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Chakrapani V.,Center for Sexuality and Health Research and Policy | Newman P.A.,University of Toronto | Singhal N.,The Humsafar Trust | Jerajani J.,The Humsafar Trust | Shunmugam M.,Center for Sexuality and Health Research and Policy
PLoS ONE | Year: 2012

Background: Recruitment of low- and middle-income country volunteers from most-at-risk populations in HIV vaccine trials is essential to vaccine development. In India, men who have sex with men (MSM) are at disproportionately high risk for HIV infection and an important population for trial recruitment. Investigations of willingness to participate (WTP) in HIV vaccine trials have focused predominantly on individual-level determinants. We explored multi-level factors associated with WTP among MSM in India. Methods: We conducted 12 focus groups (n = 68) with low socioeconomic MSM in Chennai and Mumbai, and 14 key informant interviews with MSM community leaders and service providers. Focus groups/interviews were recorded, transcribed and translated into English. Two bilingual investigators conducted thematic analysis using line-by-line coding and a constant comparative method, with member-checking by community representatives. Results: Factors associated with WTP were evidenced across the social ecology of MSM-social-structural: poverty, HIV-, sexual- and gender non-conformity stigma, institutionalized discrimination and government sponsorship of trials; community-level: endorsement by MSM community leaders and organizations, and fear of within-group discrimination; interpersonal: anticipated family discord, partner rejection, having financially-dependent family members and disclosure of same-sex sexuality; and individual-level: HIV vaccine trial knowledge and misconceptions, safety concerns, altruism and preventive misconception. Conclusion: Pervasive familial, community and social-structural factors characteristic of the Indian sociocultural context may complicate individual-focused approaches to WTP and thereby constrain the effectiveness of interventions to support recruitment and retention in HIV vaccine trials. Interventions to reduce stigma and discrimination against MSM and people living with HIV, capacity-building of MSM community organizations and transparent communications tailored to the knowledge and educational level of local communities may support meaningful engagement of MSM in HIV vaccine trials. Vigilance in providing fair but not excessive compensation and healthcare benefits and in mitigating preventive misconception are warranted to support ethical conduct of trials among MSM in India. © 2012 Chakrapani et al.

Chakrapani V.,Center for Sexuality and Health Research and Policy | Boyce P.,University of Sussex | Newman P.A.,University of Toronto | Row Kavi A.,The Humsafar Trust
Culture, Health and Sexuality | Year: 2013

Quantitative studies among men who have sex with men in India have shown high levels of unprotected anal sex. However, there is little information about the contexts in which such men may not use condoms. Relevant information on these contexts can assist in designing HIV prevention programmes to remove barriers to consistent condom use. As part of a larger study on sexual and social networks, we explored the contexts in which men who have sex with men did not use condoms, with a focus on personal, interpersonal and structural levels of experience. Data indicate the importance of understanding the different contexts that lead to unprotected sex but also reveal that the concept 'context' itself as a complex variable to consider in research of this kind, as research subjects interpret their social worlds and sexual risks in subtle and varied ways. Based on this viewpoint we make recommendations regarding HIV prevention. © 2013 © 2013 Taylor & Francis.

Newman P.A.,University of Toronto | Chakrapani V.,Center for Sexuality and Health Research and Policy | Weaver J.,University of Toronto | Shunmugam M.,Center for Sexuality and Health Research and Policy | Rubincam C.,University of Toronto
Vaccine | Year: 2014

Introduction: Men who have sex with men (MSM) are at disproportionately high risk for HIV in India and would benefit greatly from a safe and effective HIV vaccine. We assessed willingness to participate (WTP) in HIV vaccine trials and the impact of various trial characteristics on WTP among MSM in Mumbai and Chennai. Methods: We used venue-based time-space sampling to recruit MSM at cruising sites and drop-in centers at community-based organizations. Structured survey interviews assessed sociodemographics, WTP and the impact of 10 trial characteristics on WTP. We tested for differences in WTP by sociodemographics and trial characteristics, and sociodemographic differences in the impact of trial characteristics on WTP. Results: Among 400 participants (median age = 25 years), 46.9% identified as kothi, 40.0% panthi/double-decker, 13.0% gay/bisexual; 29.0% had primary school education or less; and 40.0% had monthly income < = 5000 INR (∼3USD/day). Overall, 48.1% reported being definitely willing to participate. Posttrial availability of an efficacious vaccine was the highest rated (90.98 on 100-point scale) trial characteristic, followed by availability of free medical treatment (90.79), life insurance (89.84) and side effects (79.81). Distance to the trial site, side effects, financial incentive, life insurance and free medical care had significant impacts on WTP, with differential importance of trial characteristics by sexual identity, education, income and living arrangement. Conclusion: The prioritization of trial-related financial and healthcare provisions, including access to an efficacious vaccine posttrial, among MSM in India indicates the importance of trials providing such services, as well as the value of formative research in identifying key concerns among participating communities in resource-limited settings. The significant impact of trial characteristics on WTP suggests that providing trial benefits deemed fair and important, addressing logistical concerns, and supporting educational interventions to mitigate vaccine fears may support recruitment of MSM in India in fairly and ethically conducted HIV vaccine trials. © 2014.

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