Overcoming Ethical Challenges to Engaging Men Who Have Sex with Women in HIV Research


Men who have sex with women are understudied in HIV research despite the extent to which they experience HIV-related mortality and contribute to the epidemic among women. During our experience of developing and piloting an HIV prevention intervention for men living with HIV in South Africa, and planning to have a child with an HIV-negative woman, ethical questions were posed regarding implementation of a male-centered intervention that did not require female partner participation. Two overarching ethical issues were the potential for (1) compromising women's reproductive and sexual autonomy and (2) increasing HIV-acquisition risks for the woman because the intervention efficacy was unknown. We describe here how these concerns were addressed to facilitate development of a male-centered HIV-prevention intervention. We hope this process manuscript will support researchers, clinicians, and reviewers to engage men who have sex with women in HIV prevention and care.

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We thank the participants and their families for their time and the research staff for their dedication to this project. The work described was supported by a grant from the National Institute of Mental Health (R34MH100948). Dr. Safren is supported by 1P30MH116867 and 9K24DA040489. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Mental Health, The National Institute of Drug Abuse, or the National Institutes of Health.

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Zaidi and Sayeed drafted, edited and approved the final manuscript. Matthews conceptualized, drafted, edited and approved the final manuscript. O'Neil conceptualized, edited and approved the final manuscript. All other authors participated in discussions regarding the ethical approach, edited, and approved the final manuscript.

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Correspondence to Lynn T. Matthews.

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Zaidi, H.A., Mathenjwa, M., Mosery, N. et al. Overcoming Ethical Challenges to Engaging Men Who Have Sex with Women in HIV Research. AIDS Behav (2021). https://doi.org/10.1007/s10461-021-03185-0

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  • Ethics
  • HIV
  • Engaging men
  • Reproductive health
  • Couples