Skip to main content
Top
Published in: BMC Public Health 1/2022

Open Access 01-12-2022 | Human Immunodeficiency Virus | Research

Understanding socio-sexual networks: critical consideration for HIVST intervention planning among men who have sex with men in Kenya

Authors: Lisa Lazarus, Ravi Prakash, Bernadette K. Kombo, Matthew Thomann, Kennedy Olango, Martin K. Ongaro, Samuel Kuria, Memory Melon, Helgar Musyoki, Souradet Shaw, Parinita Bhattacharjee, Robert Lorway

Published in: BMC Public Health | Issue 1/2022

Login to get access

Abstract

Background

HIV self-testing (HIVST) has emerged as a way of reaching individuals who may be less likely to access testing, including men who have sex with men (MSM). Understanding the social networks of MSM is key to tailoring interventions, such as HIVST, for particular locations.

Methods

We undertook a socio-sexual network study to characterize and identify patterns of connection among MSM and inform an HIVST intervention in three sites in Kenya. Community researchers in each site selected eight seeds to complete a demographic form and network surveys for 15 each of their sexual and social network members. Seeds recruited three respondents, including two regular service users and one MSM who was “unreached” by the program, who then each identified three respondents, resulting with data on 290 individuals.

Results

Findings illustrate the interconnectedness of community-based organization (CBO) members and non-members. In networks where a majority of members had a CBO membership, members had better contacts with programs and were more likely to have accessed health services. Larger networks had more HIV testing and seeds with frequent testing had a positive influence on their network members also being tested frequently. HIVST was tried in very few networks. Almost all network members were willing to use HIVST.

