amfAR, The Foundation for AIDS Research

GRASSROOTS: The GMT Initiative Blog

Grassroots reports on the work of amfAR-supported research teams and advocates responding to the devastating impact of HIV among gay men, other men who have sex with men, and transgender individuals (collectively, GMT).

An amfAR Scholar Researches PEP Use Among MSM in Developing Countries

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Posted by Lucile Scott, February 26, 2015

  Johan 2Johan Hugo, an HIV clinician at the Ivan Toms Centre for Men’s Health in Cape Town, South Africa

In mid-January, four GMT scholars from Belize, China, Pakistan, and South Africa arrived in Pittsburgh to begin five months of graduate-level public health study at the Center for LGBT Health Research of the Graduate School of Public Health at the University of Pittsburgh. This is the third year amfAR has supported the scholars program, which aims to strengthen GMT community-based research and responses to HIV by offering  four researchers from low- and middle-income countries courses on LGBT health research, research methods, and grant writing. The scholarship also includes round-trip travel to the U.S., housing, and a modest stipend.

By the end of their stay, the scholars will have not only improved their research skills, but also drafted a proposal to investigate culturally appropriate strategies to improve HIV services for GMT individuals in their respective countries. As this year’s scholars began designing their own research projects, the GMT Initiative checked in with a graduate from the inaugural 2013 class of amfAR HIV Scholars, Johan Hugo, an HIV clinician at the Ivan Toms Centre for Men’s Health in Cape Town, South Africa, to see how his research was progressing. In an earlier post, we talked to another 2013 alum, Lebanon’s Johnny Tohme.

amfAR: Why did you choose to focus your research on Post-Exposure Prophylaxis (PEP) use among men who have sex with men (MSM) in South Africa?

Johan: PEP studies among MSM have been done in Amsterdam, Brazil, and San Francisco, but never before in Africa—despite the fact that in most of Africa MSM have one of the highest rates of HIV infection. I work at the Ivan Toms Centre for Men’s Health in Woodstock, Cape Town. It was one of the first men’s health clinics on the African continent to address the sexual health needs of MSM, and it currently has close to 7,500 patients. The clinic provides a platform to safely study this biomedical approach to HIV prevention in a developing world setting and determine if it will be useful. If it is, we will disseminate the knowledge throughout the developing world.

Also, South African physicians’ cultural competence and their PEP competence both urgently need addressing. I have heard many horror stories of doctors making moralistic pronouncements to MSM when they try to access PEP that make them feel like second-class citizens. Due to a lack of training and their own beliefs, many physicians feel that PEP should only be used for needle stick injuries and rape cases—and definitely not for MSM.  A lot of MSM don’t even know about PEP, and the ones who do might not go to healthcare facilities to get it because they fear facing homophobia and prejudice. Our clinic has also encountered MSM who have been prescribed dangerously outdated or contraindicated PEP regimens.

amfAR: What are the results of your research so far?

Johan: There are two components to the research. The first is a 116-question Internet survey looking at MSM’s attitudes and beliefs about PEP. It went live at the end of June 2014, and we have 326 completed surveys and 403 partially completed ones. I have some provisional data, but it is way too early to answer any of my questions.

The second component is a clinical study looking at barriers and facilitators to MSM accessing and adhering to PEP. It launched in November 2014 and will run over a 9–12 month period. Men are eligible to participate if they are older than 18 and report having had high-risk, or perceived high-risk, sexual contact with another male that resulted in requesting PEP. So far we have enrolled 12 participants. I feel it is going really well, and I am very excited to see the results.

amfAR: How did the HIV Scholars program impact your research?

Johan: My passion is sexual health, and even though it can be very challenging at times, working with the MSM population is very rewarding. My time in Pittsburgh was extremely valuable, from the coursework to the time spent with Ron Stall [chair of the Department of Behavioral and Community Health Sciences at Pitt Public Health and head of the HIV Scholars program]. It was great to be able to get to know the research language and to start speaking it. I also think I made very valuable connections for the future.