Conducting HIV Research with Sexual and Gender Minorities in Sub-Saharan Africa: Experiences from Malawi

Abstract

Conducting HIV prevention research with sexual and gender minorities in social and political settings that criminalize same-sex behaviour poses numerous challenges including recruitment, retention, stakeholder engagement and social harms mitigation. Research staff are responsible for assessing these challenges and developing appropriate responses prior to study implementation. The Malawi College of Medicine-Johns Hopkins University Research Project participated in HPTN 075, to assess the feasibility of recruitment and retention of men who have sex with men in sub-Saharan Africa. Considering the logistical and ethical challenges of conducting the study in Malawi, where the legal system considers same-sex behaviour a criminal offence, the study team utilized a palette of engagement methods to implement this study safely and successfully. Stakeholders were persuaded about the study importance from the perspective that the Malawi HIV epidemic is a public health and human rights issue that supersedes personal and political agendas. Unique recruitment and retention methods resulted in 100 participants being safely enrolled within 18 weeks with an 86% retention rate at 52 weeks. While the study was designed for cisgender men who have sex with men, 27 transgender women were also enrolled. Engaging community stakeholders in problem solving to study challenges is critical for the development of shared responsibility for HIV prevention research. In countries where same-sex behaviour is criminalized, partnership building can advance HIV prevention, bolster recruitment and retention, and minimize risk of social harm to study participants and staff.