Hiv gay dating Belem Brazil
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Additionally, bias associated with interviewers selecting participants is avoided 16 RDS requires researchers to understand some of the underlying networks of the population being recruited, to assess if seed selection unduly influenced the final sample, and to identify recruitment bottlenecks and missed subpopulations. Gile et al. J Royal Statistical Soc ; 1 : J Clin Epidemiol ; 68 12 : Thumbnail Figure 1. All of the surveys were conducted in public health facilities except in Belo Horizonte and Salvador where private offices were used. Study working hours were adjusted to include evenings or weekends as required.
The study sites consisted of a receptionist and waiting area, interview areas, and a private room for testing and counseling. Our sample included men, 18 years of age or older, reporting oral or anal sex with another man or transgender woman travesti in the last 12 months; and living, studying, or working in the studied city. Respondents were asked about their relationship to the person providing the coupon.
The questionnaire and biological testing were consented separately, and participants could opt out of testing. Individuals under the influence of drugs or alcohol, or who identified as a transgender woman, were excluded. RDS requires a design effect DE multiplier. DE is the ratio of the actual variance to the variance expected with simple random sampling. Wejnert et al. Estimating design effect and calculating sample size for respondent-driven sampling studies of injection drug users in the United States.
AIDS Behav ; 16 4 : Donors limited sample size to per city, which complies with a DE of 2. Most RDS studies reach convergence at wave 5 or 6, much earlier than the sample size of participants. Centers for Disease Control and Prevention. Round 4: Formative Research Manual. City: Centers for Disease Control and Prevention; Formative research to optimize respondent-driven sampling surveys among hard-to-reach populations in HIV behavioral and biological surveillance: lessons learned from four case studies. AIDS Care ; 22 6 : The individual and FGD interview guides covered sexual identities, social and geographic organization of MSM in each city and perceived community acceptance, including violence, homophobia and stigma.
Questions related to study logistics such as the site of the study, hours of operation, social network size questions, willingness to participate and to test in the study and potential to serve as seeds were explored until saturation of responses for that topic was achieved. Data collection for the formative research was conducted between December and March, FR was conducted by a team consisting of the national and site coordinators, and a qualitative research expert to assure uniformity. Interviews for both individual and FGDs were recorded but not transcribed.
Initial interview notes were expanded by reviewing the recordings. We conducted 58 one-on-one interviews and 17 FGDs. Site coordinators were instructed to continue documenting community response and other issues during the study. Five to six seeds were identified for each site. After completing the survey interview and testing , each seed received three non-reproducible coupons to distribute.
Gay and bisexual men were more likely to have combined sex and drugs
In some sites one or two seeds were added when the directors were concerned about the speed of recruitment Table 1. Seeds and recruiters were trained to provide a detailed explanation of the study to their recruits. The need to recruit participants that met eligibility requirements from their personal networks was emphasized.
If the participant allowed, telephone messaging was used to remind respondents of appointments and to contact recruiters if their recruitees did not show up. Thumbnail Table 1. Arriving at the site, eligibility of the recruit was reviewed. Reasons for non-eligibility were explained and HIV educational materials and condoms given. Coupons and IDs were managed with an on-line coupon generator. The recruit was then read a description of the study, and risks and benefits of participation. Of these how many would you invite to participate in this study?
Following counseling, two tubes of venous blood were drawn. Respondents were counseled and immediately referred if positive. For syphilis and all positive tests, results were explained to respondents and they were referred for counseling and treatment. A series of four workshops about RDS was held: introduction to RDS, organization of the study, data analysis, and write-up.
Organization of the study was a 3-day workshop for site coordinators who then trained their local teams. Following the workshop, a pilot implementation was then conducted in each site. After this exercise, the teams met via videoconference to identify issues. Videoconferences were held repeatedly with sites until concerns were successfully addressed. When necessary, sites were visited in person. All study procedures including scheduling interviews, tablet use, pre-test counseling, referral, post-test counseling, coupon generation and incentive management were documented in standard operating procedure SOP manuals, provided to and approved by the DIAHV before initiation of fieldwork.
The questionnaire was adapted from the BBSS questionnaire used in Brazil and contained items to report international AIDS indicators for Brazil and other questions related to the national program. The questionnaire was modified to:. Each site was equipped with high-speed and reliable internet provided by the project. Information entered from computer or tablet was encrypted, uploaded and stored on the project website. The reference laboratory stored their data locally and on mirrored backups offsite.
Asmentioned above, all participants signed a consent form to participate in the interview and separately consented for each test that was offered. There appeared to be little reluctance to participate in both parts of the study, confirming results obtained from formative research. Analysis proceeded as follows.
