce HIV transmission and promote serostatus disclosure among HIV-seropositive gay and bisexual men. AIDS. 2005;19(Suppl 1):S99–109.

    Article  PubMed  Google Scholar 

  51. Choi KH, Lew S, Vittinghoff E, Catania JA, Barrett DC, Coates TJ. The efficacy of brief group counseling in HIV risk reduction among homosexual Asian and Pacific Islander men. AIDS. 1996;10(1):81–7.

    Article  PubMed  CAS  Google Scholar 

  52. McKirnan DJ, Tolou-Shams M, Courtenay-Quirk C. The Treatment Advocacy Program: a randomized controlled trial of a peer-led safer sex intervention for HIV-infected men who have sex with men. J Consult Clin Psychol. 2010;78(6):952–63.

    Article  PubMed  Google Scholar 

  53. Wilton L, Herbst JH, Coury-Doniger P, et al. Efficacy of an HIV/STI prevention intervention for black men who have sex with men: findings from the Many Men, Many Voices (3MV) project. AIDS Behav. 2009;13(3):532–44.

    Article  PubMed  Google Scholar 

  54. Carballo-Dieguez A, Dolezal C, Leu CS, et al. A randomized controlled trial to test an HIV-prevention intervention for Latino gay and bisexual men: lessons learned. AIDS Care. 2005;17(3):314–28.

    Article  PubMed  CAS  Google Scholar 

  55. Coates TJ, McKusick L, Kuno R, Stites DP. Stress reduction training changed number of sexual partners but not immune function in men with HIV. Am J Public Health. 1989;79(7):885–7.

    Article  PubMed  CAS  Google Scholar 

  56. Kelly JA, St Lawrence JS, Hood HV, Brasfield TL. Behavioral intervention to reduce AIDS risk activities. J Consult Clin Psychol. 1989;57(1):60–7.

    Article  PubMed  CAS  Google Scholar 

  57. Mausbach BT, Semple SJ, Strathdee SA, Zians J, Patterson TL. Efficacy of a behavioral intervention for increasing safer sex behaviors in HIV-positive MSM methamphetamine users: results from the EDGE study. Drug Alcohol Depend. 2007;87(2–3):249–57.

    Article  PubMed  Google Scholar 

  58. Menza TW, Jameson DR, Hughes JP, Colfax GN, Shoptaw S, Golden MR. Contingency management to reduce methamphetamine use and sexual risk among men who have sex with men: a randomized controlled trial. BMC Public Health. 2010;10:774.

    Article  PubMed  Google Scholar 

  59. Miller RL. Assisting gay men to maintain safer sex: an evaluation of an AIDS service organization’s safer sex maintenance program. AIDS Educ Prev. 1995;7(Suppl 5):48–63.

    PubMed  CAS  Google Scholar 

  60. Morgenstern J, Bux DA Jr, Parsons J, Hagman BT, Wainberg M, Irwin T. Randomized trial to reduce club drug use and HIV risk behaviors among men who have sex with men. J Consult Clin Psychol. 2009;77(4):645–56.

    Article  PubMed  Google Scholar 

  61. Peterson JL, Coates TJ, Catania J, et al. Evaluation of an HIV risk reduction intervention among African–American homosexual and bisexual men. AIDS. 1996;10(3):319–25.

    Article  PubMed  CAS  Google Scholar 

  62. Roffman RA, Stephen RS, Curtin L, et al. Relapse prevention as an interventive model for HIV risk reduction in gay and bisexual men. AIDS Educ Prev. 1998;10(1):1–18.

    PubMed  CAS  Google Scholar 

  63. Rosser BR, Hatfield LA, Miner MH, Ghiselli ME, Lee BR, Welles SL. Effects of a behavioral intervention to reduce serodiscordant unsafe sex among HIV positive men who have sex with men: the positive connections randomized controlled trial study. J Behav Med. 2010;33(2):147–58.

    Article  PubMed  Google Scholar 

  64. Serovich JM, Reed S, Grafsky EL, Andrist D. An intervention to assist men who have sex with men disclose their serostatus to casual sex partners: results from a pilot study. AIDS Educ Prev. 2009;21(3):207–19.

