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Substance Abuse and Mental Health Services Administration, 2018. To advocates of the abstinence-only approach, these disturbing statistics make it abundantly clear that a simple message of "no sex outside of marriage" for teens is the only appropriate one for educators to take. In Chile, women-only programs were only fully implemented … Appended are: (1) HRSA's Technical Assistance Contract for Abstinence Education; (2) Methodology for Identifying and Reviewing Research Studies; (3) Comments from the Department of Health and Human Services; and (4) GAO Contact and Staff ... "Unlike smoking, which is always bad for you, sexual behavior is a basic human need which can be a positive experience -- although it requires maturity and responsibility," says Michael McGee, vice president for education at Planned Parenthood Federation of America in New York City and the father of two teenagers. Pediatricians and other providers working with families affected by prenatal opioid use can advance an individualized approach to their care within the context of a family-centered system of services. The Effectiveness of Exercise Interventions on Coping with Stress: Research Synthesis. A safe, effective, and rapid nonopiate treatment. They don't say 'if you smoke, use a filter' or 'if you drink and drive, wear your safety belt.' Matthew Grossman, M.D., of Yale University explains a family-centered approach to care that lowered hospital stays from 30 to 5 days for babies born with neonatal abstinence syndrome. Prior to birth, engaging pregnant women with opioid and other substance use disorders in substance use treatment and other services as a component of prenatal care can also mitigate or prevent negative birth outcomes associated with NAS and NOWS. Contraception, on the other hand, was not -- except in passing, according to Karras. This dissertation, "The Effectiveness of Treating Abstinence Syndrome by Acupuncture Over Traditional Medication and Psychotherapy" by Kiu-yung, Helen, Lau, 劉翹溶, was obtained from The University of Hong Kong (Pokfulam, Hong Kong) and ... This factsheet offers an overview of NAS, promising practices, and grant initiatives that address serving infants with NAS and their families. Smith RJ, Aston-Jones G. Noradrenergic transmission in the extended amygdala: role in increased drug-seeking and relapse during protracted drug abstinence. After the male partner returns, even if he doesn’t have symptoms, or Pediatricians can build a supportive environment and advance an empathetic strength-based approach to engage mothers with opioid use disorder (OUD) into care and treatment. Gold MS, Pottash AC, Sweeney DR, Kleber HD. Voluntary abstinence refers to an individual actively choosing to stop taking the drug. Infants with NAS and NOWS are treated through non-pharmacological methods (such as rooming-in with mothers after birth, breastfeeding, swaddling, skin-to-skin time, and minimizing stimuli in the environment), as well as pharmacologic methods (medication) when warranted. To learn more about technical assistance services or if you have a question please email NCSACW at ncsacw@cffutures.org or call toll-free at 1–866–493–2758. Policymakers as well as public health professionals remain committed to identifying, designing, and implementing programs and initiatives to reduce the incidence of births to youth. Contact USA.gov, Clinical Guidance for Treating Pregnant and Parenting Women With Opioid Use Disorder and Their Infants, HRSA’s Home Visiting Program: Supporting Families Impacted by Opioid Use and Neonatal Abstinence Syndrome, Opioid Safety Toolkit: Emerging Treatment Options for Neonatal Abstinence Syndrome, The Neonatal Abstinence Syndrome Framework, How State Health Departments Can Use the Spectrum of Prevention to Address Neonatal Abstinence Syndrome, A Mother Centered Approach to Treat Neonatal Abstinence Syndrome, Changing How We Treat Neonatal Abstinence Syndrome: A Quality Improvement Approach Webinar, Infants With Prenatal Substance Exposure: Yale New Haven Children’s Hospital’s Approach, Opioid Use Disorder, Maternal Outcome, Neonatal Abstinence Syndrome Initiative Learning Community, Reconsidering the Standard Approach to Neonatal Abstinence Syndrome, Stronger Together: NAS Soothing Techniques for Mommies and Babies, Florida Neonatal Abstinence Syndrome (NAS) Tool Kit: A Quality Improvement Initiative, Hospital Checklist for Adoption of the Eat, Sleep, Console NAS Assessment Items, Non-pharmacologic Care for Substance Exposed Newborns, Substance-Exposed Infants: A Report on Progress in Practice and Policy Development in States Participating in a Program of In-Depth Technical Assistance, September 2014 to September 2016, Neonatal Abstinence Syndrome: A Guide for Families, Partner With Mothers To Seek and Support Recovery Post Prenatal Opioid Exposure, Substance Use During Pregnancy and Plans of Safe Care (POSC): Implications for Pediatricians, Mothers, and Infants, U.S Department of Health and Human Services - opens a new