Respondent-driven sampling: an assessment of current methodology. Sociol Methodol ; 40 1 : The estimator assumes a finite population and requires a population size estimate for each sample. To calculate this, we used the proportion of men who self-reported as having had at least one same-sex relationship in the National Survey of Knowledge, Attitudes and Practices in the Brazilian population 18 - 64 conducted in 31 This survey was powered to provide regional estimates.
Introduction
We applied this regional estimate to the total male population 18 - 64 in each city of that region as provided by the Brazilian Institute of Geography and Statistics 32 IBGE; [accessed on Jul. Both results 3. Battaggia GE. To provide a national estimate, we merged the 12 cities to create a single dataset. A total of 4, respondents was recruited Table 1. Some summary sociodemographic details of the final sample are presented in Table 2.
Thumbnail Table 2.
Socioeconomic and demographic characteristics of participants in 12 cities. As proposed in Gile et al. Additional tools include convergence and bottleneck plots. Convergence - a stable estimate of the true population proportion- should be achieved rapidly for major variables. Bottleneck plots visually demonstrate convergence by recruitment chain: widely different indicator estimates by chain would signal important differences by seed and a failure to find a true population proportion. Review of convergence and bottlenecks is through visual inspection and interpretation Table 1 and Figure2.
The convergence plot shows when in recruitment the outcome estimate is determinedThe bottleneck plot shows the estimate in terms of each recruitment chain. Visual inspection can show if one or several chains demonstrate different outcome values. Given 5 seeds, an ideal bottleneck plot would stabilize after a few waves producing a single horizontal line. Thumbnail Figure 2.
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Data were collected over a 4-month period, much faster than recruitment in and in many other surveys. Data collection times varied between 5.
Thesurveys in Rio de Janeiro and Porto Alegre failed to achieve their sample size due to the late start of data collection in reason of a six-month delay in local IRB approval. Median network size reported 4 - 10 was both relatively small and uniform across sites, which is a positive sign. Convergence was achieved on major variables for all sites. We illustrate this with HIV serostatus Figure 2 which presents results for selected cities in the 5 regions.
While there was reason to assume from the formative research that there might be bottlenecks that interfered with completion of the survey due to age, identity, behavior and class, it did not appear to be the case. One site, Porto Alegre, that might have required a larger sample size, achieved convergence, and the recruitment chains do not demonstrate bottlenecks Figure 2. While convergence for HIV prevalence in Rio de Janeiro ultimately appeared stable, early results along with the bottleneck chart demonstrate wide differences and separation in the recruitment chains in the early weeks of the study.
The study reported here suffers from some limitations. RDS, required for comparison to previous national estimates, remains controversial 34 AIDS Behav ; 21 7 ; Limitations inherent in RDS are well reviewed elsewhere 25 Specific cities and sample size were determined by the donor. Thismay have affected our results in the cities where our calculations required a larger sample size.
AIDS Behav ; 19 9 : The study took place at a time of both great political change in Brazil and with an HIV program focused on treatment. Parker R. Overall, we argue that the study was successful: large sample sizes were achieved in a relatively short period of time, with no evidence of difficulties with convergence and little evidence of bottlenecks in recruitment.
One important reason is overall receptivity among MSM in our sample. This happened in spite of the changes in national support reported in limitations. Many NGOs that participated in the study had closed by In half of the cities, finding MSM organization partners for the study was initially difficult. Perhaps these closures served to motivate participants, but we have no direct evidence of that.
Inthe FR, enthusiasm for the study appears to be associated with an enhanced willingness to test for HIV and other infections in studies directed to MSM. Many studies report health disparities and barriers to health care for MSM 37 However, the validity of social media as a proxy for HIV testing uptake could not be fully assessed. The main limiting factor to determine whether a clear connection exists between discriminatory or negative messages and uptake of HIV testing was the lack of ground-truth data at same geographical granularity and for the same time periods and frequency.
Therefore, further methodological validation would require a large-scale validation process, which is needed to compare social data and clinical data for different geographies and longer term periods, as well as deeper understanding of the bias in social media data [ 20 , 21 ]. Even with the great efforts of developing a detailed taxonomy keywords and phrases reached after several iterations for the classification of Tweets, some of them may have been misclassified in the process.
The authors noted that in the continuous process of filtering and classifying the tweets, a mechanism needs to be established to review and adjust if any systematic errors in taxonomy are identified—for instance new errors might appear when some of the words included in the taxonomy start to be used by the general population in a different context than ours. Furthermore, the evolution of false positive and false negative rates from iteration to iteration of the taxonomy should be measured.
In this study, such errors were not identified nor evaluated. In using this type of tool for communication and advocacy purposes, practitioners found that the visualization dashboard potentially public-facing enables both program managers and civil society to monitor the public reactions towards the campaigns, which facilitates program managers in establishing a more dynamic interaction with the population in promoting health messages and deconstruct misconceptions on HIV related issues.