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

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Abstract

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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References

  1. Johnson LF, Rehle TM, Jooste S, Bekker LG. Rates of HIV testing and diagnosis in South Africa: Successes and challenges. Aids. 2015;29(11):1401–9.

    Article  Google Scholar 

  2. Cornell M, Schomaker M, Garone DB, Giddy J, Hoffmann CJ, Lessells R, Egger M, Maskew M, Prozesky H, Wood R, Johnson LF, Egger M, Boulle A, Myer L. Gender differences in survival among adult patients starting antiretroviral therapy in South Africa: A multicentre cohort study. PLoS Med. 2012;9(9):e1001304.

    Article  CAS  Google Scholar 

  3. Lurie MN, Kirwa K, Callaway J, Cornell M, Boulle A, Bengtson AM, Smith M, Leon N, Colvin C. Quantifying the HIV treatment cascade in a South African health sub-district by gender: Retrospective cohort study. Trop Med Int Health. 2020;25(2):186–92.

    Article  CAS  Google Scholar 

  4. Barker G, Ricardo C, Nascimento M, World Health Organization. Engaging men and boys in changing gender-based inequity in health: Evidence from programme interventions. World Health Organization; 2007

  5. Adeyeye AO, Stirratt MJ, Burns DN. Engaging men in HIV treatment and prevention. Lancet (London, England). 2018;392(10162):2334.

    Article  Google Scholar 

  6. Sternberg P, Hubley J. Evaluating men’s involvement as a strategy in sexual and reproductive health promotion. Health Promot Int. 2004;19(3):389–96.

    Article  Google Scholar 

  7. Aluisio A, Richardson BA, Bosire R, John-Stewart G, Mbori-Ngacha D, Farquhar C. Male antenatal attendance and HIV testing are associated with decreased infant HIV infection and increased HIV free survival (1999). JAIDS. 2011;56(1):76.

    PubMed  Google Scholar 

  8. Barker G, Ricardo C, Nascimento M, Olukoya A, Santos C. Questioning gender norms with men to improve health outcomes: Evidence of impact. Global Public Health. 2010;5(5):539–53.

    Article  CAS  Google Scholar 

  9. Ladur AN, Colvin CJ, Stinson K. Perceptions of community members and healthcare workers on male involvement in prevention of mother-to-child transmission services in Khayelitsha, Cape Town South Africa. PloS One. 2015;10(7):e0133239.

    Article  Google Scholar 

  10. Cheng CY, Quaife M, Eakle R, Escobar MAC, Vickerman P, Terris-Prestholt F. Determinants of heterosexual men’s demand for long-acting injectable pre-exposure prophylaxis (PrEP) for HIV in urban South Africa. BMC Public Health. 2019;19(1):996.

    Article  Google Scholar 

  11. Makusha T, van Rooyen H, Cornell M. Reframing the approach to heterosexual men in the HIV epidemic in sub-Saharan Africa. J Int AIDS Soc. 2020. https://doi.org/10.1002/jia2.25510.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Mindry D, Wanyenze RK, Beyeza-Kashesya J, Woldetsadik MA, Finocchario-Kessler S, Goggin K, Wagner G. Safer conception for couples affected by HIV: Structural and cultural considerations in the delivery of safer conception Care in Uganda. AIDS Behav. 2017;21(8):2488–96.

    Article  Google Scholar 

  13. Mbokazi N, Madzima R, Leon N, Lurie MN, Cornell M, Schmidt BM, Colvin CJ. Health worker experiences of and perspectives on engaging men in HIV care: A qualitative study in Cape Town, South Africa. JIAPAC. 2020;19:2325958220935691.

    PubMed  PubMed Central  Google Scholar 

  14. Bor J, Rosen S, Chimbindi N, Haber N, Herbst K, Mutevedzi T, Tanser F, Pillay D, Baernighausen T. Mass HIV treatment and sex disparities in life expectancy: Demographic surveillance in rural South Africa. PLoS Med. 2015. https://doi.org/10.1371/journal.pmed.1001905.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Matthews LT, Smit JA, Moore L, Milford C, Greener R, Mosery FN, Psaros C, Safren SA, Bangsberg DR. Periconception HIV risk behavior among men and women reporting HIV-serodiscordant partners in KwaZulu-Natal South Africa. AIDS Behav. 2015;19(12):2291–303.

