title: Feasibility of a Combination HIV Prevention Program for Men Who Have Sex With Men in Blantyre, Malawi.
abstract: BACKGROUND
  The use of combination HIV prevention interventions (CHPI) now represent the standard of care to minimize HIV acquisition risks among men who have sex with men (MSM). There has been limited evaluation of these approaches in generalized HIV epidemics and/or where MSM are stigmatized. A peer-based CHPI program to target individual, social, and structural risks for HIV was developed for MSM in Blantyre, Malawi.
  
  
  METHODS
  To test the feasibility of CHPI, adult MSM were followed prospectively from January 2012 to May 2013. Participants (N = 103) completed sociobehavioral surveys and HIV testing at each of the 3 follow-up study visits.
  
  
  RESULTS
  Approximately 90% of participants attended each study visit and 93.2% (n = 96) completed the final visit. Participants met with peer educators a median of 3 times (range: 1-10) in the follow-up visits 2 and 3. Condom use at last sex improved from baseline through follow-up visit 3 with main (baseline: 62.5%, follow-up 3: 77.0%; P = 0.02) and casual male partners (baseline: 70.7%, follow-up 3: 86.3%; P = 0.01). Disclosure of sexual behaviors/orientation to family increased from 25% in follow-up 1 to 55% in follow-up 3 (P < 0.01).
  
  
  CONCLUSIONS
  Participants maintained a high level of retention in the study highlighting the feasibility of leveraging community-based organizations to recruit and retain MSM in HIV prevention and treatment interventions in stigmatizing settings. Group-level changes in sexual behavior and disclosure in safe settings for MSM were noted. CHPI may represent a useful model to providing access to other HIV prevention for MSM and aiding retention in care and treatment services for MSM living with HIV in challenging environments.
authors.affiliation: *Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; †Department of Emergency Medicine, Johns Hopkins Medical Institute, Baltimore, MD; ‡Center for the Development of People, Blantyre, Malawi; §Department of Health Systems and Policy Development, School of Public Health and Family Medicine, University of Malawi College of Medicine, Blantyre, Malawi; and ‖Centre for Global Health, Trinity College, Dublin, Ireland.
authors.forename: Andrea L
authors.initials: AL
authors.lastname: Wirtz
authors.forename: Gift
authors.initials: G
authors.lastname: Trapence
authors.forename: Vincent
authors.initials: V
authors.lastname: Jumbe
authors.forename: Eric
authors.initials: E
authors.lastname: Umar
authors.forename: Sosthenes
authors.initials: S
authors.lastname: Ketende
authors.forename: Dunker
authors.initials: D
authors.lastname: Kamba
authors.forename: Mark
authors.initials: M
authors.lastname: Berry
authors.forename: Susanne
authors.initials: S
authors.lastname: Strömdahl
authors.forename: Chris
authors.initials: C
authors.lastname: Beyrer
authors.forename: Adamson S
authors.initials: AS
authors.lastname: Muula
authors.forename: Stefan
authors.initials: S
authors.lastname: Baral
mesh_terms: D000293:Adolescent; D000328:Adult; D000818:Animals; D015658:HIV Infections / Q000453:epidemiology*; D018451:Homosexuality, Male; D006801:Humans; D008295:Malawi / Q000453:epidemiology; D008297:Male; D055815:Young Adult