My primary research programs address, 1) Social-structural challenges of HIV risk and prevention among marginalized populations, with a focus on new prevention technologies and young key populations
Men who have sex with men (MSM) continue to constitute the majority of HIV incidence in Taiwan. T... more Men who have sex with men (MSM) continue to constitute the majority of HIV incidence in Taiwan. This study examined the associations between five co-occurring psychosocial health conditions (PHCs)–childhood physical abuse (CPA), childhood sexual abuse (CSA), intimate partner violence (IPV), internalized homophobia (IH), and methamphetamine use (MU), and two outcomes (HIV infection and condomless anal sex) among a community sample of 1,000 Taiwanese MSM (mean age 28.5 years). Compared to MSM who had never experienced any PHC, MSM with one or more PHCs had greater than twofold higher odds of being HIV-positive, and those with three or more PHCs had twofold higher odds of having condomless anal sex. Interactive effects on HIV infection were identified from CPA + CSA + MU and CPA + IPV + MU. An interactive effect on condomless anal sex was detected between IH and MU. In order to control the escalating HIV epidemic among MSM in Taiwan, interventions are needed to address syndemic psychosocial health conditions.
Familism may play an important role in HIV risk behaviors among men who have sex with men (MSM) l... more Familism may play an important role in HIV risk behaviors among men who have sex with men (MSM) living in a collectivist culture. This study examined a hypothesized path from familism, stressful life events (i.e., adverse childhood experiences, intimate partner violence, and sexuality-related discriminatory experiences), and coping strategies to condomless anal sex (CAS) among Taiwanese MSM. Participants were 1,000 MSM (mean age = 28.5 years) recruited through five community-based organizations. Structural equation modeling using bootstrapping with 3,000 iterations evaluated the mediating effects of 14 coping strategies. We found a pathway from familism to CAS through stressful life events and substance use coping. The protective effects of familism on stressful life events and CAS suggest that integrating components of family support and family connection into HIV prevention and education programs may increase the effectiveness of these programs in reducing HIV risk behaviors and dysfunctional coping strategies among MSM in Taiwan.
IntroductionThe effects of climate change and associated extreme weather events (EWEs) present su... more IntroductionThe effects of climate change and associated extreme weather events (EWEs) present substantial threats to well-being. EWEs hold the potential to harm sexual health through pathways including elevated exposure to HIV and other sexually transmitted infections (STIs), disrupted healthcare access, and increased sexual and gender-based violence (SGBV). The WHO defines four components of sexual health: comprehensive sexuality education; HIV and STI prevention and care; SGBV prevention and care; and psychosexual counselling. Yet, knowledge gaps remain regarding climate change and its associations with these sexual health domains. This scoping review will therefore explore the linkages between climate change and sexual health.Methods and analysisFive electronic databases (MEDLINE, EMBASE, PsycINFO, Web of Science, CINAHL) will be searched using text words and subject headings (eg, Medical Subject Headings (MeSH), Emtree) related to sexual health and climate change from the incep...
Introduction: Amid extensive scholarship on sexual and gender diversity in Thailand, research on ... more Introduction: Amid extensive scholarship on sexual and gender diversity in Thailand, research on LGBT + discrimination, exclusion, and policy responses remains limited and fragmented. We conducted a scoping review to synthesize the literature on LGBT + inclusion and human rights in Thailand, with a focus on diverse policy options.
Methods: Using the Joanna Briggs Institute’s scoping review methodology, and PRISMA-ScR reporting guidelines, we searched 16 bibliographic databases and gray literature. Results were categorized using an adapted WHO-UNDP LGBTI Inclusion Index and reviewed using a rights-based approach to policy analysis and development.
Results: We identified 2,341 sources, scoped to 115 published from 2000 to 2020. LGBT + exclusion and discrimination were identified in multiple domains, e.g., bullying in schools, disproportionate rates of sexual violence, labor market exclusion, and health disparities. Policy proposals ranged from implementing more stringent LGBT + antidiscrimination legislation to increasing the scope and quality of LGBT + health services. Specific proposals included legalizing same-sex marriage, allowing individuals to change gender markers on identity documents, explicit inclusion of LGBT + people in laws against sexual assault/rape, and increasing data collection on LGBT + populations.
Conclusions: Numerous policy proposals address LGBT + inclusion in Thailand, though largely circumscribed to healthcare and education domains, with less attention to the family or personal security/violence. Policy Implications We illustrate the utility of a rights-based approach to policy analysis/development and use specific policy examples (e.g., same-sex marriage, government-issued identity cards, disaggregated data collection) to highlight its potential to pre-empt implementation of problematic and regressive policies, and to ensure policymakers comply with their international legal obligations.