    Article  CAS  Google Scholar 

  16. Bhatia DS, Harrison AD, Kubeka M, Milford C, Kaida A, Bajunirwe F, Wilson IB, Psaros C, Safren SA, Bangsberg DR, Smit JA, Matthews LT. The role of relationship dynamics and gender inequalities as barriers to HIV-serostatus disclosure: Qualitative study among women and men living with HIV in Durban South Africa. Front Public Health. 2017;5:188.

    Article  Google Scholar 

  17. Khidir H, Psaros C, Greener L, O’Neil K, Mathenjwa M, Mosery FN, Safren SA, Matthews LT. Developing a safer conception intervention for men living with HIV in South Africa. AIDS Behav. 2018;22(6):1725–35.

    Article  Google Scholar 

  18. Simbayi LC, Kalichman SC, Strebel A, Cloete A, Henda N, Mqeketo A. Disclosure of HIV status to sex partners and sexual risk behaviours among HIV-positive men and women, Cape Town South Africa. Sex Transm Infect. 2007;83(1):29–34.

    Article  CAS  Google Scholar 

  19. Roxo U, Mobula ML, Walker D, Ficht A, Yeiser S. Prioritizing the sexual and reproductive health and rights of adolescent girls and young women within HIV treatment and care services in emergency settings: A girl-centered agenda. Reproductive health. 2019;16(1):57.

    Article  Google Scholar 

  20. Snelling D, Walter Rasugu Omariba D, Hong S, Georgiades K, Racine Y, Boyle MH. HIV/AIDS knowledge, women’s education, epidemic severity and protective sexual behaviour in low-and middle-income countries. J Biosoc Sci. 2007;39(3):421.

    Article  Google Scholar 

  21. Hindin MJ, Muntifering CJ. Women’s autonomy and timing of most recent sexual intercourse in Sub-Saharan Africa: A multi-country analysis. J Sex Res. 2011;48(6):511–9.

    Article  Google Scholar 

  22. Redfield RR, Modi S, Moore CA, Delaney A, Honein MA, Tomlinson HL. Health care autonomy of women living with HIV. N Engl J Med. 2019;381(9):798–800.

    Article  Google Scholar 

  23. Hatcher AM, Tsai AC, Kumbakumba E, Dworkin SL, Hunt PW, Martin JN, Gina C, Bangsberg DR, Weiser SD. Sexual relationship power and depression among HIV-infected women in rural Uganda. PloS One. 2012. https://doi.org/10.1371/journal.pone.0049821.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Khidir H, Mosery N, Greener R, Milford C, Bennett K, Kaida A, Psaros C, Safren SA, Bangsberg DR, Smit JA, Matthews LT. Sexual relationship power and periconception HIV-risk behavior among HIV-infected men in serodifferent relationships. AIDS Behav. 2020;24(3):881–90.

    Article  Google Scholar 

  25. Becker S, Mlay R, Schwandt HM, Lyamuya E. Comparing couples’ and individual voluntary counseling and testing for HIV at antenatal clinics in Tanzania: A randomized trial. AIDS Behav. 2010;14(3):558–66.

    Article  Google Scholar 

  26. Johnson M, Darbes LA, Hosegood V, Ngubane T, Johnson MO, Fritz K, McGrath N. Uthando Lwethu (‘our love’): A protocol for a couples-based intervention to increase testing for HIV: A randomized controlled trial in rural KwaZulu-Natal, South Africa; 2014.

  27. Venkatesh KK, Flanigan TP, Mayer KH. Is expanded HIV treatment preventing new infections? Impact of antiretroviral therapy on sexual risk behaviors in the developing world. AIDS. 2011;25(16):1939–49.

    Article  Google Scholar 

  28. Marks G, Crepaz N, Senterfitt JW, Janssen RS. Meta-analysis of high-risk sexual behavior in persons aware and unaware they are infected with HIV in the United States: Implications for HIV prevention programs. JAIDS. 2005;39(4):446–53.

