Systematic Review of Interventions to Prevent Spread of Sexually Transmitted Infections,Including HIV,Among Young People in Europe

Aim

To examine the effectiveness of interventions seeking to prevent the spread of sexually transmitted infections (STI), including HIV, among young people in the European Union.

Methods

For this systematic review, we examined interventions that aimed at STI risk reduction and health promotion conducted in schools, clinics, and in the community for reported effectiveness (in changing sexual behavior and/or knowledge) between 1995 and 2005. We also reviewed study design and intervention methodology to discover how these factors affected the results, and we compiled a list of characteristics associated with successful and unsuccessful programs. Studies were eligible if they employed a randomized control design or intervention-only design that examined change over time and measured behavioral, biologic, or certain psychosocial outcomes.

Results

Of the 19 studies that satisfied our review criteria, 11 reported improvements in the sexual health knowledge and/or attitudes of young people. Ten of the 19 studies aimed to change sexual risk behavior and 3 studies reported a significant reduction in a specific aspect of sexual risk behavior. Two of the interventions that led to behavioral change were peer-led and the other was teacher-led. Only 1 of the 8 randomized controlled trials reported any statistically significant change in sexual behavior, and then only for young females.

Conclusion

The young people studied were more accepting of peer-led than teacher-led interventions. Peer-led interventions were also more successful in improving sexual knowledge, though there was no clear difference in their effectiveness in changing behavior. The improvement in sexual health knowledge does not necessarily lead to behavioral change. While knowledge may help improve health-seeking behavior, additional interventions are needed to reduce STIs among young people.It is estimated that nearly 1 million people contract a sexually transmitted infection (STI) every day worldwide (1). In Western Europe, 17 million new cases of curable STIs occur annually (2). In the European Union (EU), the most common STIs are chlamydial genital infections, gonorrhea, hepatitis, and syphilis (3). Addressing more than 30 other bacterial, viral, and parasitic pathogens causing STIs has re-emerged as a major public health issue in Europe, starting in 1999 and building on the 2003 global health sector strategy that focused on HIV/AIDS (4-6). At the 59th World Health Assembly, in May 2006, the World Health Organization approved the Global Strategy for the Prevention and Control of Sexually Transmitted Infections: 2006-2015. This strategy makes strong arguments for why preventing STIs is important not only for maintaining general health, but also for ensuring safe pregnancies and preventing HIV transmission.STIs are transmitted through sexual contact, including vaginal, oral, and anal sex. Some STIs can also be transmitted through childbirth or breastfeeding, as well as through sharing needles during injecting drug use. Transmission patterns have changed over time and often differ greatly among and within EU member states. In some settings, HIV coinfection with other STIs is common, while in others, they appear independently.In Europe, the populations most at risk for HIV and for other STIs are often – but not always – the same: men who have sex with men (MSM), injecting drug users and their sexual partners, and heterosexual migrants from outside of the EU. Some STIs, like Chlamydia, are more prevalent among young people (7), and interventions frequently target this group to prevent the spread of STIs, both in and out of school. Various theories, including the health belief model, the theory of reasoned action, the trans-theoretical model and social cognitive theory, have been employed to promote behavior change (8). They are utilized in various ways in concrete interventions to reach young people and reduce their risk of contracting STIs. Unfortunately, the lack of age-disaggregated data on sexual and reproductive health and varying definitions of “young” make it difficult to assess the situation and provide a common evidence base for designing these interventions (9).Inspired by an EU call to action (10), we undertook this systematic review to examine the effectiveness of STI interventions for young people in the EU in the decade after the International Conference on Population and Development, held in Cairo in 1994, which put a focus on them. In doing so, it gathers a variety of approaches, such as the major implementation models – being peer-, teacher- and health professional-led – for reaching young people with sexual and reproductive health information and services, to inform and advance future policy development.