Background Promoting sexual health among forcibly displaced adolescents is a global public health... more Background Promoting sexual health among forcibly displaced adolescents is a global public health priority. Digital sexual communication strategies (eg, sexting) may increase adolescents’ confidence in discussing sexual health issues and negotiating condom use. However, limited evidence exists describing validated measures for text-based condom negotiation in the literature. Objective This study helps fill this gap by adapting and examining the psychometric properties of a condom use experience through technology (condom use negotiated experiences through technology [CuNET]) scale. Methods Using peer network sampling, 242 forcibly displaced adolescents (aged 16-19 years) living in Kampala’s slums were recruited for participation between January and March 2018. A subscale (embarrassment to negotiate condom use) of the Multidimensional Condom Attitudes Scale was adapted to incorporate sexting, yielding CuNET. Participants were randomly assigned to calibration and validation subsamples...
Research on transmasculine people's health is scant globally, including in India. We explored... more Research on transmasculine people's health is scant globally, including in India. We explored transmasculine people's experiences in affirming their gender in family and social spaces, and how those experiences impact mental health. In 2019, we conducted four focus groups (n = 17 participants) and 10 in-depth interviews with transmasculine people in Mumbai and Chennai. Data analyses were guided by minority stress theory and the gender affirmation model. Within family, the pressure to conform to assigned gender roles and gender policing usually began in adolescence and increased over time. Some participants left parental homes due to violence. In educational settings, participants described the enforcement of gender-normative dress codes, lack of faculty support, and bullying victimisation, which led some to quit schooling. In the workplace, experiences varied depending on whether participants were visibly trans or had an incongruence between their identity documents and gender identity. Everyday discrimination experiences in diverse settings contributed to psychological distress. Amidst these challenges, participants reported resilience strategies, including self-acceptance, connecting with peers, strategic (non)disclosure, and circumventing gendered restrictions on dress and behaviour. Interventions at social-structural, institutional, family and individual levels are needed to reduce stigma and discrimination faced by transmasculine people in India and to promote their mental health.
Authors: Venkatesan Chakrapani, Peter A. Newman, Aleena Sebastian, Shruta Rawat, Murali Shunmugam... more Authors: Venkatesan Chakrapani, Peter A. Newman, Aleena Sebastian, Shruta Rawat, Murali Shunmugam, and Priyababu Sellamuthu
Coronavirus disease 2019 (COVID-19)–related lockdowns in India have disrupted the meager sources of income of many transgender women, including those in the hijra subculture who largely rely on money from providing blessings, begging, and sex work. Many have expended savings and taken high-interest loans, contributing to psychological distress. For hijras engaged in sex work, challenges to negotiating condom use and adhering to COVID-19 protective measures increase risks for contracting HIV and COVID-19 amid decreased access to HIV services. Many transgender women face challenges accessing COVID-19–related government welfare programs as they lack legal gender identity documents. Multisectoral and transgender-competent approaches are needed to mitigate the impact of the pandemic.
This study aimed to examine the effect of a syndemic theory-based intervention to reduce condomle... more This study aimed to examine the effect of a syndemic theory-based intervention to reduce condomless anal intercourse among men who have sex with men (MSM) in India. In 2016/17, a pre- and post-test comparison group design was used to implement a syndemic theory-based intervention among 459 MSM (229, intervention; 230, standard-of-care comparison) recruited through non-governmental organizations in Chandigarh, India. The intervention group received two-session peer-delivered motivational interviewing-based HIV risk reduction counselling and skills training to improve sexual communication/negotiation and condom use self-efficacy, and screening/management of psychosocial health problems. The intervention's effect on consistent condom use was estimated using difference-in-differences (DiD) approach. Mediation analysis assessed the extent to which intervention effects on the outcome were mediated by changes in psychosocial health problems and condom use self-efficacy. A process evaluation assessed implementation fidelity and intervention acceptability. Baseline consistent condom use was 43% in the intervention group and 46% in the standard-of-care group. Baseline survey findings demonstrated that a psychosocial syndemic of problematic alcohol use, internalised homonegativity and violence victimisation synergistically increased condomless anal intercourse. Using DiD, we estimated that the intervention increased consistent condom use with male partners by 16.4% (95% CI: 7.1, 25.7) and with female partners by 28.2% (95% CI: 11.9, 44.4), and decreased problematic alcohol use by 24.3% (95%CI: -33.4, -15.3), depression by 20.0% (95% CI: -27.6, -12.3) and internalised homonegativity by 34.7% (95% CI: -43.6%, -25.8%). The mediation analysis findings suggested that the intervention might have improved consistent condom use by decreasing internalised homonegativity and by increasing condom use self-efficacy. The process evaluation showed high levels of acceptability/satisfaction among participants and high levels of implementation fidelity. A syndemic theory-based intervention tailored for MSM in India is feasible, acceptable, and can reduce HIV transmission risk behaviour as well as problematic alcohol use, depression and internalised homonegativity.