    Article  PubMed  Google Scholar 

  65. Shoptaw S, Reback CJ, Peck JA, et al. Behavioral treatment approaches for methamphetamine dependence and HIV-related sexual risk behaviors among urban gay and bisexual men. Drug Alcohol Depend. 2005;78(2):125–34.

    Article  PubMed  Google Scholar 

  66. Stall RD, Paul JP, Barrett DC, Crosby GM, Bein E. An outcome evaluation to measure changes in sexual risk-taking among gay men undergoing substance use disorder treatment. J Stud Alcohol. 1999;60(6):837–45.

    PubMed  CAS  Google Scholar 

  67. Valdiserri RO, Lyter DW, Leviton LC, Callahan CM, Kingsley LA, Rinaldo CR. AIDS prevention in homosexual and bisexual men: results of a randomized trial evaluating two risk reduction interventions. AIDS. 1989;3(1):21–6.

    PubMed  CAS  Google Scholar 

  68. Williams JK, Wyatt GE, Rivkin I, Ramamurthi HC, Li X, Liu H. Risk reduction for HIV-positive African American and Latino men with histories of childhood sexual abuse. Arch Sex Behav. 2008;37(5):763–72.

    Article  PubMed  Google Scholar 

  69. Rosser BR, Bockting WO, Rugg DL, et al. A randomized controlled intervention trial of a sexual health approach to long-term HIV risk reduction for men who have sex with men: effects of the intervention on unsafe sexual behavior. AIDS Educ Prev. 2002;14(3 Suppl A):59–71.

    Article  PubMed  Google Scholar 

  70. Stall R, Mills TC, Williamson J, et al. Association of co-occurring psychosocial health problems and increased vulnerability to HIV/AIDS among urban men who have sex with men. Am J Public Health. 2003;93(6):939–42.

    Article  PubMed  Google Scholar 

  71. Stall RD, Purcell DW. Intertwining epidemics: a review of research on substance use among men who have sex with men and its connection to the AIDS epidemic. AIDS Behav. 2000;4(2):181–92.

    Article  Google Scholar 

  72. Ostrow DG, Stall R. Alcohol, tobacco, and drug use among gay and bisexual men. In: Wolitski RJ, Stall R, Valdiserri RO, editors. Unequal opportunity: health disparities affecting gay and bisexual men in the United States. New York: Oxford University Press; 2008. p. 121–58.

    Google Scholar 

  73. Shoptaw S, Reback CJ. Methamphetamine use and infectious disease-related behaviors in men who have sex with men: implications for interventions. Addiction. 2007;102(Suppl 1):130–5.

    Article  PubMed  Google Scholar 

  74. Chesney MA, Koblin BA, Barresi PJ, et al. An individually tailored intervention for HIV prevention: baseline data from the EXPLORE Study. Am J Public Health. 2003;93(6):933–8.

    Article  PubMed  Google Scholar 

  75. Jenkins RA. Recruiting substance-using men who have sex with men into HIV prevention research: current status and future directions. AIDS Behav. 2012;16(6):1411–9.

    Article  PubMed  Google Scholar 

  76. Hatfield LA, Ghiselli ME, Jacoby SM, et al. Methods for recruiting men of color who have sex with men in prevention-for-positives interventions. Prev Sci. 2010;11(1):56–66.

    Article  PubMed  Google Scholar 

  77. Parsons JT, Vial AC, Starks TJ, Golub SA. Recruiting drug using men who have sex with men in behavioral intervention trials: a comparison of internet and field-based strategies. AIDS Behav. 2013;17:688–99.

    Google Scholar 

  78. Higa D. Gay men’s brief sexual connections: settings, processes, meanings, and ethics. Dissertation. Seattle: University of Washington. 2008.

  79. Mizuno Y, Borkowf C, Millett GA, Bingham T, Ayala G, Stueve A. Homophobia and racism experienced by Latino men who have sex with men in the United States: correlates of exposure and associations with HIV risk behaviors. AIDS Behav. 2012;16(3):724–35.

