Andrea L Wirtz1, Gift Trapence, Vincent Jumbe, Eric Umar, Sosthenes Ketende, Dunker Kamba, Mark Berry, Susanne Strömdahl, Chris Beyrer, Adamson S Muula, Stefan Baral. 1. *Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; †Department of Emergency Medicine, Johns Hopkins Medical Institute, Baltimore, MD; ‡Center for the Development of People, Blantyre, Malawi; §Department of Health Systems and Policy Development, School of Public Health and Family Medicine, University of Malawi College of Medicine, Blantyre, Malawi; and ‖Centre for Global Health, Trinity College, Dublin, Ireland.
Abstract
INTRODUCTION: The use of combination HIV prevention interventions (CHPI) now represent the standard of care to minimize HIV acquisition risks among men who have sex with men (MSM). There has been limited evaluation of these approaches in generalized HIV epidemics and/or where MSM are stigmatized. A peer-based CHPI program to target individual, social, and structural risks for HIV was developed for MSM in Blantyre, Malawi. METHODS: To test the feasibility of CHPI, adult MSM were followed prospectively from January 2012 to May 2013. Participants (N = 103) completed sociobehavioral surveys and HIV testing at each of the 3 follow-up study visits. RESULTS: Approximately 90% of participants attended each study visit and 93.2% (n = 96) completed the final visit. Participants met with peer educators a median of 3 times (range: 1-10) in the follow-up visits 2 and 3. Condom use at last sex improved from baseline through follow-up visit 3 with main (baseline: 62.5%, follow-up 3: 77.0%; P = 0.02) and casual male partners (baseline: 70.7%, follow-up 3: 86.3%; P = 0.01). Disclosure of sexual behaviors/orientation to family increased from 25% in follow-up 1 to 55% in follow-up 3 (P < 0.01). DISCUSSION: Participants maintained a high level of retention in the study highlighting the feasibility of leveraging community-based organizations to recruit and retain MSM in HIV prevention and treatment interventions in stigmatizing settings. Group-level changes in sexual behavior and disclosure in safe settings for MSM were noted. CHPI may represent a useful model to providing access to other HIV prevention for MSM and aiding retention in care and treatment services for MSM living with HIV in challenging environments.
INTRODUCTION: The use of combination HIV prevention interventions (CHPI) now represent the standard of care to minimize HIV acquisition risks among men who have sex with men (MSM). There has been limited evaluation of these approaches in generalized HIV epidemics and/or where MSM are stigmatized. A peer-based CHPI program to target individual, social, and structural risks for HIV was developed for MSM in Blantyre, Malawi. METHODS: To test the feasibility of CHPI, adult MSM were followed prospectively from January 2012 to May 2013. Participants (N = 103) completed sociobehavioral surveys and HIV testing at each of the 3 follow-up study visits. RESULTS: Approximately 90% of participants attended each study visit and 93.2% (n = 96) completed the final visit. Participants met with peer educators a median of 3 times (range: 1-10) in the follow-up visits 2 and 3. Condom use at last sex improved from baseline through follow-up visit 3 with main (baseline: 62.5%, follow-up 3: 77.0%; P = 0.02) and casual male partners (baseline: 70.7%, follow-up 3: 86.3%; P = 0.01). Disclosure of sexual behaviors/orientation to family increased from 25% in follow-up 1 to 55% in follow-up 3 (P < 0.01). DISCUSSION: Participants maintained a high level of retention in the study highlighting the feasibility of leveraging community-based organizations to recruit and retain MSM in HIV prevention and treatment interventions in stigmatizing settings. Group-level changes in sexual behavior and disclosure in safe settings for MSM were noted. CHPI may represent a useful model to providing access to other HIV prevention for MSM and aiding retention in care and treatment services for MSM living with HIV in challenging environments.
Authors: Theo Lorenc; Isaac Marrero-Guillamón; Peter Aggleton; Chris Cooper; Alexis Llewellyn; Angela Lehmann; Catriona Lindsay Journal: Sex Transm Infect Date: 2011-03-25 Impact factor: 3.519
Authors: Laetitia C Rispel; Carol A Metcalf; Allanise Cloete; Julia Moorman; Vasu Reddy Journal: J Public Health Policy Date: 2011 Impact factor: 2.222
Authors: Chris Beyrer; Stefan D Baral; Frits van Griensven; Steven M Goodreau; Suwat Chariyalertsak; Andrea L Wirtz; Ron Brookmeyer Journal: Lancet Date: 2012-07-20 Impact factor: 79.321
Authors: Mark Berry; Andrea L Wirtz; Assel Janayeva; Valentina Ragoza; Assel Terlikbayeva; Bauyrzhan Amirov; Stefan Baral; Chris Beyrer Journal: PLoS One Date: 2012-08-24 Impact factor: 3.240
Authors: Stefan Baral; Gift Trapence; Felistus Motimedi; Eric Umar; Scholastika Iipinge; Friedel Dausab; Chris Beyrer Journal: PLoS One Date: 2009-03-26 Impact factor: 3.240
Authors: Caitlin E Kennedy; Stefan D Baral; Rebecca Fielding-Miller; Darrin Adams; Phumlile Dludlu; Bheki Sithole; Virginia A Fonner; Zandile Mnisi; Deanna Kerrigan Journal: J Int AIDS Soc Date: 2013-12-02 Impact factor: 5.396
Authors: Elise M van der Elst; Adrian D Smith; Evanson Gichuru; Elizabeth Wahome; Helgar Musyoki; Nicolas Muraguri; Greg Fegan; Zoe Duby; Linda-Gail Bekker; Bonnie Bender; Susan M Graham; Don Operario; Eduard J Sanders Journal: J Int AIDS Soc Date: 2013-12-02 Impact factor: 5.396
Authors: Andrea L Wirtz; Soe Naing; Emily Clouse; Kaung Htet Thu; Sandra Hsu Hnin Mon; Zin Min Tun; Stefan Baral; Aung Zayar Paing; Chris Beyrer Journal: JMIR Res Protoc Date: 2017-05-17
Authors: Daniel Nyato; Evodius Kuringe; Mary Drake; Caterina Casalini; Soori Nnko; Amani Shao; Albert Komba; Stefan D Baral; Mwita Wambura; John Changalucha Journal: BMC Public Health Date: 2018-03-20 Impact factor: 3.295
Authors: Michael E Herce; William M Miller; Agatha Bula; Jessie K Edwards; Pedro Sapalalo; Kathryn E Lancaster; Innocent Mofolo; Maria Lúcia M Furtado; Sharon S Weir Journal: J Int AIDS Soc Date: 2018-07 Impact factor: 5.396
Authors: Blessing O Kayode; Andrew Mitchell; Nicaise Ndembi; Afoke Kokogho; Habib O Ramadhani; Sylvia Adebajo; Merlin L Robb; Stefan D Baral; Julie A Ake; Manhattan E Charurat; Trevor A Crowell; Rebecca G Nowak Journal: J Int AIDS Soc Date: 2020-10 Impact factor: 5.396