window, Substance Abuse and Mental Health Services Administration - opens a new window, Administration for Child & Families - opens a new window, National Center on Substance Abuse and Child Welfare, Children and Families Affected by Parental Substance Use Disorders (SUDs), Spotlight on Disproportionality and Disparities among Families in Child Welfare and Substance Use Treatment, Supporting Families During a Public Health Crisis, Child Welfare and Alcohol and Drug Use Statistics, Tutorials for Substance Use Disorder Treatment Professionals, Tutorials for Child Welfare Professionals, Matthew Grossman, M.D., Associate Professor of Pediatrics (Hospital Medicine); Vice Chair for Quality, Department of Pediatrics; Quality and Safety Officer, Yale-New Haven Children’s Hospital. Abstinence-only education did not reduce the likelihood of engaging in vaginal intercourse (OR(adj) = .8, 95% CI = .51-1.31, p = .40), but comprehensive sex education was marginally associated with a lower likelihood of reporting having engaged in vaginal intercourse (OR(adj) = .7, 95% CI = .49-1.02, p = .06). The neonatal abstinence syndrome refers to a postnatal opioid withdrawal syndrome that can occur in 55 to 94% of newborns whose mothers were addicted to or treated with opioids while pregnant. The majority of U.S. schools (66%) provide information about contraception, such as condoms and birth control pills, as well as about other practices that fall in the safer-sex category. The latter is an unconscious state, having unhealthy consequences. Which approach is most reasonable for today's kids? Why should sex be treated differently? Placing these practices in the context of international human rights law, the book identifies government obligations to respect women's right of access to information and lays out how these obligations can be applied in practice to protect ... A fast may be total or partial concerning that from which one fasts, and may be prolonged or intermittent as to the period of fasting. 2 These infants develop a dependence on the drug while in the womb and are still dependent at birth. Except for abstinence (which is 100% effective), no birth control method is foolproof. Motivational Interviewing has been widely implemented to help people change their behaviour, but it is unclear for whom it is most beneficial. The "abstinence-only" message, in which contraception information is either prohibited or limited to a mention of its ineffectiveness, is used by 34% of schools that have a district-wide policyto teach sex education, according to a study conducted by The Alan Guttmacher Institute published in the November/December 1999 issue of Family Planning Perspectives. ncsacw.samhsa.govAn official website of the U.S. Department Health & Human Services, Have a question about government services? In medicine, abstinence is the discontinuation of a drug, often an addictive one. [6][7] Total abstinence from feeding on the flesh of cows is a hallmark of Hinduism. [2] In the Anglican Communion, the Book of Common Prayer prescribes certain days as days for fasting and abstinence, "consisting of the 40 days of Lent, the ember days, the three rogation days (the Monday to Wednesday following the Sunday after Ascension Day), and all Fridays in the year (except Christmas, if it falls on a Friday)". Other factors that researchers believe are contributing to this are a lack of sex education and abstinence-only programs. This makes them unable to have access to the drug. Factors That Can Lower/Increase Birth Control Effectiveness . This video showcases professionals and mothers demonstrating techniques to help soothe withdrawal symptoms associated with neonatal abstinence syndrome and describes the important role that birth mothers play in their child’s recovery. Neonatal opioid withdrawal syndrome (NOWS) is a related term that refers to the symptoms that infants may experience as a result of exposure to opioids specifically. Background The challenge of addressing unhealthy lifestyle choice is of global concern. In the Basic Text of Narcotics Anonymous, a large fellowship following the 12-steps outlined by AA, NA is outlined to be "a program of complete abstinence from all mood or mind-altering substances. Neonatal opioid withdrawal syndrome (NOWS) is a related term that refers to the symptoms that infants may experience as a result of exposure to opioids specifically. When at drinking establishments, they either abstain from drinking or consume non-alcoholic beverages such as tea, coffee, water, juice, and soft drinks. ... from exercise, and in a state of endorphin abstinence (Peluso & Andrade, 2005). Unfortunately, statistics indicate that one-fourth of 15-year-olds have had sexual intercourse at least once, and more than half of 17-year-olds are sexually active, according to the Institute. [citation needed] However, it is not certain whether a general abstinence from pleasures of leisure yields higher productivity. The tool kit will be updated as additional resources become available. Addicts engage in chronic drug use, followed