How to reach men who have sex with men about HIV prevention and treatment

Tanzanian researchers listed the pros and cons for different ways to reach and inform men who have sex with men (MSM) about HIV services in a 2018 study. In doing so, they can identify what works best to communicate information about HIV in this community. 

The number of HIV cases is higher in MSM than in other men, and researchers think it might be because of the social stigma, or disapproval, around MSM that prevents these men from seeking HIV services. A solution to this could be finding better ways to spread information about HIV in these communities. 

The researchers wanted to look at how existing HIV programmes convince MSM in sub-Saharan Africa to share HIV information in their communities. They wanted to see which of these strategies were lacking, and which were best, in reaching, informing and delivering HIV services to MSM. 

They gathered all the studies that were related to HIV prevention in MSM in sub-Saharan Africa, from 2007 to 2017. Then, they did  a “systematic review” of the studies, which is an established scientific method whereby researchers collect information about a topic from different peer-reviewed articles published on that topic. 

The researchers found 2627 studies on the topic, but only 15  of those met their criteria for reviewing.

These 15 papers described a few ways to reach MSM, including “respondent-driven sampling”, which means getting MSM to recruit more MSM. In this regard, researchers also noted that community-based organisations use MSM outreach workers to find more MSM, and social media or MSM hotspots may be useful. But finding these hotspots may be difficult, and not all MSM use social media.

Popular ways to deliver HIV information included virtual, community-based and facility-based (at healthcare sites). They found that “peer-led outreach”, which is communication and recruitment through friends, was the most successful because MSM felt more comfortable. 

The researchers said their conclusions must be interpreted with caution because they don’t know if their listed approaches work well, and they didn’t include non-English studies. 

They suggested that more HIV information and services should be available to MSM at healthcare sites, and that the stigma around MSM communities should be reduced so that they feel more comfortable to seek medical care. 

The researchers hoped that by knowing how to effectively educate MSM about HIV prevention and treatment, services for this community in sub-Saharan Africa will improve.

The authors of this paper were from Tanzania.

Abstract

Across sub-Saharan Africa (SSA), HIV disproportionately affects men who have sex with men (MSM) compared with other men of the same age group in the general population. Access to HIV services remains low among this group although several effective interventions have been documented. It is therefore important to identify what has worked well to increase the reach of HIV services among MSM. We searched MEDLINE, POPLINE and the Web of Science databases to collect published articles reporting HIV interventions among MSM across sub-Saharan Africa. Covidence was used to review the articles. The review protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO) - CRD42017060808.

The search identified 2627 citations, and following removal of duplicates and inclusion and exclusion criteria, only 15 papers were eligible for inclusion in the review. The articles reported various accrual strategies, namely: respondent-driven sampling, known peers identified through hotspot or baseline surveys, engagement with existing community-based organizations, and through peer educators contacting MSM in virtual sites. Some programs, however, combined some of these accrual strategies. Peer-led outreach services were indicated to reach and deliver services to more MSM. A combination of peer outreach and mobile clinics increased uptake of health information and services. Health facilities, especially MSM-friendly facilities attract access and use of services by MSM and retention into care.

There are various strategies for accrual and delivering services to MSM across SSA. However, each of these strategies have specific strengths and weaknesses necessitating combinations of interventions and integration of the specific context to inform implementation. If the best of intervention content and implementation are used to inform these services, sufficient coverage and impact of HIV prevention and treatment programs for MSM across SSA can be optimized.

Keywords: HIV intervention, Accrual, Delivery, Men who have sex with men, sub-Saharan Africa

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