Conclusion

Willingness to use HIVST was nearly universal and points to the importance of networks for reaching individuals not enrolled in programs. Network analysis can help in understanding which type of networks had higher testing and how network-based approaches can be useful to promote HIVST in certain contexts.
Appendix
Available only for authorised users
Literature
1.
go back to reference UNAIDS. 90-90-90: An ambitious treatment target to help end the AIDS epidemic. Geneva: UNAIDS; 2014. UNAIDS. 90-90-90: An ambitious treatment target to help end the AIDS epidemic. Geneva: UNAIDS; 2014.
2.
go back to reference UNAIDS. Understanding fast-track: Accelerating action to end the AIDS epidemic by 2030. Geneva: UNAIDS; 2015. UNAIDS. Understanding fast-track: Accelerating action to end the AIDS epidemic by 2030. Geneva: UNAIDS; 2015.
3.
go back to reference WHO. Guidelines on HIV self-testing and partner notification: supplement to consolidated guidelines on HIV testing services. Geneva: World Health Organization (WHO); 2016. WHO. Guidelines on HIV self-testing and partner notification: supplement to consolidated guidelines on HIV testing services. Geneva: World Health Organization (WHO); 2016.
4.
go back to reference Musheke M, Ntalasha H, Gari S, et al. A systematic review of qualitative findings on factors enabling and deterring uptake of HIV testing in Sub-Saharan Africa. BMC Public Health. 2013;13(1):1–6.CrossRef Musheke M, Ntalasha H, Gari S, et al. A systematic review of qualitative findings on factors enabling and deterring uptake of HIV testing in Sub-Saharan Africa. BMC Public Health. 2013;13(1):1–6.CrossRef
5.
go back to reference Hlongwa M, Mashamba-Thompson T, Makhunga S, et al. Men’s perspectives on HIV self-testing in sub-Saharan Africa: a systematic review and meta-synthesis. BMC Public Health. 2020;20(1):1–3.CrossRef Hlongwa M, Mashamba-Thompson T, Makhunga S, et al. Men’s perspectives on HIV self-testing in sub-Saharan Africa: a systematic review and meta-synthesis. BMC Public Health. 2020;20(1):1–3.CrossRef
6.
go back to reference Arreola S, Tùng ĐT, Walimbwa J, Solares D. Structural violence, community and access to HIV services: Participatory action research & new findings from the Global Men’s Health & Rights Study. San Francisco: MPact; 2020. Arreola S, Tùng ĐT, Walimbwa J, Solares D. Structural violence, community and access to HIV services: Participatory action research & new findings from the Global Men’s Health & Rights Study. San Francisco: MPact; 2020.
7.
go back to reference Joint United Nations. Programme on HIV/AIDS. Miles to go. Closing gaps, breaking barriers, righting injustices. Global AIDS Update. Geneva: UNAIDS 2018. Joint United Nations. Programme on HIV/AIDS. Miles to go. Closing gaps, breaking barriers, righting injustices. Global AIDS Update. Geneva: UNAIDS 2018.
8.
go back to reference Thirumurthy H, Masters SH, Mavedzenge SN, et al. Promoting male partner HIV testing and safer sexual decision making through secondary distribution of self-tests by HIV-negative female sex workers and women receiving antenatal and post-partum care in Kenya: a cohort study. Lancet HIV. 2016;3(6):e266–74.CrossRef Thirumurthy H, Masters SH, Mavedzenge SN, et al. Promoting male partner HIV testing and safer sexual decision making through secondary distribution of self-tests by HIV-negative female sex workers and women receiving antenatal and post-partum care in Kenya: a cohort study. Lancet HIV. 2016;3(6):e266–74.CrossRef
9.
go back to reference Choko AT, Desmond N, Webb EL, et al. The uptake and accuracy of oral kits for HIV self-testing in high HIV prevalence setting: a cross-sectional feasibility study in Blantyre, Malawi. PLoS Med. 2011;8(10):e1001102.CrossRef Choko AT, Desmond N, Webb EL, et al. The uptake and accuracy of oral kits for HIV self-testing in high HIV prevalence setting: a cross-sectional feasibility study in Blantyre, Malawi. PLoS Med. 2011;8(10):e1001102.CrossRef
10.
go back to reference Choko AT, MacPherson P, Webb EL, et al. Uptake, accuracy, safety, and linkage into care over two years of promoting annual self-testing for HIV in Blantyre, Malawi: a community-based prospective study. PLoS Med. 2015;12(9):e1001873.CrossRef Choko AT, MacPherson P, Webb EL, et al. Uptake, accuracy, safety, and linkage into care over two years of promoting annual self-testing for HIV in Blantyre, Malawi: a community-based prospective study. PLoS Med. 2015;12(9):e1001873.CrossRef
11.
go back to reference Krause J, Subklew-Sehume F, Kenyon C, et al. Acceptability of HIV self-testing: a systematic literature review. BMC Public Health. 2013;13(1):1–9.CrossRef Krause J, Subklew-Sehume F, Kenyon C, et al. Acceptability of HIV self-testing: a systematic literature review. BMC Public Health. 2013;13(1):1–9.CrossRef
12.
go back to reference Qin Y, Han L, Babbitt A, et al. Experiences using and organizing HIV self-testing: a global qualitative systematic review. AIDS. 2018;32(3):371.CrossRef Qin Y, Han L, Babbitt A, et al. Experiences using and organizing HIV self-testing: a global qualitative systematic review. AIDS. 2018;32(3):371.CrossRef
13.
go back to reference Indravudh PP, Hensen B, Nzawa R, et al. Who is reached by HIV self-testing? Individual factors associated with self-testing within a community-based program in rural Malawi. JAIDS. 2020;85(2):165–73.PubMed Indravudh PP, Hensen B, Nzawa R, et al. Who is reached by HIV self-testing? Individual factors associated with self-testing within a community-based program in rural Malawi. JAIDS. 2020;85(2):165–73.PubMed