by periods of abstinence, then in many cases relapse. This tool kit is intended to provide guidance to hospitals and neonatal providers in the development of individualized policies and protocols related to NAS. Two common ones are forced and voluntary. For the purposes of this article, abstinence is defined as the complete cessation of drug or alcohol use. Disclaimer. This is a print on demand edition of a hard to find publication. Addresses addiction to a wide variety of drugs, incl. nicotine, alcohol, and illicit and prescription drugs. Teen sexual activity is costly, not just for teens, but also for society. Some common reasons for choosing teetotalism are religious, health, family, philosophical or social reasons, and, sometimes, as simply a matter of taste preference. Too much work generates stress and its potential adverse effects. By clicking Subscribe, I agree to the WebMD, Smart Grocery Shopping When You Have Diabetes, Surprising Things You Didn't Know About Dogs and Cats, What You Should Know About COVID-19 Vaccines, Colon Cancer Hits Black Men, Young Adults More, FDA: COVID Vaccines for Kids, Boosters & Treatments, Moving the Needle: Getting the Unvaccinated Vaccinated, Health News and Information, Delivered to Your Inbox, Teen Girls’ Guide to Teen Boys: Changes During Puberty, Talking to Kids and Teens About Sex Topics. Earlier research conducted in 2004 on lab rats at the University of North Carolina at Chapel Hill's Bowles Center for Alcohol Studies was the first to show a burst of new brain cell development as a result of abstinence from chronic alcohol consumption. And according to surveys reported by the Kaiser Family Foundation, 82% of parents who have children 18 and younger support schools that teach this "comprehensive" approach (the term used by educators and legislators). It includes relevant research; offers strategies for MIECHV awardees and their state partners in early childhood, public health, and substance misuse and mental health treatment; and highlights promising efforts underway in Maine, Colorado, West Virginia, and Massachusetts. Jains abstain from violence in any form, and will not consume living creatures or kill bugs or insects.[8]. Alcoholics Anonymous, the worldwide fellowship of sobriety seekers, is the most effective path to abstinence, according to a comprehensive analysis conducted by a Stanford School of Medicine researcher and his collaborators.. After evaluating 35 studies — involving the work of 145 scientists and the outcomes of 10,080 participants — Keith Humphreys, PhD, professor of psychiatry … The liver secretes bile, a digestive fluid; metabolizes proteins, carbohydrates, and fats; stores glycogen, vitamins, and other substances; synthesizes blood-clotting factors; An example of forced abstinence is in-patient rehabilitation treatment, or incarceration. Print+CourseSmart This infographic compares the standard of care with emerging models for treating babies born with neonatal abstinence syndrome (NAS). [3] Catholics distinguish between fasting and abstinence; the former referring to the discipline of diminishing intake of bodily pleasures, and the latter signifying the discipline of completely restraining from bodily pleasures, most notably meats on Fridays. Association of State and Territorial Health Officials, 2017. Comorbidity of alcoholism and major depression may exert a detrimental effect on the likelihood of smoking cessation. Found inside – Page 22'Abstinence' here means refraining from any acts of protected or unprotected sex. Abstinence-only approaches In ... The effectiveness of abstinence has generally been questioned elsewhere. Others contend that sexual abstinence is only ... Abstinence education : assessing the accuracy and effectiveness of federally funded programs : testimony before the Committee on Oversight and Government Reform, House of Representatives The risks are even more startling: A sexually active teenage girl who has sex without contraception has a 90% chance of becoming pregnant within a year, according to the Institute. National Center on Substance Abuse and Child Welfare, 2018. The National Center on Substance Abuse and Child Welfare offers free technical assistance to a various of systems on making policy and practice changes to improve outcomes for families affected by substance use disorders and involvement with child welfare services. The supporters of abstinence argue that it is the only infallible way to prevent sexually transmitted diseases and unwanted pregnancies. Even though abstinence is a valued outcome of school-based sex education programs, the effectiveness of such interventions in promoting abstinent behavior is still far from settled. Symptoms of NAS and NOWS may include severe irritability, difficulty feeding, respiratory problems, and seizures. However, this does not mean that the benefits of abstinence are not stressed in these programs or that they take a backseat. Vegetarianism is the practice of a diet that excludes meat (including game, marine mammals and slaughter