Identifying candidates for safer sex advice and other prevention interventions

This document provides further detail on the evidence used and the issues considered in developing the UK National Guideline on Safer Sex Advice. The objective of the Guideline document is to provide guidance for practitioners in Level 3 Genitourinary medicine (GUM) services (Tier 5 in Scotland) on safer sex advice provided in sexually transmitted infection (STI) and HIV management consultations. The value of simple advice giving is unproven, so evidence based guidance on the format and delivery of advice as part of a combination prevention approach is included. The guideline consists of:  Recommendations on the format and delivery of brief behaviour change interventions deliverable in GUM clinics.  Recommendations on the content of safer sex advice given to individuals at continued risk of STI.  The components of a combination prevention approach to be applied  Additional advice to be provided for those living with HIV, or from groups with higher rates of HIV incidence. Much of the guidance is applicable in other sexual health and general practice settings, including HIV care services. Issues relating to implementation of behaviour change interventions in clinics, such as designing service structures and care pathways or the competencies required in different multidisciplinary staff groups, will be addressed in British Psychological Society (BPS) Good Practice Guidelines 1. Safer sex advice and individual behaviour change interventions provided within clinics are elements of a combination prevention approach that may also include group and community based behavioural interventions, structural and social changes and biomedical interventions including post-exposure prophylaxis following sexual exposure (PEPSE), pre-exposure prophylaxis (PrEP) and early initiation of antiretroviral therapy. Each of these issues is complex and in some cases contentious and the guideline includes recommendations on the application of these interventions to the individual only. The scope of these guidelines does not include the structure, development and implementation of a comprehensive combination prevention strategy, or policy development. 3 The majority of published studies are concerned with the efficacy of interventions applied to groups already considered 'high risk' such as those suggested above. The selection of subjects for published intervention studies has been based on predefined demographic criteria, such as being a man who has sex with men. No systematic reviews, meta-analyses, or original studies describing methods to systematically target potential candidates for interventions were found. One descriptive study outlines the use of some brief risk assessment tools in clinic practice to ascertain potential candidacy for …