14.
go back to reference Knight L, Makusha T, Lim J, et al. “I think it is right”: a qualitative exploration of the acceptability and desired future use of oral swab and finger-prick HIV self-tests by lay users in KwaZulu-Natal, South Africa. BMC Res Notes. 2017;10(1):1–8.CrossRef Knight L, Makusha T, Lim J, et al. “I think it is right”: a qualitative exploration of the acceptability and desired future use of oral swab and finger-prick HIV self-tests by lay users in KwaZulu-Natal, South Africa. BMC Res Notes. 2017;10(1):1–8.CrossRef
15.
go back to reference Conserve DF, Muessig KE, Maboko LL, et al. Formative research to develop the Tanzania HIV self-testing education and promotion (Tanzania STEP) project for men. PloS one. 2018;13(8):e0202521.CrossRef Conserve DF, Muessig KE, Maboko LL, et al. Formative research to develop the Tanzania HIV self-testing education and promotion (Tanzania STEP) project for men. PloS one. 2018;13(8):e0202521.CrossRef
16.
go back to reference Ngure K, Heffron R, Mugo N, et al. Feasibility and acceptability of HIV self-testing among pre-exposure prophylaxis users in Kenya. JIAS. 2017;20(1):21234.CrossRef Ngure K, Heffron R, Mugo N, et al. Feasibility and acceptability of HIV self-testing among pre-exposure prophylaxis users in Kenya. JIAS. 2017;20(1):21234.CrossRef
17.
go back to reference Zhang C, Li X, Brecht ML, et al. Can self-testing increase HIV testing among men who have sex with men: a systematic review and meta-analysis. PloS One. 2017;12(11):e0188890.CrossRef Zhang C, Li X, Brecht ML, et al. Can self-testing increase HIV testing among men who have sex with men: a systematic review and meta-analysis. PloS One. 2017;12(11):e0188890.CrossRef
18.
go back to reference Hamilton A, Thompson N, Choko AT, et al. HIV self-testing uptake and intervention strategies among men in Sub-Saharan Africa: a systematic review. Frontiers in Public Health. 2021;9:60.CrossRef Hamilton A, Thompson N, Choko AT, et al. HIV self-testing uptake and intervention strategies among men in Sub-Saharan Africa: a systematic review. Frontiers in Public Health. 2021;9:60.CrossRef
19.
go back to reference Kenworthy N, Thomann M, Parker R. From a global crisis to the ‘end of AIDS’: New epidemics of signification. Global Public Health. 2018;13(8):960–71.CrossRef Kenworthy N, Thomann M, Parker R. From a global crisis to the ‘end of AIDS’: New epidemics of signification. Global Public Health. 2018;13(8):960–71.CrossRef
20.
go back to reference Baral S, Logie CH, Grosso A, et al. Modified social ecological model: a tool to guide the assessment of the risks and risk contexts of HIV epidemics. BMC Public Health. 2013;13(1):1–8.CrossRef Baral S, Logie CH, Grosso A, et al. Modified social ecological model: a tool to guide the assessment of the risks and risk contexts of HIV epidemics. BMC Public Health. 2013;13(1):1–8.CrossRef
21.
go back to reference Chan PA, Crowley C, Rose JS, et al. A network analysis of sexually transmitted diseases and online hookup sites among men who have sex with men. Sex Transm Dis. 2018;45(7):462.CrossRef Chan PA, Crowley C, Rose JS, et al. A network analysis of sexually transmitted diseases and online hookup sites among men who have sex with men. Sex Transm Dis. 2018;45(7):462.CrossRef
22.
go back to reference Lorway R, Shaw SY, Hwang SD, et al. From individuals to complex systems: exploring the sexual networks of men who have sex with men in three cities of Karnataka, India. Sex Transm Infect. 2010;86(Suppl 3):iii70-8.CrossRef Lorway R, Shaw SY, Hwang SD, et al. From individuals to complex systems: exploring the sexual networks of men who have sex with men in three cities of Karnataka, India. Sex Transm Infect. 2010;86(Suppl 3):iii70-8.CrossRef
23.
go back to reference Maina G, Strudwick G, Lalani Y, et al. Characterizing the structure and functions of social networks of men who have sex with men in Ghana, West Africa: implications for peer-based HIV prevention. J Assoc Nurses AIDS Care. 2018;29(1):70–82.CrossRef Maina G, Strudwick G, Lalani Y, et al. Characterizing the structure and functions of social networks of men who have sex with men in Ghana, West Africa: implications for peer-based HIV prevention. J Assoc Nurses AIDS Care. 2018;29(1):70–82.CrossRef
24.
go back to reference Spicknall IH, Gift TL, Bernstein KT, et al. Sexual networks and infection transmission networks among men who have sex with men as causes of disparity and targets of prevention. Sex Transm Infect. 2017;93(5):307–8.CrossRef Spicknall IH, Gift TL, Bernstein KT, et al. Sexual networks and infection transmission networks among men who have sex with men as causes of disparity and targets of prevention. Sex Transm Infect. 2017;93(5):307–8.CrossRef
25.
go back to reference Luke DA, Harris JK. Network analysis in public health: history, methods, and applications. Annu Rev Public Health. 2007;28:69–93.CrossRef Luke DA, Harris JK. Network analysis in public health: history, methods, and applications. Annu Rev Public Health. 2007;28:69–93.CrossRef
26.
go back to reference Amirkhanian YA. Social networks, sexual networks and HIV risk in men who have sex with men. Curr HIV/AIDS Rep. 2014;11(1):81–92.CrossRef Amirkhanian YA. Social networks, sexual networks and HIV risk in men who have sex with men. Curr HIV/AIDS Rep. 2014;11(1):81–92.CrossRef
