"My friends would believe my word": appropriateness and acceptability of respondent-driven sampling in recruiting young tertiary student men who have sex with men for HIV/STI research in Nairobi, Kenya

Background: Tertiary student men who have sex with men (TSMSM) may engage in behaviors that increase their risk of infection with human immunodeficiency virus (HIV) and sexually transmitted infections (STI). Respondent-driven sampling (RDS) has become a popular method for discretely recruiting marginalized populations into HIV/STI research. We conducted formative research to assess appropriateness and acceptability of RDS in recruiting TSMSM into a prospective HIV/STI bio-behavioral survey in Nairobi, Kenya. Methods: Between September and October 2020, semi-structured qualitative interviews were held with service providers from organizations that serve MSM (n=3), and TSMSM (n=13). Interviews explored social networks of TSMSM, acceptability of using RDS as a sampling method, potential RDS implementation challenges, and proposed solutions to these challenges. Interviews were done in English, audio-recorded and transcribed then analyzed thematically using NVivo version 11. Results: Service providers reflected that TSMSM had large though concealed networks, thus making RDS an appropriate sampling method. Risk of ineligible persons attempting to participate due to the associated double incentive was noted, and using student identification documents as part of eligibility screening recommended. TSMSM also perceived RDS to be an acceptable strategy based on their large social network sizes (10-40), and the trust amongst themselves. TSMSM were concerned about participating due to the risk of being outed as MSM, seeing as same sex behavior is criminalized in Kenya, and hence emphasized that researchers needed to assure them of their confidentiality, and include MSM as part of the study team to encourage participation. TSMSM suggested coupons should indicate value of reimbursement, be pocket-sized and placed in an envelope to avoid loss, and provide directions to and contacts of the survey site for easy access. Conclusion: RDS was perceived as both an appropriate and acceptable sampling method. Anticipated challenges of RDS implementation were highlighted, and possible solutions to these challenges suggested.

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What makes an optimal delivery for PrEP against HIV: A qualitative study in MSM

International Journal of STD & AIDS ◽

10.1177/09564624211060824 ◽

2022 ◽

pp. 095646242110608

Author(s):

Janice Y. C. Lau ◽

Ngai-Sze Wong ◽

Krystal C. K. Lee ◽

Tsz-Ho Kwan ◽

Grace C. Y. Lui ◽

...

Keyword(s):

Qualitative Study ◽

Service Providers ◽

Effective Means ◽

Qualitative Assessment ◽

Theory Approach ◽

Service Model ◽

Structured Interviews ◽

Sexually Transmitted ◽

Ethnic Chinese ◽

Sex With Men

Background Pre-exposure prophylaxis (PrEP) is an effective means of HIV prevention for men who have sex with men (MSM), a key population whose engagement is crucial for achieving effective public health outcomes. An optimal service model would be important in planning the implementation of PrEP in places where such service has not been established. Methods A qualitative study was conducted to delineate the attributes of an optimal PrEP service model for MSM in Hong Kong, a city where no formal PrEP programs existed. Twenty purposively sampled MSM who were enrollees of two pilot PrEP projects participated in the semi-structured interviews promoting story-telling. The coded data were thematically analyzed following Grounded Theory approach, focusing on uncovering a typology of the essential attributes of an optimal PrEP service model, and the reasons for such preferences. Results Participating MSM were all ethnic Chinese and aged 26 to 52 years. All had received PrEP from pilot projects in conjunction with periodic screening of sexually transmitted infections (STI), HIV antibody, and plasma creatinine. Four major themes emerged as regards the attributes of a preferred PrEP service: (i) comprehensiveness of HIV/STI and safety monitoring; (ii) convenient unitary service; (iii) stigma-free PrEP access and protecting confidentiality; and (iv) affordable price. Whereas regular provision of PrEP was acceptable to MSM, unaffordability and related stigma were the anticipated challenges for potential service providers. Conclusions The qualitative assessment of MSM’s preference for PrEP service delivery has yielded important information on the many facets of a desirable service model.