by-products), poultry, fowl, fish, shellfish and other sea creatures. Having unprotected sex at any time is risky and can result in pregnancy. The clinical guide helps healthcare professionals and patients determine the most clinically appropriate action for a particular situation and informs individualized treatment decisions. We champion youth to make healthy decisions in relationships and life by promoting well-being through a primary prevention strategy, and as a national membership and advocacy organization that serves, leads, represents and equips the Sexual Risk Avoidance (SRA) field. It is not to be construed as a standard of care; rather, it is a collection of resources that may be adapted by local institutions in order to develop standardized protocols for NAS. Contingency management decreases smoking by delivering monetary incentives contingent upon objective verification of abstinence. This infographic provides key steps in caring for a baby with neonatal abstinence syndrome. Abstinence is essentially 100% effective in preventing pregnancy. Colorado Hospital Substance Exposed Newborns Collaborative, 2018. Obviously this message is embraced -- although surely not solely or entirely -- by conservative and religious groups. This webinar provides an overview the Yale New Haven Children’s Hospital initiative to improve the quality of care of infants with neonatal abstinence syndrome. This live webinar hosted by the National Center on Substance Abuse and Child Welfare (NCSACW) alongside Dr. Maya Balakrishnan discusses Tampa General Hospital’s Neonatal Intensive Care Unit (NICU) culture and practice changes in working with infants with prenatal substance exposure, their families, and their collaborative partnership with Florida’s Department of Health. This clinical guide provides comprehensive, national guidance for optimal management of pregnant and parenting women with opioid use disorder and their infants. For Jews, the principal day of fast is Yom Kippur, the Day of Atonement. Ohio Perinatal Quality Collaborative, 2014. The group was told: "Condoms can't stop AIDS all the time and won't prevent pregnancy all the time," recalls Karras. This webinar from the OMNI Learning Community highlights neonatal abstinence syndrome (NAS) and how using a statewide, multidisciplinary approach to NAS can address several levels of intervention. Orthodox Christians abstain from food and drink from midnight on the day they receive Holy Communion, and abstain from meat and dairy on Wednesdays and Fridays throughout the year, as well as during Great Lent. Flowers P et al. There are several variants of the diet, some of which also exclude eggs or products produced from animal labour such as dairy products and honey. Depending on the individual, abstinence time may vary. National Center on Substance Abuse and Child Welfare, 2017. Yes! Found inside – Page 16To maximize effectiveness, such “combination prevention” may need to work at different levels of society, including at the individual level, the interpersonal level (e.g., within a couple, families, or with peers), the sexual or social ... Furthermore, the effort itself to achieve abstinence may consume willpower from its ultimate purpose. In Judaism, Christianity and Islam, amongst others, pre-marital sex is prohibited. Found inside – Page 191Effectiveness Abstinence is the only 100% effective method of fertility control and STI prevention—if the couple or individual is truly committed to refraining from oral, vaginal, and anal sex, and if contact with genitals is also ... Critics say that such edited presentations rob teens of critical information and ignore the realities of teen sexual behavior. Screening and early identification of prenatal opioid use, along with appropriate referrals for both mothers and infants, are key to sustaining the mother-infant dyad. Abstinence may arise from an ascetic over indulgent, hasidic point of view in natural ways of procreation, present in most faiths, or from a subjective need for spiritual discipline. This natural method involves abstaining from sexual intercourse and is the most effective natural birth control method with ideally 0% fail rate. In addition, lay and monastic Buddhists refrain from killing any living creature and from consuming intoxicants, and bhikkhus keep vows of chastity. Brain Struct Funct 2008; 213:43. The infographic outlines the fundamental opportunities presented to pediatricians when working with families with a history of opioid use. Also, sperm can fertilize an egg for 72 hours (3 days) after ejaculation. There are three main triggers of relapse: stress, drug re-exposure and drug associated cues. [9] An individual may relapse if they are presented with a stressful situation that compels them to re-administer the drug that they used to take. [5], In India, Buddhists, Jains, Sikhs and Hindus abstain from eating meat and fish (basically, all living animals) on the grounds both of health and of reverence for all sentient forms of life. The effectiveness of group-based comprehensive risk-reduction and abstinence