Men who have sex with men (MSM) continue to constitute the majority of HIV incidence in Taiwan. T... more Men who have sex with men (MSM) continue to constitute the majority of HIV incidence in Taiwan. This study examined the associations between five co-occurring psychosocial health conditions (PHCs)–childhood physical abuse (CPA), childhood sexual abuse (CSA), intimate partner violence (IPV), internalized homophobia (IH), and methamphetamine use (MU), and two outcomes (HIV infection and condomless anal sex) among a community sample of 1,000 Taiwanese MSM (mean age 28.5 years). Compared to MSM who had never experienced any PHC, MSM with one or more PHCs had greater than twofold higher odds of being HIV-positive, and those with three or more PHCs had twofold higher odds of having condomless anal sex. Interactive effects on HIV infection were identified from CPA + CSA + MU and CPA + IPV + MU. An interactive effect on condomless anal sex was detected between IH and MU. In order to control the escalating HIV epidemic among MSM in Taiwan, interventions are needed to address syndemic psychosocial health conditions.
Familism may play an important role in HIV risk behaviors among men who have sex with men (MSM) l... more Familism may play an important role in HIV risk behaviors among men who have sex with men (MSM) living in a collectivist culture. This study examined a hypothesized path from familism, stressful life events (i.e., adverse childhood experiences, intimate partner violence, and sexuality-related discriminatory experiences), and coping strategies to condomless anal sex (CAS) among Taiwanese MSM. Participants were 1,000 MSM (mean age = 28.5 years) recruited through five community-based organizations. Structural equation modeling using bootstrapping with 3,000 iterations evaluated the mediating effects of 14 coping strategies. We found a pathway from familism to CAS through stressful life events and substance use coping. The protective effects of familism on stressful life events and CAS suggest that integrating components of family support and family connection into HIV prevention and education programs may increase the effectiveness of these programs in reducing HIV risk behaviors and dysfunctional coping strategies among MSM in Taiwan.
IntroductionThe effects of climate change and associated extreme weather events (EWEs) present su... more IntroductionThe effects of climate change and associated extreme weather events (EWEs) present substantial threats to well-being. EWEs hold the potential to harm sexual health through pathways including elevated exposure to HIV and other sexually transmitted infections (STIs), disrupted healthcare access, and increased sexual and gender-based violence (SGBV). The WHO defines four components of sexual health: comprehensive sexuality education; HIV and STI prevention and care; SGBV prevention and care; and psychosexual counselling. Yet, knowledge gaps remain regarding climate change and its associations with these sexual health domains. This scoping review will therefore explore the linkages between climate change and sexual health.Methods and analysisFive electronic databases (MEDLINE, EMBASE, PsycINFO, Web of Science, CINAHL) will be searched using text words and subject headings (eg, Medical Subject Headings (MeSH), Emtree) related to sexual health and climate change from the incep...
Introduction: Amid extensive scholarship on sexual and gender diversity in Thailand, research on ... more Introduction: Amid extensive scholarship on sexual and gender diversity in Thailand, research on LGBT + discrimination, exclusion, and policy responses remains limited and fragmented. We conducted a scoping review to synthesize the literature on LGBT + inclusion and human rights in Thailand, with a focus on diverse policy options.
Methods: Using the Joanna Briggs Institute’s scoping review methodology, and PRISMA-ScR reporting guidelines, we searched 16 bibliographic databases and gray literature. Results were categorized using an adapted WHO-UNDP LGBTI Inclusion Index and reviewed using a rights-based approach to policy analysis and development.
