Using Conjoint Analysis to Measure the Acceptability of Rectal Microbicides Among Men Who Have Sex with Men in Four South American Cities

via Pubmed.gov, by Kinsler JJ, Cunningham WE, Nureña CR, Nadjat-Haiem C, Grinsztejn B, Casapia M, Montoya-Herrera O, Sánchez J, Galea JT.

Abstract

Conjoint Analysis (CJA), a statistical market-based technique that assesses the value consumers place on product characteristics, may be used to predict acceptability of hypothetical products. Rectal Microbicides (RM)-substances that would prevent HIV infection during receptive anal intercourse-will require acceptability data from potential users in multiple settings to inform the development process by providing valuable information on desirable product characteristics and issues surrounding potential barriers to product use. This study applied CJA to explore the acceptability of eight different hypothetical RM among 128 MSM in Lima and Iquitos, Peru; Guayaquil, Ecuador; and Rio de Janeiro, Brazil. Overall RM acceptability was highest in Guayaquil and lowest in Rio. Product effectiveness had the greatest impact on acceptability in all four cities, but the impact of other product characteristics varied by city. This study demonstrates that MSM from the same region but from different cities place different values on RM characteristics that could impact uptake of an actual RM. Understanding specific consumer preferences is crucial during RM product development, clinical trials and eventual product dissemination.



[If an item is not written by an IRMA member, it should not be construed that IRMA has taken a position on the article's content, whether in support or in opposition.]

Meet Daniel Julio Eduardo Nuñez - A Friendly Rectal Microbicide Advocate

"If we create a circle of people around you that at least know a word or two about rectal microbicides I believe the work is done, because everyone has his own circle, so the knowledge in one way or another will flow." - Daniel Julio Eduardo Nuñez, Lima, Peru

Daniel Nuñez is studying law. While working towards his law degree he began working at Epicentro with his local gay community. It is at Epicentro that Daniel met an IRMA member (Epicentro is the headquarters for IRMA-ALC, IRMA's South American sister) and, anxious to find out more about rectal microbicides, immediately sought more information. He was quickly inspired to spread the word about IRMA and its goals.

Daniel realizes that rectal microbicides are important "because we are humans and not robots, we don't necessarily act following a program and sometimes we do things that don't correspond to safe sexual behavior". Because of this he works to make many prevention options available to everyone.

He urges every IRMA advocate and anyone interested in microbicides or HIV prevention at all to discuss options and knowledge with family and friends. With each person able to talk openly and knowledgeably about AIDS and HIV prevention, Daniel hopes that the topic will become less taboo and more can be done in the fight against AIDS.

In his free time Daniel provides freelance tech support, but he enjoys it so it doesn't feel like work. He also enjoys watching TV programs from the United States such as A Game of Thrones, his current favorite show.

Read about other friendly rectal microbicides advocates. Newly featured advocates include Luis Fernando Galarza, Amy Stapleford Jackson, Maheswar Satpathy, Vanessa Marquez, and Mark Hubbard.

Want to join the best e-mail discussion list on new prevention technologies on the planet? Send a note to IRMA here - rectalmicro@gmail.com - and we will get you signed up.Joining the list makes you an automatic IRMA member too!

[If an item is not written by an IRMA member, it should not be construed that IRMA has taken a position on the article's content, whether in support or in opposition.]

IRMA ALC Presents on PrEP and Rectal Microbicides for Lima's Gay Community

by Steve Miralles

On May 11th, IRMA ALC (América Latina y el Caribe), based at Epicentro Gay Men’s Community Center in Lima, Peru, hosted a presentation on PrEP and rectal microbicides.

More than 15 men attended the presentation that was facilitated by IRMA-ALC leaders Steve Miralles and Jerome Galea.

The 15 community members included doctors, lawyers, psychologists and others participated in an open discussion/dialogue about these HIV prevention interventions under investigation and information was shared on the current state of the field of rectal microbicides and the inclusion of Lima in a RM study hopefully in 2012. 

Also, the results of the PrEP study (iPrEx) which took place in Lima was discussed along with the study’s results and how PrEP could change the HIV panorama.

Participants received IRMA's Spanish edition of the report “From Promise to Product” (De la Promesa al Producto: Avanzando en la Investigación y Promoción de los Microbicidas Rectales) AVAC fact sheets on iPrEx and other information and resources available in Spanish thanks to the IRMA-ALC team.

