by M Chaponda, K MacQueen, N Mack, A Bullah, C Salima, H Daitoni, D Kwaitana, D Chiwanda, S Mbera, D Chilongozi, F Martinson, I Hoffman
Objectives: Interventions to prevent the transmission of HIV among men and women with high risk behavior are urgently needed. Pre-exposure prophylaxis, such as the once-daily use of oral antiretrovirals, may be an effective mechanism to prevent acquisition of HIV. Determining whether this mechanism works will require identifying people at high risk for HIV, in this case men, who can be appropriately and effectively enrolled in HIV prevention trials.
Methods: Observations were conducted at High Transmission Areas in Lilongwe, Malawi, and evaluated for their potential as recruitment sites for high risk men. High risk men were defined as meeting at least one of three criteria: (1) sex with sex worker/bar girl in last 3 months, (2) sex with 2 or more women in last 3 months, (3) STD in last three months. In-depth interviews and focus groups were conducted to explore the ethical and practical feasibility of recruiting men with multiple sexual partners into a pre-exposure prophylaxis HIV prevention trial.
Results: Eighteen potentially High Transmission Area sites were identified as suitable for recruiting high risk men. Men with multiple sexual partners varied with regard to socio-economic status, residential stability, HIV/AIDS knowledge, and ability to distinguish research from prevention goals. This variability was patterned such that men who were similar along several dimensions tended to cluster in particular settings such as hotels, clubs, and delimited neighborhoods. Men supported the conduct of HIV prevention trials in the community to evaluate pre-exposure prophylaxis.
Conclusions: Social analysis is useful for identifying clusters of men with multiple sexual partners who are interested in participating in HIV prevention trials in Lilongwe and who would be appropriate for enrollment in such trials.
Recommendations: The identification, recruitment and enrollment of men for HIV prevention trials of pre-exposure prophylaxis is likely to be successful.