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Sexual risk behaviour and sexually transmitted infections in men who have sex with men

International Journal of Research in Dermatology ◽

10.18203/issn.2455-4529.intjresdermatol20200041 ◽

2020 ◽

Vol 6 (2) ◽

pp. 178

Author(s):

Murugan Swamiappan ◽

Manjula Jagannathan ◽

Aysha Abdulla

Keyword(s):

Sexually Transmitted Infections ◽

Sexual Risk ◽

Service Providers ◽

Risk Behaviour ◽

Unprotected Sex ◽

Sexual Risk Behaviour ◽

Sexually Transmitted ◽

Condom Usage ◽

Sex With Men ◽

Clinical Records

Background: In India the estimated men who have sex with men (MSM) population is around 352, 000, among that 4.3% are living with HIV. The incidence of sexually transmitted infections (STIs) in MSM is greater than that reported in women and men who have sex with women only. The aim of the study is to determine the trends of sexual behaviour and the pattern of sexually transmitted infections in men who have sex with men.Methods: A retrospective study of the data collected from the clinical records of all MSM, who had attended the STI clinic of Kilpauk Medical College, Chennai, Tamil Nadu, during the three-year study period, from July 2016 to June 2019. Demographic data, sexual risk behaviour, condom usage and STIs, among the MSM, were computed and analyzed.Results: During the study period 489 MSM attended the STI clinic, 51.9% were bisexual and 48.1 % were homosexual. Among them, exclusive penetrative sex in 50.7%, exclusive receptive sex in 15.7% and both in 33.6% were reported. Condom usage was consistent in 18.8%, inconsistent in 28.8% and 52.9% never used condom. Unprotected sex is more common in oral sex than with anal sex. STIs were seen in 20.9% and HIV in 1.4% of MSM. Syphilis was the most common STI seen.Conclusions: Our study elucidated the high prevalence of STIs among MSM and increasing trends of sexual risk behaviour. Health service providers must take necessary steps to improve the provision of biological and medical measures to screen, treat and prevent infections.

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Social networks of men who have sex with men: a study of recruitment chains using Respondent Driven Sampling in Salvador, Bahia State, Brazil

Cadernos de Saúde Pública ◽

10.1590/0102-311x00085614 ◽

2015 ◽

Vol 31 (suppl 1) ◽

pp. 170-181 ◽

Cited By ~ 5

Author(s):

Sandra Mara Silva Brignol ◽

Inês Dourado ◽

Leila Denise Amorim ◽

José Garcia Vivas Miranda ◽

Lígia R. F. S. Kerr

Keyword(s):

Hiv Transmission ◽

Sexual Contact ◽

Demographic Characteristics ◽

Respondent Driven Sampling ◽

Friendship Networks ◽

Sexually Transmitted ◽

Positive Attitudes ◽

Number Of Sexual Partners ◽

Sex With Men ◽

Networks Structure

Abstract Social and sexual contact networks between men who have sex with men (MSM) play an important role in understanding the transmission of HIV and other sexually transmitted infections (STIs). In Salvador (Bahia State, Brazil), one of the cities in the survey Behavior, Attitudes, Practices, and Prevalence of HIV and Syphilis among Men Who Have Sex with Men in 10 Brazilian Cities, data were collected in 2008/2009 from a sample of 383 MSM using Respondent Driven Sampling (RDS). Network analysis was used to study friendship networks and sexual partner networks. The study also focused on the association between the number of links (degree) and the number of sexual partners, in addition to socio-demographic characteristics. The networks’ structure potentially facilitates HIV transmission. However, the same networks can also be used to spread messages on STI/HIV prevention, since the proximity and similarity of MSM in these networks can encourage behavior change and positive attitudes towards prevention.

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Factors Predicting Uptake of Sexually Transmitted Infections Testing among Men Who Have Sex with Men Who Are “Pre-Exposure Prophylaxis Tourists”—An Observational Prospective Cohort Study

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18073582 ◽

2021 ◽

Vol 18 (7) ◽

pp. 3582

Author(s):

Zixin Wang ◽

Yuan Fang ◽

Natthakhet Yaemim ◽

Kai J. Jonas ◽

Andrew Chidgey ◽

...

Keyword(s):