    PubMed  Google Scholar 

  29. Allen S, Meinzen-Derr J, Kautzman M, Zulu I, Trask S, Fideli U, Musonda R, Kasolo F, Gao F, Haworth A. Sexual behavior of HIV discordant couples after HIV counseling and testing. AIDS. 2003;17(5):733–40.

    Article  Google Scholar 

  30. Department of Health, Republic of South Africa. National HIV counselling and testing policy guidelines; 2015.

  31. Fenton KA, Peterman TA. HIV partner notification: Taking a new look. AIDS. 1997;11(13):1535–46.

    Article  CAS  Google Scholar 

  32. Davis J, Luchters S, Holmes W. Men and maternal and newborn health: Benefits, harms, challenges and potential strategies for engaging men. Melbourne: Compass Women’s and Children’s Health Knowledge Hub; 2012.

    Google Scholar 

  33. Richter L, Morrel, R. Baba: Men and fatherhood in South Africa. HSRC Press; 2006.

  34. Matthews LT, Crankshaw T, Giddy J, Kaida A, Smit JA, Ware NC, Bangsberg DR. Reproductive decision-making and periconception practices among HIV-positive men and women attending HIV services in Durban South Africa. AIDS Behav. 2013;17(2):461–70.

    Article  Google Scholar 

  35. Peacock D. South Africa’s Sonke gender justice network: Educating men for gender equality. Agenda. 2013;27(1):128–40.

    Article  Google Scholar 

  36. Magni S, Hatcher A, Wamoyi J, Christofides N. Predictors and patterns of transactional sex with casual partners among adult men living in an informal urban area South Africa. AIDS Behav. 2020;24(9):2616–23.

    Article  Google Scholar 

  37. Okoror TA, Falade CO, Walker EM, Olorunlana A, Anaele A. Social context surrounding HIV diagnosis and construction of masculinity: A qualitative study of stigma experiences of heterosexual HIV positive men in southwest Nigeria. BMC Public Health. 2016;16(1):507.

    Article  Google Scholar 

  38. Bashir F, Ba Wazir M, Schumann B, Lindvall K. The realities of HIV prevention. A closer look at facilitators and challenges faced by HIV prevention programmes in Sudan and Yemen. Global Health Action. 2019;12(1):1659098.

    Article  Google Scholar 

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Acknowledgements

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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Authors and Affiliations

  1. Division of Infectious Disease, University of Alabama at Birmingham, 212 Zeigler Research Building, 1720 2nd Avenue South, Birmingham, AL, 35294, USA

    Hussain A. Zaidi, Kasey O’Neil & Lynn T. Matthews

  2. Lang Center for Social and Civic Responsibility, Swarthmore College, Swarthmore, PA, USA

    Hussain A. Zaidi

  3. MatCH Research Unit (MRU), Department of Obstetrics and Gynaecology, University of the Witwatersrand, Durban, KwaZulu-Natal, South Africa

    Mxolisi Mathenjwa, Nzwakie Mosery & Jennifer A. Smit

  4. Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA

    Sadath A. Sayeed

  5. Boston Children’s Hospital, Boston, MA, USA

    Sadath A. Sayeed

  6. Harvard Medical School, Boston, MA, USA

    Christina Psaros, Hazar Khidir & David R. Bangsberg

  7. Department of Psychology, University of Miami, Miami, FL, USA

    Steven A. Safren

  8. Department of Internal Medicine, Brigham and Women’s Hospital, Boston, MA, USA

    Pooja Chitneni

Authors
  1. Hussain A. Zaidi
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  2. Mxolisi Mathenjwa
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  3. Nzwakie Mosery
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  4. Kasey O’Neil
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  6. Christina Psaros
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  7. Hazar Khidir
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  8. Steven A. Safren
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  9. David R. Bangsberg
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  10. Sadath A. Sayeed
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  11. Jennifer A. Smit
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  12. Lynn T. Matthews
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Contributions

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.

Corresponding author

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 25, 4055–4060 (2021). https://doi.org/10.1007/s10461-021-03185-0

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