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Lyons M, Harper GW, Jadwin-Cakmak L, Beyer A, Graham SM. Listening to the Voices of Gay and Bisexual Men and Other Men Who Have Sex with Men in Kenya: Recommendations for Improved HIV Prevention Programming. THE UNDERGRADUATE JOURNAL OF PUBLIC HEALTH AT THE UNIVERSITY OF MICHIGAN 2024; 7:84-96. [PMID: 37398631 PMCID: PMC10310496 DOI: 10.3998/ujph.3949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/04/2023]
Abstract
Young gay and bisexual men and other men who have sex with men (GBMSM) are a key population at high risk for new human immunodeficiency virus (HIV) infections in Kenya; thus, increased efforts are necessary to reduce their health risks. This qualitative study describes recommendations offered by young GBMSM in Kenya regarding the development and delivery of culturally appropriate HIV prevention services. Both young GBMSM Community Members and Peer Educators recommend that future HIV prevention efforts enhance economic empowerment, provide mental health and substance use services, and incorporate arts-based health promotion strategies. In addition, participants recommended that public health professionals increase the ease of access to HIV prevention services for GBMSM and that researchers disseminate findings from HIV prevention research back to the community.
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Sariola S. Mistrust: Community engagement in global health research in coastal Kenya. SOCIAL STUDIES OF SCIENCE 2023; 53:449-471. [PMID: 37002697 PMCID: PMC10240637 DOI: 10.1177/03063127231162082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
This article explores a case of mistrust in global health research and community engagement. It uses ethnographic material collected in 2014 and 2016 in Kenya, concerning community engagement by a HIV vaccine research group working with men who have sex with men and transgender women. In 2010, the research group was attacked by members of the wider community. Following the attack, the research group set up an engagement program to reduce mistrust and re-build relationships. Analysis focusing on mistrust shows the dynamics underlying the conflict: Norms around gender and sexuality, political support for LGBTIQ+ rights, and resources disparities were all at stake for those embroiled in the conflict, including researchers, study participants, religious leaders, and LGBTIQ+ activists in the region. Rather than a normative good with liberatory potential, community engagement in this paper is discussed as a relational tool with which mistrust was managed, highlighting the fragility of participation.
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Operario D, Sun S, Bermudez AN, Masa R, Shangani S, van der Elst E, Sanders E. Integrating HIV and mental health interventions to address a global syndemic among men who have sex with men. Lancet HIV 2022; 9:e574-e584. [PMID: 35750058 PMCID: PMC7613577 DOI: 10.1016/s2352-3018(22)00076-5] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 02/27/2022] [Accepted: 03/14/2022] [Indexed: 02/04/2023]
Abstract
In this Series paper, we review evidence on the co-occurring and synergistic epidemics (syndemic) of HIV and mental health problems worldwide among men who have sex with men (MSM). The multilevel determinants of this global syndemic include structural factors that enable stigma, systematic bias, and violence towards MSM across geographical and cultural contexts. Cumulative exposure to these factors over time results in population-level inequities in the burden of HIV infections and mental health problems among MSM. Evidence for this syndemic among MSM is strongest in the USA, Canada, western Europe, and parts of Asia and Latin America, with emerging evidence from sub-Saharan Africa. Integrated interventions are needed to address syndemics of HIV and mental health problems that challenge the wellbeing of MSM populations worldwide, and such interventions should consider various mental health conditions (eg, depression, anxiety, trauma, and suicidality) and their unique expressions and relationships with HIV outcomes depending on cultural contexts. In addition, interventions should identify and intervene with locally relevant structural factors that result in HIV and mental health vulnerabilities among MSM.
