Rwanda has responded strongly to HIV/AIDS, but prevention among men who have sex with men (MSM) has not yet been addressed due to a strong cultural resistance to homosexuality, and a lack of data showing the public health value of attending to the sexual health needs of this group. We conducted an exploratory study on HIV risk among MSM in Kigali using snowball sampling involving peer leaders. The 99 respondents were demographically, socially, and sexually diverse. Respondents reported relatively high numbers of male and female partners, and considerable HIV risk behaviors including commercial sex with men and women, low condom use during anal and vaginal sex, and high mobility. Many respondents reported verbal and/or physical abuse due to their sexuality. This first study of MSM in Rwanda has brought attention to a previously neglected HIV risk group and their potential driving role in the Rwandan epidemic, demonstrating the need for sensitive and targeted interventions.
The present study has highlighted the importance of unique cultural structures in Chinese FSW sexual decision-making, an understanding of which will enhance the success of HIV-prevention efforts globally.
Partner notification (PN) in the UK is of limited effectiveness. Expedited partner therapy improves PN outcomes but does not comply with existing UK professional guidance. We developed two new strategies, known as accelerated partner therapy (APT), based on elements of PN practice for which there is evidence of efficacy, and which conform to UK prescribing guidance. We explored the acceptability and feasibility of these models qualitatively in genitourinary medicine clinic attenders. Both strategies were viewed favourably. Preference was influenced by age, relationship type, whether participants were delivering or receiving APT and whether the sex partner was aware of the participant's clinic visit. APT provides a new approach to PN, which has strong patient support and complies with existing UK regulations. The complex factors that influence patients' choice of PN method suggest that provision of a range of PN options including APT may be central to improving the effectiveness of PN in the UK.
The paper explores the HIV risk context of migrant men who have sex with men, or tongzhi, in Shenzhen, China. Findings from 42 qualitative interviews indicate that respondents are living within a complex risk environment, characterised by the realities of migration and a 'weak ties', virtual men who have sex with men community, which offers little emotional support but many opportunities for sexual engagement. Male sex work has proliferated in Shenzhen, with respondents informally participating in a type of buy-sell circuit. Respondents' portrayal of their environment and conflicts were underscored by three interacting elements: sexual freedom, migration and traditional Chinese values. The confluence of these factors, and how they may influence risk prioritisation in a multi-risk environment, is explored.
Efforts to prevent HIV among adolescent girls and young women (AGYW) should focus on providing male sexual partners of AGYW with HIV prevention, testing, and treatment programming and providing AGYW, particularly those who are less educated, pregnant, or single mothers, with prevention methods that do not require negotiating safer sex with their partners.
Contemporary health research is becoming increasingly formalised, regulated and institutionalised. In the UK, this has manifested itself in the development of a framework for 'governing' health research. The framework is often presented as a neutral decision-making tool guiding elements of research (such as ethical and peer review) through formal governance processes and approval procedures. We locate the framework as emerging in the wider context of the growth of 'guidelines' in healthcare that raises questions about the extent to which formal rationality has taken hold on knowledge production and what this means for health research. We therefore explore if and how the framework prioritises particular approaches to the production of knowledge and the tensions that emerge between managerial requirements and the work of researchers. We employed qualitative telephone interviews to access the accounts of both researchers and administrators across a range of primary healthcare settings in England and to capture a range of experiences and levels of involvement in research and governance. Our analysis revealed the double-edged nature of research governance: on the one hand, the framework provided a valuable aid to decision-making and the formalisation of tacit knowledge about 'good research practice'; on the other, consequent managerial processes engaged researchers in a series of low-level activities and privileged particular ways of viewing the world. Our findings add to existing knowledge by moving beyond documenting concerns over research governance and show how the reduction of research governance according to a 'common' set of principles and procedures facilitates the production (and managerial oversight) of quantitative and clinical, over qualitative and experiential, knowledge.
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