Cohort Study ◽

Service Providers ◽

Risky Behaviors ◽

Service Planning ◽

Transmitted Infection ◽

Sexually Transmitted ◽

Sti Testing ◽

Sex With Men ◽

Exposure Prophylaxis

The term “Pre-exposure prophylaxis (PrEP) tourists” refers to individuals who obtain PrEP in other countries and use it in their home countries. A prospective observational cohort study was conducted among a group of men who have sex with men (MSM) who obtained PrEP in private clinics in Thailand and used it in Hong Kong. Participants completed two web-based self-administered surveys when obtaining PrEP in Thailand and three months afterwards. Out of 110 participants at baseline, 67 completed the follow-up. The prevalence of sexually transmitted infection (STI) testing was 47.8% during the follow-up period. Eleven participants received an STI diagnosis, and seven of them were incident infections in the past three months. Participants who perceived a higher chance for STI infection (adjusted odds ratios (AOR): 1.90, 95% CI: 1.00, 3.75) and reported higher intention to take up STI testing at baseline (AOR: 1.62, 95% CI: 1.05, 2.50) were more likely to receive STI testing during the follow-up period. Baseline perceptions that service providers would think they were having risky behaviors because of PrEP use was negatively associated with the dependent variable (AOR: 0.51, 95% CI: 0.31, 0.86). Service planning and health promotion related to STI testing is needed for MSM “PrEP tourists”.

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Example A: Using online respondent-driven sampling among men who have sex with men in Vietnam

European Journal of Public Health ◽

10.1093/eurpub/ckz185.532 ◽

2019 ◽

Vol 29 (Supplement_4) ◽

Author(s):

A E Thorson ◽

L E C Rocha

Keyword(s):

Rural Areas ◽

Controlled Trial ◽

Risk Behaviour ◽

Incidence Rates ◽

Respondent Driven Sampling ◽

Sexually Transmitted ◽

Initial Intervention ◽

Sex With Men ◽

Randomised Controlled ◽

Double Blinded

Abstract Men who have sex with men (MSM) represent a key population at enhanced risk of sexually transmitted infections including HIV. HIV incidence rates are increasing amongst MSM in Vietnam. The last prevalence rates estimates range between 4% and 12% in major cities (2014). High rates of syphilis, chlamydia and gonorrhoea have also been reported, including drug resistant gonorrhoea. MSM face a strong cultural stigma, especially predominant in rural areas, which make them hard-to-reach in relation to preventive activities. In this context, respondent-driven sampling (RDS) becomes an efficient solution for sampling as well as for testing health promotive interventions. The high Internet penetration rate makes web-based RDS to enable sampling as well as testing risk reduction interventions, an appealing alternative to reduce costs, increase data reliability and to facilitate project management of complex study designs. In this talk, we will present and discuss the implementation of a nation-wide webRDS study of MSM in Vietnam aiming to collect self-reported sexual health and risk behaviour information. Using the same web-RDS system, we combine RDS with a double-blinded randomised controlled trial to implement an online intervention based on the participants own responses to encourage self-reflection. The system allows us to follow up respondents for several months after the initial intervention to check the consequences of the intervention on individual behaviour over time.

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Respondent-Driven Sampling With Youth Who Use Drugs: A Mixed Methods Assessment

Contemporary Drug Problems ◽

10.1177/0091450919885412 ◽

2019 ◽

Vol 46 (4) ◽

pp. 363-378 ◽

Cited By ~ 2

Author(s):

Marion Selfridge ◽

Kiffer G. Card ◽

Alissa Greer ◽

Sarah Ferencz ◽

Nathan Lachowsky ◽

...

Keyword(s):

Logistic Regression ◽

People Who Inject Drugs ◽

Financial Incentive ◽

Qualitative Interviews ◽

Network Size ◽

Descriptive Statistics ◽

Respondent Driven Sampling ◽

Urban Centers ◽

Sex With Men ◽

Size Estimates

Respondent-driven sampling (RDS) has been widely used for recruiting hard-to-sample populations, particularly men who have sex with men and people who inject drugs from large urban centers. The aim of this article was to examine the feasibility of using RDS among nonmetropolitan youth who use drugs. Between May 2017 and June 2018, RDS was used to recruit youth who use drugs, ages 16–30, in three nonmetropolitan Canadian cities. All participants completed a 1-hr interviewer-administered survey. Youth received $25 for the interview, up to five coupons to recruit peers and $5 per coupon returned. Crude and RDS-weighted descriptive statistics were produced using RDS-II weights as were homophily (the tendency for people to be similar) and network size estimates. Statistically significant differences between seeds and recruits were identified using logistic regression. A subsample of recruits participated in qualitative interviews ( n = 38). Data from these interviews were inductively analyzed to identify barriers that could be used to explain the challenges with chain-referral recruitment among this population. In total, 449 youth were recruited. Due to unproductive chains, 57.2% ( n = 257) of the sample was comprised of seeds and 322 (72%) did not have a single coupon returned. Barriers to recruiting other youth included logistical challenges, fear of police, concerns about confidentiality, stigma of substance use, and poor financial incentive. Our study shows that RDS can be used to reach younger participants but also highlights the need for formative research and flexibility in recruitment to help mitigate unsuccessful RDS among nonmetropolitan youth who use drugs.

