MSM and HIVAIDS: Is More Research Needed

1
MSM and HIV/AIDS Is More Research Needed?

• Theo Sandfort
• HIV Center for Clinical and Behavioral Studies
• New York State Psychiatric Institute
• and Columbia University, New York
• MSM HIV Advancing a Global Agenda for Gay
• Men and Other Men Who Have Sex with Men
• Toronto, August 11, 2006

2
Six Questions

• Why do we need research?
• Can research solve practical problems?
• Hasnt enough research been done?
• Why would we need more research?
• Do we need one specific kind of research?
• How to establish research priorities?

3
Why Do We Need Research?

• We are trying to solve problems, e.g.,
• Preventing further spread of HIV
• Counteracting HIV-related stigma
• Promoting access to health care
• To solve problems we need good theories
• Theories about the problem that we want to solve
• Theories about how that problem can be solved
• Good theories have various characteristics,
  including
• Based on clear conceptual rigor and are
  internally consistent
• Potential for human intervention and social
  policy
• Are supported by empirical evidence

4
Can Research Solve Problems?

• Research outcomes dont dictate what has to be
  done
• Study outcomes have to be interpreted and
  translated to specific situation
• Policies and interventions are also informed by
  other factors, including
• Principles of human rights
• Assumptions about people and society
• Available resources
• Doing research changes the situation

5
Hasnt Enough Research Been Done?
Number of published peer-reviewed papers
according to PsycINFO per year (1987-2005)
6
Hasnt Enough Research Been Done?

• There is too much MSM research to keep up with
  to digest
• Relevance of empirical findings not always
  self-evident translation is needed
• Strong need for increasing accessibility of
  available knowledge resources
• Strong need for establishment of practical
  meaning of available research outcomes

7
Why Would We Need More Research?

• Specific local needs
• Epidemiological developments
• Changing social and cultural contexts, e.g.,
• Gay globalization
• Increasing acceptance of (specific forms) of
  homosexuality
• Technological developments and their consequences
  (e.g., Internet, medication, microbicides)
• Changing perspectives (e.g., individual versus
  structural approaches)

8
Do We Need One Specific Kind of Research?

• Social scientific and behavioral research
• Understand unsafe sex practices in relation to
  social position of MSM and in context of other
  health behaviors
• Understand MSMs experience world as a context
  for intimate bonding, sexual expression, and
  sexual risk
• Understand community building as it relates to
  safe sex practices and presents context for
  prevention
• Program evaluation
• How are interventions perceived evaluated?
• What works and why? Why didnt what work?

9
Do We Need One Specific Kind of Research?

• Epidemiological research
• Follow developments (e.g., sexual behavior
  surveillance, HIV prevalence incidence)
• Understand role of homosexual transmission in
  general epidemic
• Network epidemiology
• Policy research
• Understand funding streams (prevention and
  research)
• Understand neglect of MSM in national strategies

10
How To Establish Research Priorities?

• One universal agenda not possible
• Should be based on understanding of what is
  already known
• Relevance of unknown outcome should be clear in
  advance
• Agenda should be set in collaboration with major
  local stakeholders