PrEP for Black MSM
Community-Based Ethnography and Clinic-Based Treatment
In the United States 61% of all new HIV infections in 2009 occurred among men who have sex with men (MSM). Pre-exposore prophylaxis (PrEP) is a promising tool for HIV prevention and Black MSM could potentially benefit in the future from PrEP. The PrEP for Black MSM project investigates the feasibility of introducing PrEP among Black MSM in Harlem. Through community-based ethnographic research, the team will explore the structural and cultural factors that shape men's sexual relationships and health systems engagement. This will entail listening to what Black MSM have to say about their own lives here in Harlem. Key concepts that will inform the research are; Social Networks, Social Risks and Life Projects, and the research will shed light on how Black MSM in Harlem navigate their own social worlds and manage competing priorities, intimate relationships and obligations. Findings will inform the design of a PrEP-based package of care targeted and Black MSM who are initiating PrEP, and will lay the groundwork for a randomized controlled trial for PrEP for Black MSM in a community-based clinic.
This collaborative project will be undertaken by researchers from the Sociomedical Sciences Department, the Columbia Community Partnership for Health Center, and the International Center for AIDS Care and Treatment Programs. Jennifer Hirsch, Deputy Chair of the Sociomedical Sciences Doctorate Program, and Paul Colson, Program Director at Columbia University, are the principle investigators. The research is funded by the National Institute of Mental Health as part of a competitive Request for Proposals (RFP) on Advancing HIV Prevention through Transformative Behavioural and Social Science Research.
Love, Marriage & HIV
A Multisite Ethnographic Study of Gender and HIV Risk
Principal Investigator: Jennifer S. Hirsch
Funded by the Demographic and Behavioral Sciences Branch, National Institute of Child Health and Human Development
Grant Number 1 RO1 HD41724
Objective: For women in many parts of the world, the behavior that puts them at greatest risk for HIV infection is unprotected sex within marriage. This comparative ethnographic study explores how social and cultural factors influence marital and extramarital intimate relationships and examines the sexual and the HIV prevention practices of men and women engaged in building these relationships across five locations in countries at different stages of the HIV epidemic. By detailing the processes through which contextual factors shape women's risk of marital HIV infection, this study contributes to our understanding of ways to reduce the risk of heterosexual HIV transmission.
Background and Significance: The study is guided by three premises: that the role of married men in sustaining heterosexual transmission of HIV has been insufficiently explored; that spreading ideologies of monogamous companionate marriage may put married women at particular risk, and that culturally specific knowledge about the social, economic, and emotional context of sexual relationships can provide important insight into the avenues through which gender inequality combines with economic organization and emerging ideologies of marital love to put women at risk for marital HIV transmission.
Methods: Five developing country sites representing different stages of the HIV epidemic have been selected for study: Degollado, Jalisco; Tari, Papua New Guineau; Hanoi, Vietnam, Ubakala, Nigeria, and Bulubandi, Uganda. In each site, researchers used ethnographic methods to examine the social and cultural determinants of the risk of marital transmission of HIV. The primary method of data collection was marital case histories; in each site researchers collected 20-30 marital case histories, from couples systematically selected so that the overall sample included variation in age, social class, and participation in labor migration. These marital case studies were complemented by key informant interviews, archival work, and intensive participant observation in domestic and social spaces. For each field site, ethnographic data will be analyzed to relate relationship- and macro-level factors to specific attitudes and behaviors. The ethnographic findings will be pooled to conduct an analysis of key themes and findings across sites.
Implications: The assumption that marriage equals monogamy may be costing women their lives. Data from this project is being used to trace the social and ideological contexts within which men and women build sexual relationships and become exposed to HIV risk and to develop proposals for culturally-appropriate, gender-sensitive interventions to reduce this risk.
See below to learn more about our project sites, including photos, summary of fieldwork activities, descriptions of intervention/community education activities, in-country research teams, some preliminary findings, list of recent presentations and forthcoming publications, news coverage, local collaborating agencies, and contact information for each field site director.
The preliminary research on which we drew in developing this grant, "Mexican Men in the Urban South: Social Ties and HIV Risk", was funded as a pilot study by Emory's Center for AIDS Research. In addition, in writing the grant the entire project team drew upon our prior experiences in these five field sites, which were funded by a variety of sources, including the NSF Program in Cultural Anthropology, The Andrew Mellon Foundation through a grant to the Johns Hopkins University of Population Dynamics, and the International Migration Program at the Social Science Research Council.
During the developmental phase the project also received vital institutional support from the Department of International Health at Rollins School of Public Health (now the Department of Global Health). In particular, we would like to offer our undying thanks to Carlos del Rio and Claire Sterk for their help and mentoring, and Maria Sullivan and Laurie Ferrell for administrative and technical support.