‘MSM’ as a ‘doing thing’

Drawing upon long-term ethnographic research in Namibia, I examine the label ‘MSM’ through a materialist interpretation of affect, viewing ‘MSM’ as a ‘doing thing’ that unsettles the boundaries between subjects and objects. From this analytic perspective, I reconsider the ‘MSM’ label as an inadequate signifier that overlooks, conceals, or erases social complexity. Instead, this perspective reveals what happens when the MSM label travels, thereby better accounting for the socialities it is instrumental in making up. Its very design and appearance – which portray bodies and behaviours in universalistic ways – allow this ‘doing thing’ to gain entry to diverse spaces where it comes to exist alongside some contentious postcolonial political formations, such as those surrounding LGBT rights. I argue that although the label is designed to be insulated from politics, as a ‘neutral’ behavioural category, when ‘MSM’ travels it is still highly relational, continually entangling itself in contexts, stirring up postcolonial anxieties, and reinforcing global inequalities, while also setting the stage for global health worlds coming into being

Making up MSM

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Views and Experiences of Mucosal Sampling in HIV Clinical Research among Kenyan Volunteers

HIV transmission predominantly occurs across mucosal surfaces. Efforts to find an effective and efficacious HIV vaccine, requires understanding the various mechanisms of sexual HIV transmission including immune responses to various HIV vaccine candidates along the mucosal pathways.  In this paper, we describe the experiences of health volunteers in three Phase 1 HIV vaccines trials and an observation study that comprised of high- risk and low risk healthy participants with regard to the collection of rectal, cervical and seminal mucosal samples. The paper emanates from a study that examined the views and experiences of volunteers in participating in HIV clinical research, at the KAVI-Institute of Clinical Research, Nairobi, Kenya. The study followed a mixed methods phenomenological research approach with a dominant qualitative strand. In the first phase, quantitative data was collected via a survey questionnaire involving 116 volunteers that helped identify 28 volunteers for the qualitative phase.  Quantitative data were analyzed using SPPS while qualitative data was transcribed verbatim, thematic themes identified for coding and entered into Atlas ti for analysis. Participants had a mean age of 28.5 ± 5.7 years (range 20–51 years). There were more males (n =85) than females (n= 31). In general, volunteers expressed mixed reactions towards the collection and use of mucosal samples. Both none-consenting and consenting volunteers cited invasiveness of their privacy.Also reported were experiences of physical and psychological discomforts, with men terming the collection of semen via masturbation as unnatural and contravening individuals’ religious and cultural beliefs. The findings reveal a knowledge gap among community members with use of mucosal samples and modes of collection

‘That is because we are alone’:A relational qualitative study of socio-spatial inequities in maternal and newborn health programme coverage in rural Uttar Pradesh, India

This qualitative study was conducted in Uttar Pradesh state, India to explore how interrelated socio-economic position and spatial characteristics of four diverse villages may have influenced equity in coverage of community-based maternal and newborn health (MNH) services. We conducted social mapping and three focus group discussions in each village, among women of lower and higher socio-economic position who recently gave birth, and with community health workers (n = 134). Data were analysed in NVivo 11.0 using thematic framework analysis. The extent of socio-economic hierarchies and spatial disparateness within the village, combined with distance to larger centers, together shaped villages’ level of socio-spatial remoteness. Disadvantaged socio-economic groups expressed being more often spatially isolated, with less access to infrastructure, resources or services, which was heightened if the village was physically distant from larger centers. In more socio-spatially remote villages, inequities in coverage of MNH services that disadvantaged lower socio-economic position groups were compounded as these groups more often experienced ASHA vacancies, as well as greater distance to and poorer perceived quality of health services nearest the village. The results inform a conceptual framework of ‘socio-spatial remoteness’ that can guide public health research and programmes to more comprehensively address health inequities within India and beyond.</p

‘That is because we are alone’:A relational qualitative study of socio-spatial inequities in maternal and newborn health programme coverage in rural Uttar Pradesh, India

This qualitative study was conducted in Uttar Pradesh state, India to explore how interrelated socio-economic position and spatial characteristics of four diverse villages may have influenced equity in coverage of community-based maternal and newborn health (MNH) services. We conducted social mapping and three focus group discussions in each village, among women of lower and higher socio-economic position who recently gave birth, and with community health workers (n = 134). Data were analysed in NVivo 11.0 using thematic framework analysis. The extent of socio-economic hierarchies and spatial disparateness within the village, combined with distance to larger centers, together shaped villages’ level of socio-spatial remoteness. Disadvantaged socio-economic groups expressed being more often spatially isolated, with less access to infrastructure, resources or services, which was heightened if the village was physically distant from larger centers. In more socio-spatially remote villages, inequities in coverage of MNH services that disadvantaged lower socio-economic position groups were compounded as these groups more often experienced ASHA vacancies, as well as greater distance to and poorer perceived quality of health services nearest the village. The results inform a conceptual framework of ‘socio-spatial remoteness’ that can guide public health research and programmes to more comprehensively address health inequities within India and beyond.</p

Women in health and their economic, equity and livelihood statuses during emergency preparedness and response (WHEELER) protocol: a mixed methods study in Kenya.

Introduction: Kenya reported its first COVID-19 case on 13 March 2020. Pandemic-driven health system changes followed and unforeseen societal, economic and health effects reported. This protocol aims to describe the methods used to identify the gender equality and health equity gaps and possible disproportional health and socioeconomic impacts experienced by paid and unpaid (community health volunteer) female healthcare providers in Kilifi and Mombasa Counties, Kenya during the COVID-19 pandemic. Methods and analysis: Participatory mixed methods framed by gender analysis and human-centred design will be used. Research implementation will follow four of the five phases of the human-centred design approach. Community research advisory groups and local advisory boards will be established to ensure integration and the sustainability of participatory research design. Ethics and dissemination: Ethical approval was obtained from the Institutional Scientific and Ethics Review Committee at the Aga Khan University and the University of Manitoba. This study will generate evidence on root cultural, structural, socioeconomic and political factors that perpetuate gender inequities and female disadvantage in the paid and unpaid health sectors. It will also identify evidence-based policy options for future safeguarding of the unpaid and paid female health workforce during emergency preparedness, response and recovery periods

Factors Associated with Sexual Violence against Men Who Have Sex with Men and Transgendered Individuals in Karnataka, India

There is a lack of information on sexual violence (SV) among men who have sex with men and transgendered individuals (MSM-T) in southern India. As SV has been associated with HIV vulnerability, this study examined health related behaviours and practices associated with SV among MSM-T.Data were from cross-sectional surveys from four districts in Karnataka, India.Multivariable logistic regression models were constructed to examine factors related to SV. Multivariable negative binomial regression models examined the association between physician visits and SV.A total of 543 MSM-T were included in the study. Prevalence of SV was 18% in the past year. HIV prevalence among those reporting SV was 20%, compared to 12% among those not reporting SV (p = .104). In multivariable models, and among sex workers, those reporting SV were more likely to report anal sex with 5+ casual sex partners in the past week (AOR: 4.1; 95%CI: 1.2-14.3, p = .029). Increased physician visits among those reporting SV was reported only for those involved in sex work (ARR: 1.7; 95%CI: 1.1-2.7, p = .012).These results demonstrate high levels of SV among MSM-T populations, highlighting the importance of integrating interventions to reduce violence as part of HIV prevention programs and health services