FAQ IT! : A venue-based HIV prevalence study among Men who have Sex with Men (MSM) in

Flanders, Belgium:

On methods en ethics

Wim Vanden BergheHIV/STI Epidemiology and Control Unit

Department of MicrobiologyInstitute of Tropical Medicine, Antwerp

Methods in health survey researchBrussels, 17th December 2010

Overview presentation

Background

Research questions

Methods and data collection procedures

Ethics

Results and conclusions

Dissemination of the results

Background : Epidemiology of HIV (Belgians)

Source: Belgian InSTItute of Public Health

Background : Research objectives

• A rise in confirmed HIV diagnoses among MSM since 1999, continues until today - Not only in Belgium but in most Western countries

• Reasons: a better uptake of HIV testing but also a rise in sexual risk behaviour

• Funding : Flemish ministry of well-being

• A need for more targeted HIV prevalence estimates among MSM

• Evidence-based prevention

Research questions

• What is the prevalence of HIV among different kinds of MSM venues in Flanders?

• How many HIV infections are not (yet) detected?

• What is the frequency of sexual risk behaviour and is there an association with HIV serostatus?

Methods: Time-space sampling

• Pioneered by the CDC, US

• Hard to reach groups => no offical listing (of MSM)

• Urban health research

• Location-based populations (museums, polling, clubs/bars)

• Probability-based method => A random sample!!!

• Subcultural venues or spaces have to exist for the target group otherwise respondent driven sampling

Methods: Time-space sampling

• Mixed methods = qualitative and quantitative research

• Mapping and etnography of the venues:

Discussion on research and framework with venue owners

Description of settings and public

=> List of eligible settings

Methods: Time-space sampling

• Multi-level randomization:

Time (day of week, time of day)

Space/Venue

Individuals within venues? => research showed not necessary

Methods: Substrata of venues

• Three substrata of 7 venues :

N1: A selection of cruising venues (n=4)

N2: A selection of regular gay (dance)clubs or bars (n=2)

N3: A selection of party’s, clubs targetting younger MSM (<25 years old)(n=3)

Methods : Sample size

• Sample size for each substratum based on:

HIV prevalence estimates from neighbouring countries

Self-report HIV prevalence estimates

Methods: Community-based research

• Interviewers (n=8) : community volunteers

• Principles of community-based research:

Community partners should be involved at the earliest stages of the project, helping to define research objectives and having input into how the project will be organized.

Research processes and outcomes should benefit the community. Community members should be hired and trained whenever possible and appropriate.

Community members should be part of the analysis and interpretation of data and should have input into how the results are distributed. This does not imply censorship of data or of publication, but rather the opportunity to make clear the community's views about the interpretation prior to final publication.

Productive partnerships between researchers and community members should be encouraged to last beyond the life of the project. This will make it more likely that research findings will be incorporated into ongoing community programs and therefore provide the greatest possible benefit to the community from research.

Methods: Social Marketing

Frequently= Asked

QueSTIons

Data collection procedures

• Self-administered behavioural questionnairein 3 languages

• Interviewer-assisted fingerprick : blood sample on filterpaper

Data collection procedures: Inclusion/exclusion

• Inclusion:

18 years oldSexual contact in the last 12 months

• Exclusion:

Mentally/physically fitAlready participated

Data collection procedures: Setting flowchart

Interviewer A :Information Participate?

Inclusion check

Interviewer B : Informed consentBiosample support

Self administered :Behavioural survey :

20 questions

Interviewer B :Feedback on the research

Incentive (free drink)

1 or 2 interviewer(s) A : entrance

1 or 2 interviewer(s) B : table near the entrance or other fixed point

Shift = 3 hours mainly between 10 pm and 4 am

After each shift: storage!

