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Interventions, Barriers, and Facilitators to Address the Sexual Problems of Gay, Bisexual and Other Men Who Have Sex with Men Living with HIV: A Rapid Sco** Review

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Abstract

Sexual problems are common among gay, bisexual, and other men who have sex with men (GBM) after diagnosis with HIV. However, these are often overlooked in care and research, where sexual risk reduction and biomedical aspects of sexual health tend to dominate. We conducted a rapid sco** review to investigate which sexual problems of GBM living with HIV are addressed by interventions, and the barriers and facilitators to their implementation. Literature from high-income countries published in English since 2010 was reviewed. Medline, Embase, PsycInfo, and Scopus databases were searched on July 4, 2022. Targeted sexual problems were categorized according to the ten dimensions of Robinson’s Sexual Health Model, and barriers and facilitators, according to the five domains of the Consolidated Framework for Implementation Research (CFIR). Interventions focused solely on the dimension of Sexual Health Care/Safer Sex were excluded. Relevant information was extracted from the qualifying documents with NVivo 12 software for content analysis. Fifty-two documents were included, referring to 37 interventions which mainly took place in the United States (n = 29/37; 78%), were group-based (n = 16; 41%), and used counselling techniques (n = 23; 62%; e.g., motivational interviewing, cognitive-behavioral therapy). Their settings were mostly primary care (n = 15; 40%) or community-based (n = 16; 43%). On average, interventions addressed three sexual health dimensions (SD = 2; range: 1–10). The most targeted dimension was Sexual Health Care/Safer Sex (n = 26; 70%), which concerned sexual risk reduction. Next, Challenges (n = 23; 62%), included substance use (n = 7; 19%), sexual compulsivity (n = 6; 16%), sexual abuse (n = 6; 16%), and intimate partner violence (n = 4; 11%). Third was Talking About Sex (n = 22; 59%) which mostly concerned HIV disclosure. About a third of interventions addressed Culture/Sexual identity (n = 14; 38%), Intimacy/Relationships (n = 12; 33%), and Positive sexuality (n = 11; 30%). Finally, few targeted Body Image (n = 4; 11%), Spirituality (n = 3; 8%), Sexual Anatomy Functioning (n = 2; 5%) or Masturbation/Fantasy (n = 1; 3%). Forty-one documents (79%) mentioned implementation barriers or facilitators, particularly about the characteristics of the interventions (41% and 78%, respectively; e.g., cost, excessive duration, acceptability, feasibility) and of the individuals involved (37% and 46%; e.g., perceived stigmatization, provider expertise). The other three CFIR dimensions were less common (5%–17%). The search strategy of this review may not have captured all eligible documents, due to its limit to English-language publications. Overall, most interventions incorporated a focus on Sexual Health Care/Safer Sex, at the expenses of other prevalent sexual problems among GBM living with HIV, such as intimate partner violence (Challenges), erectile dysfunction (Sexual Anatomy Functioning), and Body Image dissatisfaction. These findings suggest they could receive more attention within clinical care and at the community level. They also highlight the importance of cost-effective and acceptable interventions conducted in non-stigmatizing environments, where patients’ needs can be met by providers who are adequately trained on sexuality-related topics.

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Data Availability

Data about the retrieved documents is available on request to the corresponding author at bertrand.lebouche@mcgill.ca.

Code Availability

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Acknowledgements

Two academic librarians, Genevieve Gore (McGill University) and Lindsay Hale (The Research Institute of the McGill University Health Centre) contributed to develop the review search strategy. Members of Bertrand Lebouché’s research team provided important inputs that contributed to the development of the review.

Funding

Francesco Avallone is supported by a doctoral stipend provided by Bertrand Lebouché, a Fellowship Award by the Research Institute of the McGill University Health Centre (January 2023–December 2023), and a doctoral training scholarship from Fonds de recherche du Québec–Santé (FRQS) (Grant No. #329804). Bertrand Lebouché is supported by 2 career awards: a Senior Salary Award from FRQS (Grant No. #311200) and the LE 250, from the Quebec’s Ministry of Health for researchers in Family Medicine. Bertrand Lebouché also holds a Canadian Institutes for Health Research Strategy for Patient Oriented Research (SPOR) Mentorship Chair in Innovative Clinical Trials.

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Authors and Affiliations

  1. Center for Outcomes Research and Evaluation, Research Institute, McGill University Health Centre, Montreal, QC, Canada

    Francesco Avallone, Kim Engler, Joseph Cox & Bertrand Lebouché

  2. Department of Family Medicine, McGill University, Montreal, QC, Canada

    Francesco Avallone & Bertrand Lebouché

  3. Chronic Viral Illness Service, Royal Victoria Hospital, McGill University Health Centre, Montreal, QC, Canada

    Joseph Cox & Bertrand Lebouché

  4. Department of Epidemiology and Biostatistics, School of Population and Global Health, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada

    Joseph Cox

  5. Department of Public Health, Environments & Society, Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, London, UK

    Ford Hickson

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FA conceived the paper, prepared the review protocol, designed the search strategy, conducted the screening process, and wrote the first draft of the paper. KE and BL co-designed the review and contributed to the paper. KE was the second reviewer and screened 20% of abstracts and full texts. FH and JC reviewed the manuscript. All authors approved the final manuscript.

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Avallone, F., Engler, K., Cox, J. et al. Interventions, Barriers, and Facilitators to Address the Sexual Problems of Gay, Bisexual and Other Men Who Have Sex with Men Living with HIV: A Rapid Sco** Review. AIDS Behav 28, 450–472 (2024). https://doi.org/10.1007/s10461-023-04237-3

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