An analysis of research that is relevant to HIV prevention
in the United Kingdom
has identified several important topics on which little research is done. Writing in the journal BMC Public Health, the authors point to
the lack of studies into combination prevention packages, individuals with
undiagnosed infection, the impact of social policy and the implementation of interventions that have been
successful in other countries. It is rare for the impact of mass media campaigns to be evaluated.
The authors say that although innovative, evidence-based
approaches are needed in HIV prevention, large areas of interest are
The analysis was conducted by the National Institute of
Health Research Evaluation Trials and Studies Coordinating Centre, whose staff
searched databases for studies conducted between 2006 and 2009 in the UK, United States,
Canada, Australia and New Zealand. (Studies conducted in European
countries were excluded).
They identified 868 relevant systematic reviews, randomised
controlled trials, cohort studies, case-control studies and surveys. They then categorised
them both in terms of the activities or topics they dealt with, and the social
The most widely studied areas were:
- Intervention technologies, such as circumcision,
pre-exposure prophylaxis, condoms, the use of HIV treatment to reduce
infectivity and needle exchange (216 studies).
- The investigation of sexual or risk-taking
behaviour and studies of interventions which aim to change behaviour (206
- Descriptive epidemiology: studies seeking to
understand the distribution of disease in populations and the association of
infection with age, socio-economic groups and sexual activities (162 studies).
Nonetheless the authors didn’t look in detail at the studies
or attempt to assess their quality. They say that even when there are a
significant number of publications on a topic, this “does not necessarily
equate to high quality, robust research or provide evidence that translates to
Moreover a number of under-researched areas were identified:
- Undiagnosed infection: better understanding of
the characteristics of people with undiagnosed infection, interventions which
aim to reach these individuals and understanding of the barriers to HIV
testing. Only four papers were identified which covered this area, mostly
conducted with gay men.
- Research which tests the ability of an
intervention that has been successful in one place to be repeated, translated
or adapted in a new setting. Only three studies were found. However the authors
note that since most HIV prevention research comes from the United States,
we need to know if approaches developed there are as effective in other
- Studies on policies, laws or ethical issues
which impact on HIV prevention. This would include prosecutions of HIV transmission,
but despite this having become a key issue in recent years, only three studies
- Combination prevention: when more than one
prevention intervention is provided in combination, for example when sexually
transmitted infection screening is provided together with an educational
intervention. Ten studies were categorised as addressing this issue, but only
two actually evaluated the added value of putting interventions together.
- Studies covering social factors that impact on
HIV (e.g. education or housing), structural interventions which address social
factors, and research into stigma and discrimination. A total of 26 studies
- Educational interventions, including campaigns,
social marketing, leaflets, videos and school-based work. The researchers
expected to find more than 28 studies in this area; they were particularly
surprised to identify only two studies of the impact of mass-media campaigns.
In terms of the risk groups most often researched, these
were people with diagnosed HIV, drug and alcohol users, men who have sex with
men, and young people.
Less research is conducted specifically with older people,
transgender people, sex workers, heterosexuals (especially heterosexual men),
non-black ethnic groups and people who are socially excluded.
The authors say that they would welcome suggestions for research
that would help fill the gaps in the evidence base.