HIV Research with Men who Have Sex with Men (MSM): Advantages and Challenges of Different Methods for Most Appropriately Targeting a Key Population

This article discusses the advantages and challenges of conducting HIV research with men who have sex with men (MSM). It highlights the importance of accurate sampling methods in targeting the MSM population and their impact on surveillance systems. The article also explores the different methods used in HIV research, such as chain-referral sampling, venue-based sampling, respondent-driven sampling, time location sampling, and internet sampling. It provides insights into the benefits and limitations of each method and emphasizes the need for effective tools and techniques to target the MSM population in order to reduce the risk of HIV infection.

Public Health

Table of Contents
Title..................................................................................................................................................1
Introduction......................................................................................................................................1
Literature Review.............................................................................................................................2
Research Methodology....................................................................................................................3
Findings............................................................................................................................................6
References........................................................................................................................................7

Title
“HIV Research with Men who Have Sex with Men (MSM): Advantages and
Challenges of Different Methods for Most Appropriately Targeting a Key Population”.
Introduction
Human immunodeficiency virus is a major concern of public health worldwide. HIV is a
virus which effects the immune system and alters its functionality. Data provided by European
centre for disease prevention and control as well as WHO suggest that population of the country
is getting effected by HIV every other day. The changing lifestyles and complications of social
cultural sub groups are need to be considered in healthcare policies because of the evolution of
Acquired Immunodeficiency syndrome as a global threat (Inciardi, 2018). Populations like drug
users, female sex workers and men who have sex with men are at risk of acquiring and
transmitting HIV and other infectious diseases.
Globally, gay and other men who have sex with men are 27 times more likely to acquire
HIV than the general population. Some nations have progressive attitudes and policies regarding
homosexuality, lesbian, gay, bisexual, queer and transgender community. In some countries
where same-sex activity is legal, other laws discriminate against LGBTQ (lesbian, gay, bisexual,
transgender, queer) people and stigma and discrimination stop people from accessing HIV
services and can lead to risk-behaviours that drive transmission.
However, in general population, those men who had sex with other men are highly
effecting through HIV infections. There is a large concern about newly identified HIV epidemics
among population of men to men sex (MSM) in Asia, Africa and America in current past years.
Thus, occurrence of HIV infections in MSM of western world is increasing day by day. Recent
data suggests that around 25.6% of recently diagnosed HIV infections are caused due to sex
between men. The chances of HIV infections among MSM in Europe has increased by 27% in
last ten years. Heterosexual contact and injections drug users are more prone to such infections.
Biological vulnerability is the major cause of MSM to suffer from HIV infections. However,
regardless of biological vulnerability there are several others reasons for transmission of HIV
infections in MSM can also leads through high risk of sexual behaviours such as doing
unprotected sex and multiple and coexisting parters. Thus it is matter of concern for the country
to build measures for protecting population from such type of infectious diseases.
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Literature Review
As per views given by Ana Gama, Maria O. Martins and Sónia Dias (2017), HIV/AIDS
investigation aids in providing a deep knowledge of local epidemics which covers the reservoir
and all possible sources of infections over a period of time. It also includes the biological and
behavioural elements influencing the transmission. Such surveillance provide a solid bade for
evaluating and designing suitable interventions. A crucial components of public health
investigation is the representation of data of the population which are under study. The gay men
population which has high proportion of individuals having this disease tends to come in contact
with social and health care services. Such practitioners and health care providers report the
occurrence of disease which serves as a investigation mechanism.
HIV prevalence in gay men is so high in many countries which means that members of
this group have an chance of being exposed to the virus. This is mainly due to having
unprotected-sex. There are some factors that put in gay men at heightened risk of HIV. However,
it includes biological Factors which means that high vulnerability to HIV among this group is an
unprotected anal sex carries a higher risk of transmission than vaginal sex. This is because the
walls of anus are thin and more easily torn which results into creating an entry point for HIV into
the bloodstream. Meanwhile, gay men have experienced homophobic stigma, discrimination and
violence. Gay men have hide their identity and sexual orientation.
Having a sexually transmitted infection also makes more susceptible to HIV infection. As
a result, gay men who is suffering from HIV are living with an undiagnosed STI (sexually
transmitted disease) which may put them at higher risk of HIV. However, it is prevent by
condoms and lubricants, community empowerment, limit your number of sex partners, consider
pre-exposure prophylaxis, get tested for HIV, choose less risky sexual behaviours. Moreover,
PrEP is a pill taken everyday by HIV gay men, PEP (post exposure prophylaxis) is taken after
potential exposure to HIV.