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Gedela K, Luis H, Loverian RF, Maharani S, Rajus N, Wignall FS, Garner A, Sukmaningrum E, McOwan A, Nwokolo N, Whitlock G, Irwanto I. Lights, camera…research! Short film and social media to recruit to HIV research in Indonesia. Digit Health 2022; 8:20552076221090049. [PMID: 35548711 PMCID: PMC9081712 DOI: 10.1177/20552076221090049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 03/09/2022] [Indexed: 11/16/2022] Open
Abstract
Introduction HIV prevalence among men who have sex with men has increased in Indonesia, amid reports of growing stigma against lesbian, gay, bisexual and transgender individuals and policies that have pushed back public health outreach to these groups. Methods We assessed the utility of tailored short film and targeted social media engagement to recruit men who have sex with men in Indonesia to HIV social science research. A short HIV testing promotion film, anonymised short survey and invite to a wider research study was embedded on a website platform and disseminated using geo and social/community group targeting for 1 month via a social networking app and social media platforms. Results From 3 January 2021 to 3 February 2021, there were over 2200 hits of the website within Indonesia. A total of 177 male web users who identified as men who have sex with men or preferred not to declare their sexuality, engaged by watching the short film and completing the survey, they were aged between 17 and 60 years old, of Indonesian nationality and living in Indonesia. Of these, 88% indicated having at least one HIV test in their lifetime, 66% had felt shame with respect to their sexuality and 53% indicated feeling afraid to have a HIV test. Ninety (51%) of the 177 validated using their email or mobile phone number demonstrating willingness to be contacted to join a further study. Twenty-three eligible men who have sex with men, aged 21–55 years old, joined a further social science research study. Participants were from diverse backgrounds and included men born in provinces outside Bali, of different socio-economic and employment backgrounds and diverse relationship contexts. Discussion Engaging, empowering digital media involving key health messaging can provide health education in more effective ways, build trust and bring communities together. Targeted digital and social media approaches could reach increasingly marginalised and vulnerable communities to promote individual and public health and enable recruitment to valuable medical research.
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Affiliation(s)
- K Gedela
- Chelsea and Westminster NHS Foundation Trust, London, UK
| | - H Luis
- Yayasan Bali Peduli HIV/Sexual Health Clinic, Denpasar, Bali, Indonesia
| | - RF Loverian
- Pusat Unggulan Kebijakan Kesehatan dan Inovasi Sosial (PUI-PT PPH, PUK21S), HIV/AIDS Research Centre, Atma Jaya Catholic University, Jakarta, Indonesia
| | - S Maharani
- Pusat Unggulan Kebijakan Kesehatan dan Inovasi Sosial (PUI-PT PPH, PUK21S), HIV/AIDS Research Centre, Atma Jaya Catholic University, Jakarta, Indonesia
| | - N Rajus
- Yayasan Bali Peduli HIV/Sexual Health Clinic, Denpasar, Bali, Indonesia
| | - FS Wignall
- Yayasan Bali Peduli HIV/Sexual Health Clinic, Denpasar, Bali, Indonesia
| | - A Garner
- Hornet Social Network, San Francisco, USA
| | - E Sukmaningrum
- Pusat Unggulan Kebijakan Kesehatan dan Inovasi Sosial (PUI-PT PPH, PUK21S), HIV/AIDS Research Centre, Atma Jaya Catholic University, Jakarta, Indonesia
| | - A McOwan
- Chelsea and Westminster NHS Foundation Trust, London, UK
| | - N Nwokolo
- Chelsea and Westminster NHS Foundation Trust, London, UK
| | - G Whitlock
- Chelsea and Westminster NHS Foundation Trust, London, UK
| | - I Irwanto
- Pusat Unggulan Kebijakan Kesehatan dan Inovasi Sosial (PUI-PT PPH, PUK21S), HIV/AIDS Research Centre, Atma Jaya Catholic University, Jakarta, Indonesia