Results: We identified 2,341 sources, scoped to 115 published from 2000 to 2020. LGBT + exclusion and discrimination were identified in multiple domains, e.g., bullying in schools, disproportionate rates of sexual violence, labor market exclusion, and health disparities. Policy proposals ranged from implementing more stringent LGBT + antidiscrimination legislation to increasing the scope and quality of LGBT + health services. Specific proposals included legalizing same-sex marriage, allowing individuals to change gender markers on identity documents, explicit inclusion of LGBT + people in laws against sexual assault/rape, and increasing data collection on LGBT + populations.
Conclusions: Numerous policy proposals address LGBT + inclusion in Thailand, though largely circumscribed to healthcare and education domains, with less attention to the family or personal security/violence. Policy Implications We illustrate the utility of a rights-based approach to policy analysis/development and use specific policy examples (e.g., same-sex marriage, government-issued identity cards, disaggregated data collection) to highlight its potential to pre-empt implementation of problematic and regressive policies, and to ensure policymakers comply with their international legal obligations.
Background Promoting sexual health among forcibly displaced adolescents is a global public health... more Background Promoting sexual health among forcibly displaced adolescents is a global public health priority. Digital sexual communication strategies (eg, sexting) may increase adolescents’ confidence in discussing sexual health issues and negotiating condom use. However, limited evidence exists describing validated measures for text-based condom negotiation in the literature. Objective This study helps fill this gap by adapting and examining the psychometric properties of a condom use experience through technology (condom use negotiated experiences through technology [CuNET]) scale. Methods Using peer network sampling, 242 forcibly displaced adolescents (aged 16-19 years) living in Kampala’s slums were recruited for participation between January and March 2018. A subscale (embarrassment to negotiate condom use) of the Multidimensional Condom Attitudes Scale was adapted to incorporate sexting, yielding CuNET. Participants were randomly assigned to calibration and validation subsamples...
Research on transmasculine people's health is scant globally, including in India. We explored... more Research on transmasculine people's health is scant globally, including in India. We explored transmasculine people's experiences in affirming their gender in family and social spaces, and how those experiences impact mental health. In 2019, we conducted four focus groups (n = 17 participants) and 10 in-depth interviews with transmasculine people in Mumbai and Chennai. Data analyses were guided by minority stress theory and the gender affirmation model. Within family, the pressure to conform to assigned gender roles and gender policing usually began in adolescence and increased over time. Some participants left parental homes due to violence. In educational settings, participants described the enforcement of gender-normative dress codes, lack of faculty support, and bullying victimisation, which led some to quit schooling. In the workplace, experiences varied depending on whether participants were visibly trans or had an incongruence between their identity documents and gender identity. Everyday discrimination experiences in diverse settings contributed to psychological distress. Amidst these challenges, participants reported resilience strategies, including self-acceptance, connecting with peers, strategic (non)disclosure, and circumventing gendered restrictions on dress and behaviour. Interventions at social-structural, institutional, family and individual levels are needed to reduce stigma and discrimination faced by transmasculine people in India and to promote their mental health.
Authors: Venkatesan Chakrapani, Peter A. Newman, Aleena Sebastian, Shruta Rawat, Murali Shunmugam... more Authors: Venkatesan Chakrapani, Peter A. Newman, Aleena Sebastian, Shruta Rawat, Murali Shunmugam, and Priyababu Sellamuthu
Coronavirus disease 2019 (COVID-19)–related lockdowns in India have disrupted the meager sources of income of many transgender women, including those in the hijra subculture who largely rely on money from providing blessings, begging, and sex work. Many have expended savings and taken high-interest loans, contributing to psychological distress. For hijras engaged in sex work, challenges to negotiating condom use and adhering to COVID-19 protective measures increase risks for contracting HIV and COVID-19 amid decreased access to HIV services. Many transgender women face challenges accessing COVID-19–related government welfare programs as they lack legal gender identity documents. Multisectoral and transgender-competent approaches are needed to mitigate the impact of the pandemic.