Now underway is the preparation of a radio program about rectal microbicides and iPrex to be aired in July on Epicentro's weekly program Espacio Común and an article for the next edition of Epicentro's magazine La Antena.

Visit IRMA ALC on Facebook. And check out the IRMA ALC page on the IRMA website to see some of those Spanish resources.

Also available in Spanish are IRMA's documents on lube safety:

Safety of lubricants for rectal use: A fact sheet for HIV educators and advocates

Safety of lubricants for rectal use: Questions & Answers for HIV educators and advocates

[If an item is not written by an IRMA member, it should not be construed that IRMA has taken a position on the article's content, whether in support or in opposition.]

Acceptability of pre-exposure prophylaxis as an HIV prevention strategy: barriers and facilitators to pre-exposure prophylaxis uptake among at-risk Peruvian populations

IRMA Steering Committee member Jerome T. Galea is lead author of this fascinating paper. Here he provides an overview of the study.

Click here to access the full paper.

"The study examined pre-exposure prophylaxis acceptability (PrEP) among female sex workers, male-to-female transgendered persons and men who have sex with men in Lima, Peru.  Focus groups explored social issues associated with PrEP acceptability and Conjoint Analysis – a consumer research market technique – assessed the preferences participants had with regards to eight hypothetical PrEP “scenarios”.  This was the first study of it's kind to apply this technique.

"Each scenario was made up of the same characteristics but differed slightly (for example, higher cost versus lower cost; daily dosing versus non-daily dosing; some side effects versus no side effects, and so on).  Participants had to rank the scenarios in order of preference taking into account all of the product’s chacteristics, and in doing so expressed the value they placed on the various characteristics.  Focus groups helped to explain the reasons behind the preferences made.

"There were some unexpected findings. For example, cost trumped effectiveness; a low-out-of pocket cost had the single greatest impact on PrEP acceptability. While we expected cost to be an important factor we were surprised that it was more important than the ability of the product to actually prevent HIV infection. 

"Another surprise was that in the focus groups we learned that participants preferred that PrEP be dispensed in health centers as opposed to pharmacies. This surprised us as we hypothesized that pharmacies would provide faster, easier and more widespread access, but participants cited privacy concerns with PrEP being dispensed by pharmacies.

"The next step is to replicate this sort of research to more populations at risk in different settings. We have learned that the existence of an effective product does not guarantee its use (recent studies on the female condom, for example, highlight the challenges of understanding the needs and perceptions of the target user and also the necessity of dispelling myths that often arise when new products are introduced). 

"We cannot generalize our findings to all persons at risk for HIV, in Peru or elsewhere, but do propose it as a model for future exploration of the topic now that oral PrEP has been shown to work but has not yet been scaled up for widespread use."

*Read AIDSmeds coverage of this study here.


[If an item is not written by an IRMA member, it should not be construed that IRMA has taken a position on the article's content, whether in support or in opposition.]

Circumcision Does Not Protect MSM of Peru and US From HIV

via International AIDS Society, by Mark Mascolini

Circumcision did not protect men who have sex with men (MSM) from acquiring HIV infection, according to an analysis of more than 1800 men in Peru and the United States. The findings confirm results of earlier studies. Three randomized trials in Africa showed that circumcision does lower the risk of HIV infection in heterosexual men.

This analysis involved 1824 MSM, 1362 (75%) of them from Peru and 462 (25%) from the United States. All men were negative for HIV and positive for herpes simplex virus type 2 (HSV-2). They were enrolled in a randomized placebo-controlled trial of HSV-2 suppression to prevent HIV infection. That study found treating HSV-2 did not lower the risk of HSV-2 acquisition.

All study participants were assessed for circumcision status at enrollment and were tested for HIV every 3 months for up to 18 months. Researchers determined partner-specific sexual behavior for up to the last 3 partners during the previous 3 months.

Univariate analysis revealed no significant association between circumcision and HIV acquisition (relative risk [RR] 0.84, 95% confidence interval [CI] 0.50 to 1.42). Multivariate analysis that assumed a linear relationship between the proportion of insertive sex acts and effect of circumcision on HIV acquisition found that the interaction between circumcision and the proportion of insertive acts was not significant in lowering HIV risk (P = 0.11).