27.
go back to reference Xiao W, Yan L, Chen L, et al. Sexual network distribution of HIV self-testing kits: Findings from the process evaluation of an intervention for men who have sex with men in China. PloS One. 2020;15(4):e0232094.CrossRef Xiao W, Yan L, Chen L, et al. Sexual network distribution of HIV self-testing kits: Findings from the process evaluation of an intervention for men who have sex with men in China. PloS One. 2020;15(4):e0232094.CrossRef
28.
go back to reference Lippman SA, Lane T, Rabede O, et al. High acceptability and increased HIV testing frequency following introduction of HIV self-testing and network distribution among South African MSM. JAIDS. 2018;77(3):279.PubMed Lippman SA, Lane T, Rabede O, et al. High acceptability and increased HIV testing frequency following introduction of HIV self-testing and network distribution among South African MSM. JAIDS. 2018;77(3):279.PubMed
29.
go back to reference Okoboi S, Lazarus O, Castelnuovo B, et al. Peer distribution of HIV self-test kits to men who have sex with men to identify undiagnosed HIV infection in Uganda: a pilot study. PloS One. 2020;15(1):e0227741.CrossRef Okoboi S, Lazarus O, Castelnuovo B, et al. Peer distribution of HIV self-test kits to men who have sex with men to identify undiagnosed HIV infection in Uganda: a pilot study. PloS One. 2020;15(1):e0227741.CrossRef
30.
go back to reference Lightfoot MA, Campbell CK, Moss N, et al. Using a social network strategy to distribute HIV self-test kits to African American and Latino MSM. JAIDS. 2018;79(1):38–45.PubMed Lightfoot MA, Campbell CK, Moss N, et al. Using a social network strategy to distribute HIV self-test kits to African American and Latino MSM. JAIDS. 2018;79(1):38–45.PubMed
31.
go back to reference Bhattacharjee P, Rego D, Musyoki H, et al. Evaluation of community-based HIV self-testing delivery strategies on reducing undiagnosed HIV infection, and improving linkage to prevention and treatment services, among men who have sex with men in Kenya: a programme science study protocol. BMC Public Health. 2019;19(1):1–3.CrossRef Bhattacharjee P, Rego D, Musyoki H, et al. Evaluation of community-based HIV self-testing delivery strategies on reducing undiagnosed HIV infection, and improving linkage to prevention and treatment services, among men who have sex with men in Kenya: a programme science study protocol. BMC Public Health. 2019;19(1):1–3.CrossRef
34.
go back to reference National AIDS and STI Control Programme (NASCOP), Kenya. Key population mapping and size estimation in selected counties in Kenya: Phase 1- Key Findings. Kenya: Ministry of Health; 2019. National AIDS and STI Control Programme (NASCOP), Kenya. Key population mapping and size estimation in selected counties in Kenya: Phase 1- Key Findings. Kenya: Ministry of Health; 2019.
36.
go back to reference National AIDS and STI Control Programme (NASCOP), Kenya. Quarterly Programme Reports. Kenya: Ministry of Health; 2018. National AIDS and STI Control Programme (NASCOP), Kenya. Quarterly Programme Reports. Kenya: Ministry of Health; 2018.
37.
go back to reference Israel BA, Schulz AJ, Parker EA, et al. Review of community-based research: assessing partnership approaches to improve public health. Annu Rev Public Health. 1998;19(1):173–202.CrossRef Israel BA, Schulz AJ, Parker EA, et al. Review of community-based research: assessing partnership approaches to improve public health. Annu Rev Public Health. 1998;19(1):173–202.CrossRef
38.
go back to reference Anderson EE. CIRTification: Community involvement in research training. Facilitator manual. Chicago: Center for Clinical and Translational Science. University of Illinois; 2012. Anderson EE. CIRTification: Community involvement in research training. Facilitator manual. Chicago: Center for Clinical and Translational Science. University of Illinois; 2012.
39.
go back to reference Tun W, Vu L, Dirisu O, et al. Uptake of HIV self-testing and linkage to treatment among men who have sex with men (MSM) in Nigeria: A pilot programme using key opinion leaders to reach MSM. JIAS. 2018;21:e25124.CrossRef Tun W, Vu L, Dirisu O, et al. Uptake of HIV self-testing and linkage to treatment among men who have sex with men (MSM) in Nigeria: A pilot programme using key opinion leaders to reach MSM. JIAS. 2018;21:e25124.CrossRef
40.
go back to reference World Health Organization. WHO recommends HIV self-testing: evidence update and considerations for success: policy brief: World Health Organization; 2019. World Health Organization. WHO recommends HIV self-testing: evidence update and considerations for success: policy brief: World Health Organization; 2019.
Metadata
Title
Understanding socio-sexual networks: critical consideration for HIVST intervention planning among men who have sex with men in Kenya
Authors
Lisa Lazarus
Ravi Prakash
Bernadette K. Kombo
Matthew Thomann
Kennedy Olango
Martin K. Ongaro
Samuel Kuria
Memory Melon
Helgar Musyoki
Souradet Shaw
Parinita Bhattacharjee
Robert Lorway
Publication date
01-12-2022
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2022
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/s12889-022-12901-x

Other articles of this Issue 1/2022

BMC Public Health 1/2022 Go to the issue