Respondent-driven sampling as a recruitment method for men who have sex with men in southern sub-Saharan Africa: a cross-sectional analysis by wave

Abstract

Objectives Respondent-driven sampling (RDS) is a popular method for recruiting men who have sex with men (MSM). Our objective is to describe the ability of RDS to reach MSM for HIV testing in three southern African nations. Methods Data collected via RDS among MSM in Lesotho (N=318), Swaziland (N=310), and Malawi (N=334) were analyzed by wave in order to characterize differences in sample characteristics. Seeds were recruited from MSM-affiliated community-based organizations. Men were interviewed during a single study visit and tested for HIV. Chi-square tests for trend were used to examine differences in the proportions across wave category. Results A maximum of 13–19 recruitment waves were achieved in each study site. The percentage of those who identified as gay/homosexual decreased as waves increased in Lesotho (49% to 27%, p<0.01). In Swaziland and Lesotho, knowledge that anal sex was the riskiest type of sex for HIV transmission decreased across waves (39% to 23%, p<0.05, and 37% to 19%, p<0.05). The percentage of participants who had ever received more than one HIV test decreased across waves in Malawi (31% to 12%, p<0.01). In Lesotho and Malawi, the prevalence of testing positive for HIV decreased across waves (48% to 15%, p<0.01 and 23% to 11%, p<0.05). Among those living with HIV, the proportion of those unaware of their status increased across waves in all study sites although this finding was not statistically significant. Conclusions RDS that extends deeper into recruitment waves may be a promising method of reaching MSM with varying levels of HIV prevention needs.

Online Sex-Seeking Among Men who have Sex with Men in Nigeria: Implications for Online Intervention

“…In the bivariate analysis, those who reported a larger MSM network (OR=1.02, p=0.001), reported participation in MSM community activities (OR=1.81, p<0.001), reported a larger number of male anal sex partners (OR=1.05, p<0.05), and participated in an earlier RDS accrual wave (a marker of community “connectedness”(29, 30)) (OR=0.93, p<0.001) were more likely to seek-sex online (Table 2). After adjusting for age, education level, marital status, religion, and study site, the variables that remained significantly associated with online sex-seeking were participation in an earlier RDS accrual wave (Adjusted Odds Ratio [AOR]=0.97, p=0.03), participation in MSM community activities (AOR=1.45, p=0.02), and engagement in high risk sex (AOR=1.52, p=0.03).…”

“…These seeds recruit their peers, who then recruit additional peers, and so on until the desired sample size is reached, resulting in multiple waves of recruitment. RDS has been shown to be effective in populations of MSM who are less engaged in the MSM community as well as in HIV prevention activities (29, 30). …”

“…The survey instrument was validated in previous studies of MSM throughout Sub-Saharan Africa (30, 32–34) and was pre-tested in Lagos and Abuja before enrollment and initiation of the study. Survey measures of interest included socio-demographics, MSM social and sexual networks, experiences and perceptions of sexual behavior stigma in social and healthcare settings, and HIV treatment uptake.…”

The Where and How for Reaching Transgender Women and Men Who Have Sex with Men with HIV Prevention Services in Guatemala

“…Men and transgender women with the largest social networks were interviewed at NGOs, parks and streets. Social networks can be leveraged to reach more hidden populations that identify as bisexual or heterosexual and people who do not frequent social venues [38]. Figure 1 summarizes the recommendations based on the results from study.…”

Recruiting the social contacts of patients with STI for HIV screening in Lilongwe, Malawi: process evaluation and assessment of acceptability

“…This finding has important implications; finding one person from a specific hard-to reach population could serve as a gateway to others from this same population. This phenomenon has been observed with frequency in sub-Saharan African high-risk populations, such as sex workers, injection drug users and men who have sex with men, [17][18][19][20][21][22][23] but this phenomenon is less well described among patients with STI who primarily experience risk from heterosexual sexual contact with the general population. [24][25][26][27] This observation is important since heterosexual transmission in the general population is the primary source of HIV transmission in sub-Saharan Africa.…”