Determining the feasibility of and approach to conducting an HIV assessment of men who have sex with men in Zambia
Background: Recent research has found that HIV prevalence is much higher among men who have sex with men (MSM) compared to other adult populations throughout the world, including developing countries. However, only a handful of HIV behavioral assessments for MSM have been conducted in Africa, and even fewer have assessed HIV prevalence, in order to better understand this underserved population. An obstacle is that MSM behavior continues to be illegal in most African nations, including Zambia. The purpose of this research was to determine the feasibility of safely and successfully assessing Zambian MSM.
Methods: Systematic formative research was conducted in 2006, including: literature reviews and internet searches; key informant interviews with government officials, non-government organization representatives, and the target population; and social venue observations. Information was gathered with standardized probes and forms for each part of the process. Key informant interviews were completed with 60 individuals from Lusaka, Livingstone, Mazabuka, and the Copperbelt Region. Six MSM social venues and other public locales were observed for potential recruitment.
Results: Information synthesis provided a summary of MSM in Zambia, including: historical context (e.g., MSM role in traditional society); MSM social networks (e.g., venue-based, school-based); possible access points (e.g., certain HIV testing sites); safety and confidentiality concerns; potential collaborators for assessment and program efforts (e.g., sympathetic referral sites); and requisite inclusion of local MSM in future assessment development and implementation. Informants generally agreed that MSM should be targeted for HIV assessment, although some people initially doubted the need to address this hard-to-reach population. Respondent-driven sampling was the consensus recruitment method (versus venue-based sampling) in order to maximize safety and confidentiality of participants, and to maintain low visibility of scarce and valued social venues.
Conclusions: It is feasible to securely access MSM in Zambia for HIV assessment, preferably through Respondent-Driven Sampling.
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