Ethical aspects

• Informed consent (no name required)

• Anonymity (number)

• Non-disclosure of HIV status

• Storage + analysis samples at AIDS reference laboratory, Institute of Tropical Medicine, Antwerp : tested for HIV and confirmed

• Ethical clearance by IRB of ITM and EC of UHA

Info/prevention leaflets and incentives

• Info leaflet on the research project was given to the respondent with info and locations for HIV/STI testing

• “Did you know…” leaflet => everyone present, passing by

• Incentive respondent: free drink at the venue

• Distribution of free condoms/lubricant => everyone present, passing by

Results

General sample characteristics

• 6 months : september 2009 – march 2010

• Total respondents : 658

• Substrata :- N1 (n=3) = Cruising venues (Antwerp) = 167- N2 (n=2) = Regular gay venues (Antwerp) = 219- N3 (n=3) = Younger MSM venues (Antwerp, Ghent)= 263

• Participation rates : N1 58%, N2 75%, N3 70%

• No bloodsample : 8.5%

HIV prevalence

-Wat is de prevalentie van HIV infectie bij MSM in Vlaamse MSM

uitgaanssettings?

HIV status : bio sample

14,5%

4,9%1,8%

,0%

5,0%

10,0%

15,0%

20,0%

N1=152 HIV + : 3,2%-31,8%

N2=205 N3=221 HIV + : 0,9%-7,1% Steekproef

HIV+

Disc (n=4)

Hiv status : self report

5,8%3,3%

16,1% 17,5%

26,0%

16,1%

,0%

5,0%

10,0%

15,0%

20,0%

25,0%

30,0%

N1=161 N2=206 N3=246

Steekproef

HIV +Niet gekend

Percentage undetected HIV infections

•14,3% of HIV + men were unaware of their status or thought they were -

•Five men reported being HIV + but were -

•Four respondents had discordant results = HIV-/?

Socio demographics

Age (in years)

Gem.N1 = 161 38,5N2 = 215 30,6N3 = 255 27,5

Totaal 31,4

Nationaliteit

65,0%77,8% 83,7%

29,4%16,7% 13,6%

,0%

20,0%

40,0%

60,0%

80,0%

100,0%

N1=163 N2=216 N3=258

Steekproef

Belgisch

Nederlands

Frans

Andere

Woonplaats

5,210,2

7,26,2

5,419,6

46,1

,0 10,0 20,0 30,0 40,0 50,0

BrusselWallonïe

Vl-BrLimburgWest-VlOost-Vl

Antwerpen

Main conclusions HIV prevalence study

First venue-based study in Belgium for estimation of HIV prevalence among MSM

Use of time-space sampling and blood sampling through finger prick => feasible and well accepted

• N1 : 14,5%, N2 : 4,9%, N3 1,8% => range, age specific!

• 14,3% of HIV positive men was unaware of their status

• +/- 50% HIV test, +/- 60% STI test in the last 12m

• Effect mobility within the European context

• Less condom use among HIV positive men at cruising venues (harm reduction!)

• High rates of Co-infections HIV/STI and Drug use

Limitations of the study

• Time-space sampling => results are representative only for MSM present at the settings that were visited => no generalization is possible

• Reasons why certain venue owners did not want to participate are unknown

• Reasons for not giving a blood sample are unknown

• What role do incentives play?

Dissemination of results

• Output for scientific journals

• Community reporting:

General press :

Dissemination of results

• Community reporting:

Community press

www.faqit.be

Dissemination of results

• Evidence-based prevention:

Next steps…

• “Community day” planned for march 2011:

• Interpretation of results by the target group

• Group discussions with different stakeholders

• New research questions?

• Output : direct prevention activities

• European HIV prevalence project among MSM (SIALON)

Thank you!

Wim Vanden BergheHIV/STI Epidemiology and Control UnitDepartment of MicrobiologyInstitute of Tropical MedicineNationalestraat 155B-2000 AntwerpBelgiumwvandenberghe@itg.be03 247 0712

www.itg.be

www.faqit.be