Peer support benefits MSM in Malawi

Feasibility of a combination HIV prevention program for men who have sex with men in Blantyre, Malawi.

Wirtz AL, Trapence G, Jumbe V, Umar E, Ketende S, Kamba D, Berry M, Stromdahl S, Beyrer C, Muula AS, Baral S. J Acquir Immune Defic Syndr. 2015 Oct 1;70(2):155-62. doi: 10.1097/QAI.0000000000000693.

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.

Abstract access [1]

Editor’s notes: Gay men and other men who have sex with men are a key, difficult-to-reach population in many parts of sub-Saharan Africa. Stigma and criminalization of same-sex practices cause many challenges in improving access to HIV prevention and treatment services. This study tested the feasibility of a combination HIV prevention programme for gay men and other men who have sex with men in Malawi. The programme worked at three levels. At the individual level peer educators provided outreach to increase use of condoms, lubricants and other prevention methods. The health sector level provided training for doctors and nurses, to improve access to services. The community level built capacity to advocate in national HIV strategies and support decriminalisation of homosexuality. Study participants were identified by respondent-driven sampling. Retention was very high in the cohort, and over 16 months, participants reported improved behaviour-associated outcomes. This study was implemented by a community-based organisation and peer educators, and used several methods to protect participant confidentiality and privacy which can be adopted by others working in stigmatising settings. Overall, the study demonstrates that HIV prevention programmes for gay men and other men who have sex with men can be implemented if security measures and awareness of the social and political situation are well maintained.  

Africa [6]
Malawi [7]
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