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Prevalence of STI symptoms and high levels of stigma in STI healthcare among men who have sex with men in Dar es Salaam, Tanzania: a respondent-driven sampling study

International Journal of STD & AIDS ◽

10.1177/0956462416683625 ◽

2016 ◽

Vol 28 (9) ◽

pp. 925-928 ◽

Cited By ~ 6

Author(s):

Michael W Ross ◽

Markus Larsson ◽

Joyce E Nyoni ◽

Anette Agardh

Keyword(s):

Dar Es Salaam ◽

Respondent Driven Sampling ◽

Self Medication ◽

Public Clinic ◽

Sexually Transmitted ◽

Source Of Infection ◽

Hiv Cascade ◽

Sex With Men ◽

Public Clinics ◽

Groin Swelling

Symptoms of sexually transmitted infections (STIs), whether they are presented for treatment or diagnosis, and how they are received by the clinician where they are presented, may be concomitants of stigma associated with homosexuality in homophobic climates. We analyzed respondent-driven sampling data from a study on 200 young men who have sex with men (MSM) in Dar es Salaam, Tanzania to examine sample prevalence, treatment and clinician response to 10 symptoms potentially associated with STIs. Survey measures included 10 self-reported STI symptoms, further specified according to location (genital, anal, oral), further specified according to place of diagnosis, place of, treatment whether there was pharmacy treatment or self-medication, healthcare worker (HCW) inquiries about source of infection and whether the HCW was polite. Most common symptoms reported were genital pain, burning urination, genital itching/burning, penile discharge, and groin swelling. Anal symptoms had the lowest proportion of treatment at public clinics and among the highest proportion of pharmacy treatment; anal sores had the highest proportion of self-medication. HCWs were reported as not being polite in response to 71–90% of the symptoms, (median = 82%). The findings suggest that stigma and negative HCW response are barriers to public clinic treatment for MSM in Tanzania and that these may have implications for both STI treatment and the HIV cascade.

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Project BESPOKE (Integrated Bio-Behavioral Assessment of HIV and STI Among Young Tertiary Student Men Who Have Sex With Men in Nairobi, Kenya): A Respondent-Driven Sampling Survey Protocol

Frontiers in Public Health ◽

10.3389/fpubh.2021.619694 ◽

2021 ◽

Vol 9 ◽

Author(s):

Samuel Waweru Mwaniki ◽

Peter Mwangi Mugo ◽

Thesla Palanee-Phillips

Keyword(s):

Health Services ◽

Population Size ◽

Phase Ii ◽

Behavioral Assessment ◽

Phase Iii ◽

Respondent Driven Sampling ◽

Sti Prevention ◽

Tertiary Institutions ◽

Tertiary Student ◽

Sex With Men

Introduction: Globally, men who have sex with men (MSM) are a key population for the human immunodeficiency virus (HIV) epidemic. Among MSM, young men who have sex with men (YMSM) are disproportionately affected by HIV and other sexually transmitted infections (STI). However, there is a dearth of research and interventions targeting HIV/STI prevention among YMSM. In Kenya, there is paucity of knowledge on the burden of HIV/STI and related factors among YMSM, including tertiary student men who have sex with men (TSMSM). The barriers TSMSM experience in accessing and utilizing health services in their learning institutions have seldom been explored. In the context of healthcare providers (HCP) working in tertiary institutions, little is known about their knowledge, attitudes, and practices toward providing services to TSMSM.Methods: The aims of the study are to: estimate prevalence and correlates of HIV/STI among TSMSM; estimate population size of TSMSM; explore experiences of TSMSM with access and utilization of health services; and assess HCP knowledge of, attitudes toward, and practices in provision of services to TSMSM. A mixed-methods approach will be used in three phases: Phase I—formative qualitative research will be conducted to understand TSMSM social networks, select “seeds”, and explore strategies for implementing a respondent-driven sampling (RDS) survey. Interviews will be conducted with at least three staff who work in community based/non-governmental organizations (CBO/NGO) that serve MSM and at least 10 TSMSM. Phase II—an integrated bio-behavioral assessment (IBBA) will be conducted, where 200 TSMSM recruited by RDS will be offered HIV/STI testing, complete a behavioral survey, and provide information for population size estimation (PSE). Phase III—in-depth interviews will be held with 20 TSMSM selected from 200 TSMSM in phase II, to explore their experiences with access and utilization of healthcare services. Focus group discussions (FGD) will be conducted with HCP working in tertiary institutions to assess their knowledge of, attitudes toward, and practices in providing services to TSMSM. Data collection started in September 2020 and is expected to end by September 2021.Discussion: Findings from this study will be useful in informing HIV/STI prevention programming for TSMSM, by policy makers such the Kenyan ministries of health and education, tertiary education institutions, service providers, advocacy groups, and other interested stakeholders.

