Grant: Fellowship - PA: Health Services/Population Health HIV/AIDS Research

In many regions of the world, HIV first emerged among populations of men who have sex with men (MSM). More than a quarter-century later and in an increasingly broad range of countries, contexts and development levels, male-to-male sexual contact remains an important route of HIV transmission. Men who haves sex with men is a technical phrase intended to be less stigmatizing than culturally bound terms such as gay, bisexual, or homosexual. It describes same-sex behaviors between men rather than identities, orientations, or cultural categories. Therefore, the term MSM includes gay men, bisexuals, MSM who do not identify as gay or bisexual despite their behaviors, male sex workers, transgendered people, and a range of culture- and country-specific populations of MSM. Research among MSM in low- and middle-income countries has been limited by the criminalization and social stigmatization of their behavior, safety considerations for study participants, the hidden nature of this population, and lack of targeted funding. Thus, most available data evaluating determinants of HIV risk among MSM are derived from high-income countries. Data regarding MSM in Africa are the sparsest in the world, but are beginning to emerge. We recently completed the first study to evaluate HIV risk status of MSM in Malawi and demonstrated that MSM are a high-risk group for HIV infection and human rights abuses. In response to this, we are proposing a pre-intervention study of the potential utility of combined biomedical and behavioral HIV prevention strategies for MSM in Malawi. This work would use both quantitative and qualitative methods to better characterize which HIV prevention strategies are most likely to work for MSM in Malawi. The results of this study are vital to inform future clinical trials of HIV prevention strategies as well as being used when advocating for the targeted allocation of HIV prevention expenditures based on evidence-based need for MSM in Malawi.