A third analysis that divided men into those who had fewer than 60 insertive acts with recent partners and those who had 60 or more partners determined that circumcision reduced the risk of HIV acquisition 69% (RR 0.31), but that association was not statistically significant (95% CI 0.06 to 1.51) among men who repeated at least 60% of insertive acts with recent male partners.

The researchers conclude that “circumcision does not have a significant protective effect against HIV acquisition among MSM from Peru and US.” However, they suggest “there may be reduced risk for men who are primarily insertive with their male partners” and they call for further investigation of this association.

Source: Jorge Sánchez, Victor G. Sal y Rosas, James P. Hughes, Jared M. Baeten, Jonathan Fuchs, Susan P. Buchbinder, Beryl A. Koblin, Martín Casapia, Abner Ortiz, Connie Celum. Male circumcision and risk of HIV acquisition among MSM. AIDS. 2011; 25: 519-529.

Click here for the study abstract.

[If an item is not written by an IRMA member, it should not be construed that IRMA has taken a position on the article's content, whether in support or in opposition.]

Meet a Friendly Rectal Microbicide Advocate: Gerald Díaz Panduro

via IRMA

Panduro is a psychologist from Huánuco, Perú that focuses on HIV/AIDS and people living with HIV/AIDS.

While recruiting participants for a UCLA rectal microbicide study in Lima, Panduro stumbled upon IRMA-ALC, which had also been involved with the study. Since then, Panduro has been spreading the word about rectal microbicides and raising interest in the hopes that a rectal microbicide study might take place in Perú.

Panduro believes that once there is an effective microbicide available, when it's combined with condoms it will be the best tool to fight HIV/AIDS.

Panduro also enjoys going to the movies and photography.

Read about other friendly rectal microbicides advocates

Learn more about IRMA membership

[If an item is not written by an IRMA member, it should not be construed that IRMA has taken a position on the article's content, whether in support or in opposition.]

IRMA's South American Chapter Celebrates Our New Report

by Steve Miralles of IRMA-ALC

Last Friday September 24 the Spanish version of IRMA's latest report - From Promise to Product: Advancing Rectal Microbicide Research and Advocacy - was officially presented in Lima, Peru at Epicentro - a social organization that provides information about sexual and holistic health, as well as cultural activities, to the gay community in Lima. Epicentro is also the home of IRMA-ALC (América Latina y El Caribe.)

In this event we had the participation of doctors, psychologists, persons from trans groups, representatives of PLWHA groups, researchers, activists, IRMA members and general public interested in learning about rectal microbicides and its perspectives in Latin America.

For those wishing to obtain a printed copy of the report in Spanish (De la Promesa al Producto: Avanzando en la Investigación y Promoción de los Microbicidas Rectales) can communicate by mail irma-alc@epicentro.org.pe , or you can download it in Spanish on the IRMA-ALC page of the IRMA website.

Visit IRMA-ALC on Facebook.





Este viernes 24 de septiembre fue presentado en Lima, Perú en Epicentro (un espacio de socialización en Lima, donde se brindaran servicios e información sobre salud sexual y mental, además de fomentar actividades culturales) el informe realizado por IRMA e IRMA-LAC (América Latina y El Caribe), De la Promesa al Producto: Avanzando en la Investigación y Promoción de los Microbicidas Rectales.

En este evento contamos con la participación de médicos, psicólogos, representantes de grupos trans, representantes de grupos de PVVS, investigadores, activistas, representantes de IRMA y público en general, interesados en conocer el panorama en Latinoamérica de microbicidas rectales.

Para quien desee obtener una copia de dicho informe en español puede comunicarse al correo irma-alc@epicentro.org.pe , o si desea, puede obtener el informe en pdf aqui.

IRMA-LAC en Facebook.

Closeted Calamity: The Hidden HIV Epidemic of Men Who Have Sex with Men

via Scientific American, by Bob Roehr

Excerpt:

Even in Africa, at the heart of the pandemic, in Malawi, 21 percent of MSM are infected with the virus compared with 11 percent of the general population, whereas Zambia's rates are 33 percent versus 15 percent, respectively, says Chris Beyrer, director of the Johns Hopkins Center of Public Health and Human Rights.

"The argument that gay and bisexual men are a trivial sideshow in the global fight against AIDS is wrong," he told the Global Forum on MSM and HIV, an advocacy network that met this summer prior to the International AIDS Conference in Vienna, Austria.

Read the rest.