education interventions to prevent or reduce the risk of adolescent pregnancy, human immunodeficiency virus, and sexually transmitted infections: Two systematic reviews for the guide to community preventive services. It is also the most effective way to avoid STIs. It is widely accepted that abstinence from addictive drugs gives successful outcome. When comparing harm reduction versus abstinence, you need to first look at each individually to start. [citation needed], Individuals report that when engaging in abstinence, the longer they are not taking the drug, the more they crave it. Neonatal Abstinence Syndrome (NAS) involves a group of problems that occur in a newborn who was exposed to addictive drugs (typically opiates) while in the mother’s womb. The precise nature of fetal growth means that any interference on the size or effectiveness of the brain can have permanent consequences to the child. Another significant benefit of abstinence is that it markedly reduces the likelihood of contracting a sexually transmitted disease . Mormons abstain from certain foods and drinks by combining spiritual discipline with health concerns. Mormons also fast one day a month, for both spiritual and charitable reasons (the money saved by skipping meals is donated to the needy). But, by definition, abstinence works only when teens are sexually inactive -- without exception. Contemporary and colloquial usage has somewhat expanded teetotalism to include strict abstinence from most "recreational" intoxicants (legal and illegal, see controlled substances). [13], Self-enforced restraint from pleasurable activities, Please review the contents of the section and, Rehabilitation for Addicted Prisoners Trust, "DSM-5 Criteria for Substance Use Disorders: Recommendations and Rationale", "Effects of Acute or Chronic Environmental Enrichment on Regional Fos Protein Expression following Sucrose Cue-reactivity testing in Rats", "The Vegetarian Society - Definitions Information Sheet", "Systematic review on the effectiveness of caffeine abstinence on the quality of sleep", https://en.wikipedia.org/w/index.php?title=Abstinence&oldid=1035645372, Short description is different from Wikidata, Wikipedia indefinitely move-protected pages, Articles needing additional medical references from November 2017, All articles needing additional references, Articles requiring reliable medical sources, Articles with unsourced statements from November 2017, Articles with unsourced statements from April 2021, Articles with unsourced statements from May 2012, Wikipedia articles incorporating a citation from Collier's Encyclopedia, Wikipedia articles incorporating a citation from the 1911 Encyclopaedia Britannica with Wikisource reference, Creative Commons Attribution-ShareAlike License, This page was last edited on 26 July 2021, at 21:50. The Teen Pregnancy Prevention Evidence Review did not examine curriculum content to make assessments about whether a program was medically or scientifically accurate, or inclusive of populations that are diverse in terms of race, ethnicity, sexual orientation, and sexual identity. Finishing the states with the highest teen pregnancy rates is Tennessee with 23.7 per 1,000. Opiate withdrawal using clonidine. Women's specific treatment needs have led some providers to develop women-only SUD treatment programs in several countries. Found inside – Page 11Abstinence. Education. Programs. Are. Effective. Christine Kim and Robert Rector Christine Kim is a policy analyst and Robert Rector is a senior research fellow in the domestic policy studies department at the Heritage Foundation, ... Fasting is primarily the act of willingly abstaining from some or all food, drink, or both, for a period of time. Drug and alcohol abstinence has long been heralded as … Most frequently, the term refers to sexual abstinence, but it can also mean abstinence from alcohol, drugs, food, etc. The Seventh-day Adventist Church encourages the consumption of only clean meats as specified in Leviticus and strongly discourages the consumption of alcohol, smoking, and the use of narcotics. Florida Perinatal Quality Collaborative, 2019. This take on sex education is known among educators as the "abstinence-only approach," in which totally refraining from sex outside of marriage (including masturbation) is generally the only option presented to students. [9] Addicts decide to abstain due to the negative consequences that are often associated with the drug. This resource from the CHoSEN Collaborative provides healthcare professionals with strategies as they standardize non-pharmacologic interventions for infants with neonatal abstinence syndrome. Dr. Matthew Grossman highlights research findings, including the methods and results of the hospital study published in Pediatrics. Forced abstinence occurs when an individual is removed from the drug environment. Health Resources and Services Administration, 2018. Texas Department of State Health Services, 2014. "The responsibility of a public institution serving kids is risk avoidance, not harm reduction," says