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Sandfort TGM, L Hamilton E, Marais A, Guo X, Sugarman J, Chen YQ, Cummings V, Dadabhai S, Dominguez K, Panchia R, Schnabel D, Zulu F, Reynolds D, Radebe O, Mbeda C, Kamba D, Kanyemba B, Ogendo A, Stirratt M, Chege W, Lucas J, Fawzy M, McKinstry LA, Eshleman SH. The feasibility of recruiting and retaining men who have sex with men and transgender women in a multinational prospective HIV prevention research cohort study in sub-Saharan Africa (HPTN 075). J Int AIDS Soc 2020; 23 Suppl 6:e25600. [PMID: 33000911 PMCID: PMC7527761 DOI: 10.1002/jia2.25600] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 06/30/2020] [Accepted: 07/21/2020] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION Men who have sex with men (MSM) and transgender women (TGW) in sub-Saharan Africa (SSA) are profoundly affected by HIV with high HIV prevalence and incidence. This population also faces strong social stigma and legal barriers, potentially impeding participation in research. To date, few multi-country longitudinal HIV research studies with MSM/TGW have been conducted in SSA. Primary objective of the HIV Prevention Trials Network (HPTN) 075 study was to assess feasibility of recruiting and retaining a multinational prospective cohort of MSM/TGW in SSA for HIV prevention research. METHODS HPTN 075, conducted from 2015 to 2017, was designed to enroll 400 MSM/TGW at four sites in SSA (100 per site: Kisumu, Kenya; Blantyre, Malawi; Cape Town, South Africa; and Soweto, South Africa). The number of HIV-positive persons was capped at 20 per site; HIV-positive persons already in care were excluded from participation. The one-year study included five biobehavioural assessments. Community-based input and risk mitigation protocols were included in study design and conduct. RESULTS Of 624 persons screened, 401 were enrolled. One in five participants was classified as transgender. Main reasons for ineligibility included: (a) being HIV positive after the cap was reached (29.6%); (b) not reporting anal intercourse with a man in the preceding three months (20.6%); and (c) being HIV positive and already in care (17.5%). Five (1.2%) participants died during the study (unrelated to study participation). 92.9% of the eligible participants (368/396) completed the final study visit and 86.1% participated in all visits. The main, overlapping reasons for early termination included being (a) unable to adhere to the visit schedule, predominantly because of relocation (46.4%), and (b) unable to contact the participant (32.1%). Participants reported strong motivation to participate and few participation barriers. Four participants reported social harms (loss of confidentiality and sexual harassment by study staff) that were successfully addressed. CONCLUSIONS HPTN 075 successfully enrolled a multinational sample of MSM/TGW in SSA in a prospective HIV prevention research study with a high retention rate and few documented social harms. This supports the feasibility of conducting large-scale research trials in this population to address its urgent, unmet HIV prevention needs.
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Affiliation(s)
- Theodorus GM Sandfort
- HIV Center for Clinical and Behavioral StudiesNew York State Psychiatric Institute and Columbia UniversityNew YorkNYUSA
| | | | - Anita Marais
- Perinatal HIV Research UnitUniversity of the WitwatersrandSoweto HPTN CRSSowetoSouth Africa
| | - Xu Guo
- Vaccine and Infectious Disease DivisionFred Hutchinson Cancer Research CenterSeattleWAUSA
| | - Jeremy Sugarman
- Berman Institute of BioethicsJohns Hopkins UniversityBaltimoreMDUSA
| | - Ying Q Chen
- Vaccine and Infectious Disease DivisionFred Hutchinson Cancer Research CenterSeattleWAUSA
| | - Vanessa Cummings
- Department of PathologyJohns Hopkins University School of MedicineBaltimoreMDUSA
| | - Sufia Dadabhai
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBlantyreMalawi
| | - Karen Dominguez
- Desmond Tutu HIV CentreUCT Medical SchoolCape TownSouth Africa
| | - Ravindre Panchia
- Perinatal HIV Research UnitUniversity of the WitwatersrandSoweto HPTN CRSSowetoSouth Africa
| | | | - Fatima Zulu
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBlantyreMalawi
| | | | | | - Calvin Mbeda
- Kenya Medical Research Institute (KEMRI) CDCKisumuKenya
| | - Dunker Kamba
- Centre for the Development of People (CEDEP)BlantyreMalawi
| | - Brian Kanyemba
- Desmond Tutu HIV CentreUCT Medical SchoolCape TownSouth Africa
| | - Arthur Ogendo
- Kenya Medical Research Institute (KEMRI) CDCKisumuKenya
| | - Michael Stirratt
- Division of AIDS ResearchNational Institute of Mental HealthBethesdaMDUSA
| | - Wairimu Chege
- Division of AIDNational Institute of Allergy and Infectious DiseaseNational Institutes of HealthBethesdaMDUSA
| | | | | | - Laura A McKinstry
- Vaccine and Infectious Disease DivisionFred Hutchinson Cancer Research CenterSeattleWAUSA
| | - Susan H Eshleman
- Department of PathologyJohns Hopkins University School of MedicineBaltimoreMDUSA
