Homelessness and drug use - a narrative systematic review of interventions to promote sexual health

The objective of this research project was to examine the effectiveness of sexual health promotion interventions in homeless drug using populations. The following databases were searched: Medline (1966 to 2003), EMBASE (1980 to 2003), psycinfo (1985 to 2003), CINAHL (1982 to 2003), web of Science (1981 to 2003) and the Cochrane Library (Evidence Based health). Two independent researchers selected studies for inclusion. Inclusion criteria covered longitudinal studies using comparative statistics examining interventions to promote sexual health amongst homeless drug users. Studies excluding drug users from the study sample or where no mention was made of housing status were excluded. A narrative analysis of the papers was adopted to elicit common themes emerging from the studies. Of 99 papers identified, only 6 fulfilled the inclusion criteria. Interventions which seek to effect attitudinal and behavioural change through interactive methods such as role-play, video games and group work led to a self-reported reduction in both risk from drugs and sexual activity. The evidence for maintenance of risk reduction over one year remains unclear. Interventions do not appear to promote risky sexual activity in previously sexually inactive participants.