Elford Jonathan, Hart Graham
City University London, Institute of Health Sciences, St. Bartholomew School of Nursing and Midwifery, 20 Bartholomew Close, London EC1A 7 QN, UK.
AIDS Educ Prev. 2003 Aug;15(4):294-308. doi: 10.1521/aeap.15.5.294.23825.
Systematic reviews of HIV prevention research provide clear evidence that behavioral interventions can influence the sexual behavior of men who have sex with men (MSM). However, if HIV prevention works, why are rates of high-risk sexual behavior increasing among MSM in major European, Australian, Canadian, and U.S. cities? The evidence generated by systematic reviews alone may not provide a clear answer to this question. This is because (a) it is uncertain whether experimental interventions shown to be effective in one setting, place, or moment in time can be repeated successfully in another; (b) we have limited understanding of the processes that underlie the interventions; (c) interventions shown to work in an experimental study may not necessarily be effective in everyday life. To answer the question, we need to be alert to the changing risk environment in which men have sex with other men. We also need to develop a new program of research addressing the transferability, sustainability, and effectiveness of sexual health promotion among MSM. Randomized controlled trials will remain one of the optimal means of evaluating behavioral interventions in such a program. By further strengthening the evidence base, we may identify opportunities for innovative as well as effective HIV prevention initiatives.
对艾滋病预防研究的系统评价提供了明确证据，表明行为干预可以影响男男性行为者（MSM）的性行为。然而，如果艾滋病预防措施有效，为何在欧洲、澳大利亚、加拿大和美国的主要城市中，男男性行为者的高危性行为发生率却在上升？仅靠系统评价得出的证据可能无法明确回答这个问题。这是因为：（a）在某一环境、地点或时刻显示有效的实验性干预措施能否在其他地方成功重复尚不确定；（b）我们对干预措施背后的过程了解有限；（c）在实验研究中显示有效的干预措施在日常生活中不一定有效。要回答这个问题，我们需要留意男男性行为者所处的不断变化的风险环境。我们还需要开展一项新的研究计划，探讨男男性行为者性健康促进的可转移性、可持续性和有效性。随机对照试验仍将是评估此类计划中行为干预措施的最佳手段之一。通过进一步加强证据基础，我们或许能够找到创新且有效的艾滋病预防举措的机会。