It has been denoted that the daily available HIV investigation data's sources were from
patients having sexually transmitted diseases and pregnant women getting antenatal care.
Sometimes there is a deficiency of facility based data, in such cases general population survey of
public health is considered to obtain authenticate data of HIV investigation. But this practice is
very costly and thus survey based investigation, where the status of health, common symptoms
as well as related behaviour of gay men population is surveillance. When the data has been
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compared, population based survey provided more data about gay men behaviour investigation
acquired in developing countries with respect to HIV/AIDS.
Moreover, the probability sampling is much more preferred method for investigation
when it come in terms of scientific study. In probability sampling, all the components of sample
are randomly chosen from a known frame of sample. Such investigation method targets most
easily and generally approachable population, but due to some causes it can only get access of
small group of population which categorise as sub groups. To achieve a efficient study, it is very
important to focus on such segments of gay men population which play vital role in transmitting
HIV from men to men. The HIV and behaviour status of missed and covered population by
conventional investigation efforts can be different (Myrick, 2016). Therefore, there is a huge and
potential hazard of failing surveillance data to obtain prime causes of infection that may result in
the transmission of HIV if it not controlled. More precisely, by determining the occurrence of
HIV and behaviour over a period of time in gay men population is crucial in implementing and
planning precise, targeted and effective preventive programmes to lower the number of HIV
patients in gay men population.
Research Methodology
As mentioned widely, simple random method of sampling is most valued when observed
from statistical point of view, but when applied in vulnerable population it may be less
convenient, highly expensive and impossible approach. Simultaneously, for high risk population
different method like non probabilistic approach is used frequently. In last decades, it has been
observed that all HIV investigation studies were based on non probability approach like chain
referral sampling. Such approaches based on assumed work, where peers has more ability to
involve members of masked population than the investigators.
Chain-referral and Venue-based Sampling Methods
As acknowledged, Snowball sampling also known as chain referral sampling is
considered to be one of the most widely used approach, which is efficient and productive in
sensitive issues. This involves selecting members of a specific and extraordinary population.
This method focuses on identifying a small group of unit from whom suitable data and
informations are collected, these individuals then assist in identifying other members which will
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be included in the process of sampling. Snowball sampling requires less time and cost to
assemble large group of people, but meanwhile it lacks in validity and is bias towards sampling.
Another type of sampling is venue based sampling, which involve in recruiting samples
in various places and at times where the population is gathered intentionally or reasonably. The
venues are generally considered those where gay men are gathered, so that the sampling can be
comprehensive and validated. Venue based sampling is a very convenient method to obtain
population without depending on members and participants connections, but this method lacks to
obtain accurate information about target and it sometimes demands to get access at few venues
which are not easily accessible for sampling. Due to their demerits, any one approach is not
sufficient to gather relevant information about behavioural and biological status of gay men in
sub group and selected population. Thus, combination of methods have been used for reaching
and accessing data from vulnerable population.
Respondent driven sampling method
Additionally, Respondent driven sampling method have also been designed specifically
to avoid biases related to chain referral and venue based method. This method have been widely
applied to more than 120 studies. For investigating high risked and vulnerable population of
HIV/AIDS in gay men is investigated by this approach, where sex workers and drug users are
injected in many countries. Respondent driven sampling method has been particularly used by
U.S Centre For Disease Control and Prevention to trace the epidemic of HIV and render data for
making decisions in public health. This method when applied always create unbiased estimation
for the high risk population. This method not only provide greater validity but also collect data
statistically which is easy to conclude. On the other hand, it has its own disadvantages which
includes recruitment ineffectiveness and homophily as some other groups are more participatory
than others in recruiting and individuals having similar characteristics are more recruited creating
homophily (Hergenrather and et. al., 2016). Another problem associated with respondent driven
sampling method is the large amount of time taken to collect sample from large population to
ensure statistical data entry.