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HIV self-tests for men who have sex with men, accessed via a digital vending machine: a qualitative study of acceptability

International Journal of STD & AIDS ◽

10.1177/0956462419890726 ◽

2020 ◽

Vol 31 (5) ◽

pp. 420-425

Author(s):

S Raffe ◽

A Pollard ◽

JH Vera ◽

S Soni ◽

C Peralta ◽

...

Keyword(s):

Qualitative Interviews ◽

Negative Effects ◽

Sexually Transmitted ◽

Inappropriate Use ◽

Vending Machines ◽

Self Testing ◽

Poor Understanding ◽

Undiagnosed Hiv ◽

Sex With Men ◽

The Uk

As the number of people living with undiagnosed HIV infection in the UK declines, innovative ways to access those least engaged with services are needed. This study explores the attitudes of men who have sex with men (MSM) towards using HIV self-testing (HIVST) kits distributed via a vending machine in a sauna (a licenced sex-on-premise venue). Twenty-three MSM attending the sauna were recruited to take part in semi-structured qualitative interviews. The participants were overwhelmingly positive about the HIVST vending machine. They identified convenience and flexibility as major benefits to testing in this way. The sauna was felt to be an appropriate location for the intervention. Limitations identified included the potential to reduce screening for other sexually transmitted infections and the inappropriate use of HIVST kits as a tool for risk-assessment prior to condomless sex, with a poor understanding of the window period. The implications of receiving a positive result without immediate access to support were also a concern. HIVST vending machines are an acceptable, innovative way to encourage HIV testing. Providers need to ensure this intervention is supported by adequate information regarding the limitations of the test and how to access comprehensive services to avoid any unintended negative effects.

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Recommendations for Intervention Content to Enhance HIV Pre-Exposure Prophylaxis Uptake among Men Who have Sex with Men Receiving Care at Sexually Transmitted Disease Clinics

Journal of Men s Health ◽

10.15586/jomh.v16i3.198 ◽

2020 ◽

Vol 16 (3) ◽

pp. e47-e59

Author(s):

Amy Nunn ◽

Genoviva Sowemimo-Coker ◽

Jacob Van den Berg ◽

Cassandra Sutten Coats ◽

Collette Sosnowy ◽

...

Keyword(s):

Side Effects ◽

Sexually Transmitted Disease ◽

Qualitative Interviews ◽

Transmitted Disease ◽

Anal Intercourse ◽

Unprotected Anal Intercourse ◽

Sexually Transmitted ◽

Culturally Tailored ◽

Sex With Men ◽

Exposure Prophylaxis

Background and objective Pre-exposure prophylaxis (PrEP) uptake has been suboptimal. Sexually transmitted disease (STD) clinics provide important opportunities to scale PrEP uptake. Material and methods To inform the development of a brief intervention to enhance PrEP uptake in STD clinics, we conducted 32 qualitative interviews to explore barriers and facilitators of PrEP uptake among PrEP eligible, PrEP naïve, and men who have sex with men (MSM) presenting for STD screening services. We also solicited input for intervention components to enhance PrEP uptake at STD clinics. Results Most participants’ self-perceived HIV risks were low despite reporting unprotected anal intercourse. Many were reluctant to take any medications, expressed apprehension about perceived side effects of PrEP, and were unaware of how to obtain PrEP. Participants recommended that interventions focusing on enhancing PrEP uptake in STD clinics should include: culturally tailored educational materials about PrEP, informational graphics indicating PrEP’s relative efficacy in reducing HIV transmission risks, and comprehensive PrEP navigation. Most participants did not feel strongly about gender, race or ethnicity of providers; however, nearly all preferred gay affirming providers. Brief interventions to enhance PrEP uptake among MSM in STD clinics should include efforts to raise self-awareness of HIV risk, provide information about PrEP’s efficacy relative to other interventions, underscore PrEP’s relatively few side effects, and provide culturally tailored messaging.

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