This study aimed to examine the effect of a syndemic theory-based intervention to reduce condomle... more This study aimed to examine the effect of a syndemic theory-based intervention to reduce condomless anal intercourse among men who have sex with men (MSM) in India. In 2016/17, a pre- and post-test comparison group design was used to implement a syndemic theory-based intervention among 459 MSM (229, intervention; 230, standard-of-care comparison) recruited through non-governmental organizations in Chandigarh, India. The intervention group received two-session peer-delivered motivational interviewing-based HIV risk reduction counselling and skills training to improve sexual communication/negotiation and condom use self-efficacy, and screening/management of psychosocial health problems. The intervention's effect on consistent condom use was estimated using difference-in-differences (DiD) approach. Mediation analysis assessed the extent to which intervention effects on the outcome were mediated by changes in psychosocial health problems and condom use self-efficacy. A process evaluation assessed implementation fidelity and intervention acceptability. Baseline consistent condom use was 43% in the intervention group and 46% in the standard-of-care group. Baseline survey findings demonstrated that a psychosocial syndemic of problematic alcohol use, internalised homonegativity and violence victimisation synergistically increased condomless anal intercourse. Using DiD, we estimated that the intervention increased consistent condom use with male partners by 16.4% (95% CI: 7.1, 25.7) and with female partners by 28.2% (95% CI: 11.9, 44.4), and decreased problematic alcohol use by 24.3% (95%CI: -33.4, -15.3), depression by 20.0% (95% CI: -27.6, -12.3) and internalised homonegativity by 34.7% (95% CI: -43.6%, -25.8%). The mediation analysis findings suggested that the intervention might have improved consistent condom use by decreasing internalised homonegativity and by increasing condom use self-efficacy. The process evaluation showed high levels of acceptability/satisfaction among participants and high levels of implementation fidelity. A syndemic theory-based intervention tailored for MSM in India is feasible, acceptable, and can reduce HIV transmission risk behaviour as well as problematic alcohol use, depression and internalised homonegativity.
Background: Informed consent (IC) is a dialogical process between researchers and potential parti... more Background: Informed consent (IC) is a dialogical process between researchers and potential participants, which should be founded upon a reciprocal research rapport. A bilateral, dialogical process should be rooted in an ethos of credibility and trust. This paper will explore enablers and inhibitors of trust within the IC process in HIV vaccine trials (HVTs) in South Africa. Methods: The study employed an open qualitative, process-oriented exploratory design, using Focus Group Discussions (FGDs) to elicit mental models or key representations of critical research-related concepts from key constituencies, including CAB representatives, educators, and site staff involved in consent processes at an HIV prevention trial research site. Four FGDs were conducted - each constituency was interviewed separately - with approximately eight participants per group. Transcribed FGDs were subjected to thematic analysis by three qualitative researchers. Results: Findings showed several barriers to credibility and trust around research, researchers, and key research-related concepts indicated by community members, which may complicate how concepts are understood, interpreted or believed. Study respondents reported and engaged in several strategies to build trust and develop research rapport - likely to be foundational to research participation. We found socio-economic, political, gender, race and culture-based mental models that may compete with or, alternatively, complement explanations of concepts offered by site-staff (e.g. vaccine-induced seropositivity [VISP]). Conclusions: Authentic IC should involve a systematic exploration of these barriers and enablers to trust as part of the on-going IC process, to complement efforts to promote and assess understanding. We make a series of recommendations for stakeholders who wish to incorporate trust-building into their engagement and consent work to enhance partnering and decision-making for HIV prevention trials. Author(s): Clinton L Rautenbach1, Graham C Lindegger1, Catherine M Slack1, Peter A Newman2, Melissa Wallace3 Institute(s): 1University of KwaZulu Natal, HIV/AIDS Vaccine Ethics Group (HAVEG), Pietermaritzburg,, South Africa, 2University of Toronto, Factor-Inwentash: Department of Social Work, Toronto, ON, Canada, 3Desmond Tutu HIV Foundation, Socio-Behavioural and Adolescent Division Leader, Cape Town, South Africa
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Methods: Using the Joanna Briggs Institute’s scoping review methodology, and PRISMA-ScR reporting guidelines, we searched 16 bibliographic databases and gray literature. Results were categorized using an adapted WHO-UNDP LGBTI Inclusion Index and reviewed using a rights-based approach to policy analysis and development.
Results: We identified 2,341 sources, scoped to 115 published from 2000 to 2020. LGBT + exclusion and discrimination were identified in multiple domains, e.g., bullying in schools, disproportionate rates of sexual violence, labor market exclusion, and health disparities. Policy proposals ranged from implementing more stringent LGBT + antidiscrimination legislation to increasing the scope and quality of LGBT + health services. Specific proposals included legalizing same-sex marriage, allowing individuals to change gender markers on identity documents, explicit inclusion of LGBT + people in laws against sexual assault/rape, and increasing data collection on LGBT + populations.
Conclusions: Numerous policy proposals address LGBT + inclusion in Thailand, though largely circumscribed to healthcare and education domains, with less attention to the family or personal security/violence. Policy Implications We illustrate the utility of a rights-based approach to policy analysis/development and use specific policy examples (e.g., same-sex marriage, government-issued identity cards, disaggregated data collection) to highlight its potential to pre-empt implementation of problematic and regressive policies, and to ensure policymakers comply with their international legal obligations.