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Mweemba O, Smith H, Coombe H. Exploring the Gender-Specific Impact of Educational Film on Maternal and Child Health Knowledge and Behavior: A Qualitative Study in Serenje District, Zambia. INTERNATIONAL QUARTERLY OF COMMUNITY HEALTH EDUCATION 2020; 41:209-223. [DOI: 10.1177/0272684x20916600] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Educational film is a communication tool that helps to present complex information simply and clearly, keeping audiences interested for longer and helping to reinforce important learning. Medical Aid Films produces educational films targeted at communities and health workers, with a focus on maternal and child health (MCH) content. Pilot work suggests that film screenings have attracted male as well as female viewers and have started to increase male involvement in MCH care. We explored stakeholder perspectives and gender-specific responses to educational films screened in a rural district of Serenje, Zambia. Methods A qualitative study using focus group discussions and in-depth interviews with men and women who had viewed the films at least once, and key informant interviews with health workers who helped deliver the film screenings. Thematic framework analysis was used to derive themes and subthemes, and illustrative quotes are used to substantiate interpretation of the findings. Results Men’s and women’s perspectives are clustered around the influence of the films on knowledge and behavior in relation to MCH topics and male involvement and overall community responses to the films. The three themes summarizing key informant perspectives relate to their impressions of the influence of the films on male involvement in MCH and their views on using film to deliver heath information. Conclusion Educational films have the potential to improve women’s and men’s knowledge and awareness of MCH topics, including healthy nutrition and welfare of women during pregnancy, the need to seek skilled care during pregnancy and for childbirth, and the importance of male involvement in supporting the care of women and children. Before widespread implementation, decisions must be made about whether and how to integrate the films with community health education programs, the needs, values, and preferences of men and women and how to present and deliver the film content in a way that maximizes participation of men and women in MCH but does not undermine women’s rights, autonomy, or safety.
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Affiliation(s)
- Oliver Mweemba
- Department of Health Promotion and Education, School of Public Health, University of Zambia
| | - Helen Smith
- Bradford Institute for Health Research, Bradford, England
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Granderson RM, Harper GW, Wade R, Odero W, Onyango Olwango DP, Fields EL. Gender Role Strain and the Precarious Manhood of Sexual Minority Kenyan Men. PSYCHOLOGY OF SEXUAL ORIENTATION AND GENDER DIVERSITY 2019; 6:420-432. [PMID: 33620336 PMCID: PMC7897423 DOI: 10.1037/sgd0000340] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Examining the impact of precarious manhood on the mental health of sexual minority men living in Kenya, we hypothesized that (a) men who have sex with men exclusively (MSME) and men who have sex with men and women (MSMW) would display differential patterns of conformity to norms of masculinity; (b) these differences would result in distinct patterns of association between masculine conformity and symptoms of psychological distress for MSME and MSMW; and (c) conformity to norms of masculinity would be bidirectionally associated with symptoms of depression and anxiety. Using data collected from 391 young men who participated in a community-based, cross-sectional study of HIV-related risk and resilience among young sexual minority men in western Kenya, we ran a multivariate analysis of variance (MANOVA) to assess differences in conformity to masculine norms and four hierarchical linear regression models to examine the associations between conformity to masculine norms and symptoms of anxiety and depression for MSME and MSMW. MANOVA results revealed no significant differences between MSME and MSMW in overall conformity to masculinity, although MSMW were significantly more likely to conform to the masculine norm of power over women. Regression results revealed that conformity to norms of masculinity was bidirectionally associated with psychological distress and that these patterns of association were distinct for MSME and MSMW. The discussion explores possible explanations for revealed differences between MSME and MSMW using existing research. Clinical implications, limitations, and opportunities for future research are also discussed.