Time location sampling
Time location sampling (TLS) is the another approach which has been considering in
recent years. TLS is a venue-based method which is used for sampling of population, especially
population of sex between men and have an advantage that such populations tend to gather at
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specific locations. Population of MSM (gays) usually gather at commercials and non commercial
venues such as gay bars and drift areas which is primarily known to attract gays. In TLS method,
such locations are mentioned in maps or in through some some formative research exercises. The
method involves methods for identifying dates and time at which such populations gather into
these specific locations. Data collection is done either through all or from a sample of sub group
members of MSM at that particular site. Sampling weight is provided by number of members
present at such specific locations. However, TLS is sometimes recognised as probability
sampling method.
TLS method is proved to be more efficient over other sampling methods because it has a
ability to provide information about a fact that gays are not only associated with specific
locations, and move at multiple location during course of a single day. Thus, TLS provide
statistical and proper information to the researchers to construct a sample with known properties.
In a HIV biological survey which was implemented in nine European countries, TLS
provide a sample of around 3,661 MSM which was collected through private and public
locations, considering commercial venues such as discs, pubs, bars, cafes etc. as well as non-
commercial venues like events. Thus, sampling framed were constructed in order to identify at-
risk population of gays suffering from HIV infections (Murphy and et. al., 2016). Thus it helps in
to identify sexual risk behavioural patterns and knowledge of statical data in a population.
However, this method has some limitations that it sometimes misses some important
locations which are need to be taken into account for sampling. Venues and locations of gay
gatherings change over time.
Internet sampling
Internet is being widely used by MSM to search online partners. Thus internet is also
providing methods for recruiting MSM in HIV research. There are number of advantages of this
method such as faster sampling, lower cost of operations and high level of anonymity which
helps to catch more MSM partners without disclosing their sexual status (Ferlatte and et. al.,
2017). In comparison to TLS, it is more advanced and good method. Current studies shows that
internet sampling method have reached to around 225,320 participants compare to TLS sampling
method who have just reached to 55,193 participants. Internet sampling method reaches to higher
number of respondents. European MSM internet survey has a strength that it reach to the highest
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and most geographical data set to analyse the country level stigma and methods through which it
helps in to reduce the risks of HIV infections.
However there are some limitations to this method that it does reach to only participants
that access to internet. It has a biased selection process. Thus, due to these limitations outcomes
of sampling will be difficult to predict the risk factors in MSM.
Findings
Considering the above investigation, it has been analysed that it is very essential to gain
understanding about epidemics of HIV (AIDS) and high surveillance systems. It is observed that
accurate methods of sampling can be consider at the core of any surveillance systems with high
quality for carrying out track transmission dynamics among select populations. However, it is
evaluated that it is a global challenge to identify the target group in society and hard to reach
MSM subgroup. It is very important to determine the group them only specific laws and
government bodies can take effective actions against them for reducing the risk of occurring HIV
infection.
On the other hand, it has been identified that effective methods were used in this study
which reflects the best efforts to find out the respondents belongs to MSM subgroup. These
effective methods of sampling are favourable as it contribute for gaining unbiased trends of HIV
prevalence along with relevant risk behaviours between the selected target population.
Meanwhile, it has been analysed that relevant benefits as well as limitations were also discussed
in this study of use sampling approaches for gaining better research outcomes. It is observed that
community based participatory approach can be consider to be supportive in terms of helping to
select effective tools and technique in order to target MSM in appropriate manner.
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References
Books and journals
Inciardi, J., 2018. Sex, drugs, and HIV/AIDS in Brazil. Routledge.
Myrick, R., 2016. AIDS, communication, and empowerment: Gay male identity and the politics
of public health messages. Routledge.
Hergenrather, K.C. and et. al., 2016. Enhancing HIV prevention among young men who have
sex with men: A systematic review of HIV behavioral interventions for young gay and
bisexual men. AIDS Education and Prevention, 28(3), pp.252-271.
Murphy, P.J. and et. al., 2016. Serostatus disclosure, stigma resistance, and identity management
among HIV-positive gay men in Ireland. Qualitative health research, 26(11), pp.1459-
1472.
Ferlatte, O. and et. al., 2017. Stigma and suicide among gay and bisexual men living with
HIV. AIDS care, 29(11), pp.1346-1350.
Online
Gama A., Martins M. O. and Dias S., 2017. HIV Research with Men who Have Sex with Men
(MSM): Advantages and Challenges of Different Methods for Most Appropriately
Targeting a Key Population. [Online]. Available
through:<https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5690451/#b18>
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