Coronavirus disease 2019 (COVID-19)–related lockdowns in India have disrupted the meager sources of income of many transgender women, including those in the hijra subculture who largely rely on money from providing blessings, begging, and sex work. Many have expended savings and taken high-interest loans, contributing to psychological distress. For hijras engaged in sex work, challenges to negotiating condom use and adhering to COVID-19 protective measures increase risks for contracting HIV and COVID-19 amid decreased access to HIV services. Many transgender women face challenges accessing COVID-19–related government welfare programs as they lack legal gender identity documents. Multisectoral and transgender-competent approaches are needed to mitigate the impact of the pandemic.
Methods: Using the Joanna Briggs Institute’s scoping review methodology, and PRISMA-ScR reporting guidelines, we searched 16 bibliographic databases and gray literature. Results were categorized using an adapted WHO-UNDP LGBTI Inclusion Index and reviewed using a rights-based approach to policy analysis and development.
Results: We identified 2,341 sources, scoped to 115 published from 2000 to 2020. LGBT + exclusion and discrimination were identified in multiple domains, e.g., bullying in schools, disproportionate rates of sexual violence, labor market exclusion, and health disparities. Policy proposals ranged from implementing more stringent LGBT + antidiscrimination legislation to increasing the scope and quality of LGBT + health services. Specific proposals included legalizing same-sex marriage, allowing individuals to change gender markers on identity documents, explicit inclusion of LGBT + people in laws against sexual assault/rape, and increasing data collection on LGBT + populations.
Conclusions: Numerous policy proposals address LGBT + inclusion in Thailand, though largely circumscribed to healthcare and education domains, with less attention to the family or personal security/violence. Policy Implications We illustrate the utility of a rights-based approach to policy analysis/development and use specific policy examples (e.g., same-sex marriage, government-issued identity cards, disaggregated data collection) to highlight its potential to pre-empt implementation of problematic and regressive policies, and to ensure policymakers comply with their international legal obligations.
Coronavirus disease 2019 (COVID-19)–related lockdowns in India have disrupted the meager sources of income of many transgender women, including those in the hijra subculture who largely rely on money from providing blessings, begging, and sex work. Many have expended savings and taken high-interest loans, contributing to psychological distress. For hijras engaged in sex work, challenges to negotiating condom use and adhering to COVID-19 protective measures increase risks for contracting HIV and COVID-19 amid decreased access to HIV services. Many transgender women face challenges accessing COVID-19–related government welfare programs as they lack legal gender identity documents. Multisectoral and transgender-competent approaches are needed to mitigate the impact of the pandemic.
Methods: The study employed an open qualitative, process-oriented exploratory design, using Focus Group Discussions (FGDs) to elicit mental models or key representations of critical research-related concepts from key constituencies, including CAB representatives, educators, and site staff involved in consent processes at an HIV prevention trial research site. Four FGDs were conducted - each constituency was interviewed separately - with approximately eight participants per group. Transcribed FGDs were subjected to thematic analysis by three qualitative researchers.
Results: Findings showed several barriers to credibility and trust around research, researchers, and key research-related concepts indicated by community members, which may complicate how concepts are understood, interpreted or believed. Study respondents reported and engaged in several strategies to build trust and develop research rapport - likely to be foundational to research participation. We found socio-economic, political, gender, race and culture-based mental models that may compete with or, alternatively, complement explanations of concepts offered by site-staff (e.g. vaccine-induced seropositivity [VISP]).
Conclusions: Authentic IC should involve a systematic exploration of these barriers and enablers to trust as part of the on-going IC process, to complement efforts to promote and assess understanding. We make a series of recommendations for stakeholders who wish to incorporate trust-building into their engagement and consent work to enhance partnering and decision-making for HIV prevention trials.
Author(s): Clinton L Rautenbach1, Graham C Lindegger1, Catherine M Slack1, Peter A Newman2, Melissa Wallace3
Institute(s): 1University of KwaZulu Natal, HIV/AIDS Vaccine Ethics Group (HAVEG), Pietermaritzburg,, South Africa, 2University of Toronto, Factor-Inwentash: Department of Social Work, Toronto, ON, Canada, 3Desmond Tutu HIV Foundation, Socio-Behavioural and Adolescent Division Leader, Cape Town, South Africa