Advancing bio-behavioural surveys for understanding HIV risk factors amongst Men who have Sex with Men

Abstract

A considerable number of studies targeting the HIV epidemic amongst Men who have Sex with Men (MSM) have been published over the last decade. Despite concerted efforts promoted by the World Health Organization (WHO), the European Commission, and the Joint United Nations Programme on HIV/AIDS (UNAIDS), there remains a need for the harmonised collection of reliable and comparable bio-behavioural data across European countries within the framework of a SecondGeneration Surveillance System (SGSS) approach. Linked to this, there is also increasing recognition that innovative and reliable approaches are needed to engage effectively with so-called ‘hard-toreach’ strata within diverse MSM communities in order to generate robust and generalisable prevalence estimates on the HIV epidemic. Complementing such estimates, better understandings of the epidemiological patterns including associated risk factors for HIV and other sexually transmitted infections (STI) amongst MSM are required. Finally, an important issue in the literature relates to the need for effective initiatives targeting MSM populations that are based on research evidence and tailored for vulnerable populations, and designed specifically to increase access to testing and HIV/STI treatment.

This appraisal utilises eleven published papers to describe the contribution that has been made to the development of HIV bio-behavioural survey methodology, to improve further the current knowledge base regarding behavioural risk factors influencing the HIV epidemic amongst MSM, and to new approaches to increase testing and treatment.

A first strand within this thesis sets the foundations of the methodological issues that have been further advanced through the implementation of two multi-site European projects, namely, Sialon and Sialon II. The thesis concentrates on the successful adaptation and implementation of advanced methods targeting hard to-reach MSM, improving existing venue-based and network-based sampling methodologies, as well as championing the use of international indicators embedded in a SGSS multisite survey. This demonstrates the significant contribution of this research in producing HIV/STI estimates with increased precision, generalisability, and comparability across European countries A second strand within this thesis based on several different (albeit related) projects supported by relevant publications, examines and expands upon the knowledge of risk and health-seeking behaviours amongst MSM. Despite the growing body of knowledge in the field, the analysis performed particularly on Sialon and Sialon II datasets is unique, as no previous data are available based on sampling methods designed specifically for hard-to-reach MSM, in the context of a panEuropean bio-behavioural study.

Building on the Sialon research and its related publications, a final strand of the thesis focuses on the recent field evaluation of the innovative WHO Point-Of-Care Testing strategy, assessing its feasibility and usefulness when targeting MSM. The results of such evaluation research provide key insights on weaknesses and opportunities of this novel approach.

The thesis concludes with an overview of the strengths and limitations of advancing bio-behavioural surveys for understanding HIV risk factors amongst MSM as well as considerations of future potential developments particularly in terms of advanced sampling methodologies.

Date of Award	2019
Original language	English
Awarding Institution	University of Brighton
Supervisor	Nigel Sherriff (Supervisor), Jorg Huber (Supervisor) & Anne Mandy (Supervisor)