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Affiliation(s)
| | | | - Ryan Wade
- University of Illinois at Urbana-Champaign
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Gichuru E, Kombo B, Mumba N, Sariola S, Sanders EJ, van der Elst EM. Engaging religious leaders to support HIV prevention and care for gays, bisexual men, and other men who have sex with men in coastal Kenya. CRITICAL PUBLIC HEALTH 2018; 28:294-305. [PMID: 29770367 PMCID: PMC5935049 DOI: 10.1080/09581596.2018.1447647] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Accepted: 02/28/2018] [Indexed: 01/18/2023]
Abstract
In Kenyan communities, religious leaders are important gatekeepers in matters of health and public morality. In a context that is generally homophobic, religious leaders may aggravate or reduce stigmatization of sexual minorities such as gay and bisexual men, and other men who have sex with men (GBMSM). Literature indicates mixed results in efforts to encourage religious leaders to work effectively and sensitively with issues regarding HIV and sexuality. This paper describes the implementation of an engagement intervention with religious leaders from different denominations, which took place following a homophobic hate attack that was led by local religious leaders, at an HIV research clinic for GBMSM on the Kenyan coast. After the homophobic attack, tailored engagement activities, including a comprehensive four-day online sensitivity training course took place between June 2015 and October 2016 in the Kenyan coast. HIV researchers, together with trained GBMSM activists, organized the series of engagement activities for religious leaders which unfolded iteratively, with each subsequent activity informed by the results of the previous one. Facilitated conversations were used to explore differences and disagreements in relation to questions of scripture, mission, HIV, and human sexuality. As a result, researchers noted that many religious leaders, who initially expressed exceedingly negative attitudes towards GBMSM, started to express far more accepting and supportive views of sexuality, sexual identities, and same-sex relations. This paper describes the changes in religious leaders’ discourses relating to GBMSM, and highlights the possibility of using engagement interventions to build trust between research institutes, religious leaders, and GBMSM.
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Affiliation(s)
- Evans Gichuru
- Kenya Medical Research Institute - Wellcome Trust Research Programme, Kilifi, Kenya
| | - Bernadette Kombo
- Kenya Medical Research Institute - Wellcome Trust Research Programme, Kilifi, Kenya
| | - Noni Mumba
- Kenya Medical Research Institute - Wellcome Trust Research Programme, Kilifi, Kenya
| | - Salla Sariola
- Nuffield Department of Population Health, University of Oxford, Oxford, UK.,University of Turku, Turku, Finland
| | - Eduard J Sanders
- Kenya Medical Research Institute - Wellcome Trust Research Programme, Kilifi, Kenya.,Department of Global Health, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.,Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Elise M van der Elst
- Kenya Medical Research Institute - Wellcome Trust Research Programme, Kilifi, Kenya.,Department of Global Health, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
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Black GF, Davies A, Iskander D, Chambers M. Reflections on the ethics of participatory visual methods to engage communities in global health research. Glob Bioeth 2017; 29:22-38. [PMID: 29434532 PMCID: PMC5800484 DOI: 10.1080/11287462.2017.1415722] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 12/07/2017] [Indexed: 11/18/2022] Open
Abstract
There is a growing body of literature describing conceptual frameworks for working with participatory visual methods (PVM). Through a global health lens, this paper examines some key themes within these frameworks. We reflect on our experiences of working with with an array of PVM to engage community members in Vietnam, Kenya, the Philippines and South Africa in biomedical research and public health. The participants that we have engaged in these processes live in under-resourced areas with high prevalence of communicable and non-communicable diseases. Our paper describes some of the challenges that we have encountered while using PVM to foster knowledge exchange, build relationships and facilitate change among individuals and families, community members, health workers, biomedical scientists and researchers. We consider multiple ethical situations that have arisen through our work and discuss the ways in which we have navigated and negotiated them. We offer our reflections and learning from facilitating these processes and in doing so we add novel contributions to ethical framework concepts.
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Affiliation(s)
- Gillian F Black
- Sustainable Livelihoods Foundation (SLF), Wynberg Cape Town, South Africa
| | - Alun Davies
- Kenya Medical Research Institute - Wellcome Trust Research Programme, Kilifi, Kilifi County, Kenya.,Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Dalia Iskander
- Department of Anthropology, University of Durham, Durham, UK
| | - Mary Chambers
- Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
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