    Article  PubMed  Google Scholar 

  80. Van Devanter N, Duncan A, Burrell-Piggott T, et al. The influence of substance use, social sexual environment, psychosocial factors, and partner characteristics on high-risk sexual behavior among young black and Latino men who have sex with men living with HIV: a qualitative study. AIDS Patient Care STDS. 2011;25(2):113–21.

    Article  Google Scholar 

  81. Crepaz N, Lyles CM, Wolitski RJ, et al. Do prevention interventions reduce HIV risk behaviours among people living with HIV? A meta-analytic review of controlled trials. AIDS. 2006;20(2):143–57.

    Article  PubMed  Google Scholar 

  82. CDC. HIV surveillance in men who have sex with men (MSM). Atlanta. 2012. http://www.cdc.gov/hiv/topics/surveillance/resources/slides/msm/index.htm. Accessed 8 Jun 2012.

  83. Bull SS, Lloyd L, Rietmeijer C, McFarlane M. Recruitment and retention of an online sample for an HIV prevention intervention targeting men who have sex with men: the Smart Sex Quest Project. AIDS Care. 2004;16(8):931–43.

    Article  PubMed  Google Scholar 

  84. Rhodes SD, Vissman AT, Stowers J, et al. A CBPR partnership increases HIV testing among men who have sex with men (MSM): outcome findings from a pilot test of the CyBER/testing internet intervention. Health Educ Behav. 2011;38(3):311–20.

    Article  PubMed  Google Scholar 

  85. Chiasson MA, Shaw FS, Humberstone M, Hirshfield S, Hartel D. Increased HIV disclosure three months after an online video intervention for men who have sex with men (MSM). AIDS Care. 2009;21(9):1081–9.

    Article  PubMed  Google Scholar 

  86. Reback CJ, Ling D, Shoptaw S, Rohde J. Developing a text messaging risk reduction intervention for methamphetamine-using MSM: research note. Open AIDS J. 2010;4:116–22.

    PubMed  Google Scholar 

  87. Bowen AM, Horvath K, Williams ML. A randomized control trial of internet-delivered HIV prevention targeting rural MSM. Health Educ Res. 2007;22(1):120–7.

    Article  PubMed  Google Scholar 

  88. El-Bassel N, Gilbert L, Witte S, Wu E, Hunt T, Remien RH. Couple-based HIV prevention in the United States: advantages, gaps, and future directions. J Acquir Immune Defic Syndr. 2010;55(Suppl 2):S98–101.

    Article  PubMed  Google Scholar 

  89. Sullivan PS, Salazar L, Buchbinder S, Sanchez TH. Estimating the proportion of HIV transmissions from main sex partners among men who have sex with men in five US cities. AIDS. 2009;23(9):1153–62.

    Article  PubMed  Google Scholar 

  90. Wu E, El-Bassel N, McVinney LD, et al. Feasibility and promise of a couple-based HIV/STI preventive intervention for methamphetamine-using, black men who have sex with men. AIDS Behav. 2011;15(8):1745–54.

    Article  PubMed  Google Scholar 

  91. Elford J, Hart G. If HIV prevention works, why are rates of high-risk sexual behavior increasing among MSM? AIDS Educ Prev. 2003;15(4):294–308.

    Article  PubMed  Google Scholar 

  92. Sullivan PS, Wolitski RJ. HIV infection among gay and bisexual men. In: Sullivan PS, Wolitski RJ, editors. Unequal opportunity: health disparities affecting gay and bisexual men in the United States. New York: Oxford Univeristy Press; 2008. p. 221–47.

    Google Scholar 

  93. Chen HT. The bottom-up approach to integrative validity: a new perspective for program evaluation. Eval Program Plan. 2010;33(3):205–14.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Darrel H. Higa.

Additional information

The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the U.S. Centers for Disease Control and Prevention.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Higa, D.H., Crepaz, N., Marshall, K.J. et al. A Systematic Review to Identify Challenges of Demonstrating Efficacy of HIV Behavioral Interventions for Gay, Bisexual, and Other Men Who Have Sex with Men (MSM). AIDS Behav 17, 1231–1244 (2013). https://doi.org/10.1007/s10461-013-0418-z

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10461-013-0418-z

Keywords

Navigation