Experience consistently shows that better collaboration is needed between researchers and community-based organizations (CBOs) around studies of HIV treatment and prevention interventions involving gay men and other men who have sex with men (MSM). This is, especially true in resource-constrained settings. In addition, working with MSM in these contexts presents unique challenges from the often prevalent stigma, discrimination, and security concerns.
To meet this ongoing need, a group led by amfAR, The Foundation for AIDS Research; the International AIDS Vaccine Initiative (IAVI); the John Hopkins University - Center for Public Health and Human Rights (JHU-CPHHR); and the United Nations Development Program (UNDP) has updated important guidance to help researchers and CBOs maximize the benefits and minimize any potential risks of working together on this critically needed research.
The revised "Respect, Protect, Fulfill" will be released on 28 November, at the Key Populations Pre-conference of the 18th International Conference on HIV/AIDS and other STIs in Africa (ICASA), which takes place in Harare, Zimbabwe, from 29 November through 4 December 2015.
First released during the 16th ICASA Conference in Addis Ababa, Ethiopia, in 2011, the document offers practical advice on how best to engage MSM in epidemiologic studies and intervention research, including HIV prevention and treatment trials such as vaccines, pre-exposure prophylaxis (PrEP), and combination approaches.
The document identifies essential factors for both researchers and CBOs to consider in the design, conduct, implementation, validation, and dissemination of studies in order to protect the rights and safety of study participants. It includes recommendations for action and checklists to help researchers and CBOs understand the challenges and benefits of working together. It also demonstrates how partnerships contribute to better research outcomes that can be shared to influence policies and practices. It is designed for low- and middle-income countries but is also pertinent in rights-constrained environments in high-income countries, where rates of HIV among MSM remain disproportionately high.
"More research on the impact of HIV and AIDS among MSM is needed worldwide," said Kevin Frost, CEO of amfAR. "But in order to succeed and provide real benefit to science and people living with or at risk for HIV, there must be greater involvement of representatives of affected communities at every stage of the process."
Policies and attitudes about MSM impact HIV outreach and service delivery in many ways. "Respect, Protect, Fulfill" uses seven case studies to illustrate the complicated relationships among MSM, HIV/AIDS, and human rights around the world, including successes and challenges in Belize, Brazil, Jamaica, Liberia, Kenya, and South Africa.
"By providing best practices for conducting research with key populations, we can help researchers and funders better engage with them," said George Victor Owino, senior program associate at IAVI. "Stigma, discrimination, and security are still major barriers to HIV prevention among MSM and other vulnerable groups. We must find safe and productive ways to advance research."
"In the last 10 years we've seen an increase in the amount of research focused on gay men and other MSM across low- and middle-income settings, which has been associated with increased investment in evidenced-based programs," said Dr. Stefan Baral, associate professor in the Department of Epidemiology and director of the Key Populations Program at Johns Hopkins University-Center for Public Health and Human Rights. "However, with the mainstreaming of this work, there continues to be great risk and limited benefit for individual participants if appropriate strategies are not undertaken to ensure community leadership in the development of the methods, implementation of the studies, and dissemination of the results.
"For gay men and other MSM, the end of AIDS must be more than just a slogan; and inclusion in the Sustainable Development Agenda must be more than just a promise," said Clifton Cortez, Team Leader for Gender, HIV Key Populations and LGBTI at UNDP. "Whether in New York or Bangkok, Nairobi or Moscow, Lima or Suva, Cairo or Kingston, we must work together and build alliances to challenge homophobic and other punitive laws that threaten our health and our lives."
The updated "Respect, Protect, Fulfill" was compiled through a participatory process that enlisted input from researchers and MSM community leaders and organizations throughout the world. This guidance is meant to be a living document and a useful resource to anyone working across the spectrum of HIV research involving MSM. The publication is available at www.amfar.org/respectprotectfulfill. Funding for this revision was provided by IAVI through support from the United States Agency for International Development (USAID), and by amfAR, The Foundation for AIDS Research.