Peter Brandt, President of the National Coalition for Abstinence Education in Colorado Springs and the parent of twotwenty-somethings. Abstinence is a self-enforced restraint from indulging in bodily activities that are widely experienced as giving pleasure. Most teetotaller organizations also demand from their members that they do not promote or produce alcoholic intoxicants. However, most people find it difficult to comply with abstinence, so only a few of them use this method. JAMA 1980; 243:343. In Theravada Buddhism, bhikkhus also refrain from eating in the afternoon, and cannot accept money. All rights reserved. Feb. 21, 2000 (San Francisco) -- Assembled in the auditorium of Mackenzie Junior High School in Lubbock, Texas, 15-year-old John Karras -- and the other students who returned a parental permission slip -- sat quietly while a guest speaker discussed S-E-X. One hundred-four participants met at least three to four of the criteria which included: (1) age range between 18 and 30 years; (2) be at least a high school graduate; (3) have participated in either an abstinence-only or comprehensive ... Neonatal abstinence syndrome (NAS) is a treatable condition that newborns may experience as a result of prenatal exposure to certain substances, most often opioids. In the context of drug use, individuals may, at some point, decide to abstain from taking the drug following chronic use. This report highlights the efforts of five states participating in NCSACW’s Substance-Exposed In-Depth Technical Assistance (SEI-IDTA) initiative. . GAO-07-87 Abstinence Education: Efforts to Assess the Accuracy and Effectiveness of Federally Funded Programs Calendar Method WebMD does not provide medical advice, diagnosis or treatment. The antibiotic rifampin (also known as Rifadin and Rimactane) is the only exception — it can lower the effectiveness of nexplanon and other birth control methods. A general abstinence from pleasures or leisure, either partial or full, may be motivated by ambition, career or general self-respect (excluding the point of view that even the latter examples may be regarded as sources of pleasure). Liver, the largest gland in the body, a spongy mass of wedge-shaped lobes that has many metabolic and secretory functions. Dr. Grossman shares the approach developed at Yale and the results. Smoking cessation is the action leading towards the discontinuation of the consumption of a smoked substance, mainly tobacco, but it may encompass cannabis and other substances as well. Just as disturbing is that in a single act of vaginal intercourse with an infected male partner, a female teenager has a 30% risk of contracting genital herpes, a 50% chance of contracting gonorrhea, and a 1 in 100 chance of acquiring HIV. Found inside – Page 315April 23 , 2008 G A O ABSTINENCE EDUCATION Accountability Integrity Meliability Highlights Assessing the Accuracy and Effectiveness of Federally Funded Programs Highlights of GAO - 08-6647 , a testimony before the Committee on Oversight ... The supporters of abstinence argue that it is the only infallible way to prevent sexually transmitted diseases and unwanted pregnancies. Neonatal abstinence syndrome (NAS) is a treatable condition that newborns may experience as a result of prenatal exposure to certain substances, most often opioids. For Muslims, the period of fasting lasts during the whole month of Ramadan, from dawn to dusk. Of NIH report on condom effectiveness -- The declines in adolescent pregnancy, birth and abortion rates in the 1990s: what factors are responsible? Fasting practices may preclude sexual activity as well as food, in addition to refraining from eating certain types or groups of foods; for example, one might refrain from eating meat. The virtues of abstinence were discussed. Abstinence. Alcohol Abstinence . [11][12] I think it is morally irresponsible to deprive young people of information that can save their lives.". ", To advocates of an approach that includes contraception information, the answer to this question is easy. x Traditional treatment programs for substance use disorder (SUD) tend to be male-dominated environments, which can negatively affect women's access to treatment and related outcomes. This is lower than its 2018 rate of 25.3. Ascend is the nation's leader in Sexual Risk Avoidance education. A complete fast in its traditional definition is abstinence of all food and liquids except for water. If the individual is in an environment where they are in contact with the drug, they may feel compelled to engage in drug-taking behaviour (for example, someone who is practicing sobriety that finds themselves in a bar and re-engages in drinking alcohol). (2017) ‘The clinical effectiveness of individual behaviour change interventions to reduce risky sexual behaviour after a negative human immunodeficiency virus test in men who have sex with men: systematic and realist reviews and intervention development’, Health Technology Assessment, Volume 21, Issue 5, DOI 10.3310/hta21050.

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