Sexual health research: understanding HIV and improving health among men who have sex with men

HIV (Human Immunodeficiency Virus) has claimed tens of millions of lives globally. In recent years deaths from HIV-related causes are still over 600,000 annually worldwide, while approximately 38 million people are currently living with HIV.

91¶¶Òõ research into HIV and other sexually transmitted infections, and research focused on sexual health among men who have sex with men (MSM), has spearheaded a range of prevention methodologies including a new Lesbian, Gay, Bisexual and Trans (LGBT) community organisation funded by the national government in Slovakia, and the development of a nationally coordinated HIV prevention campaign in Japan.

Men who have sex with men continue to be disproportionately affected by HIV

Whilst HIV is now considered a chronic disease and preventable, significant transmission continues throughout the European Union (EU) and the World Health Organization (WHO) European Region. Epidemic patterns and trends are complex and vary widely yet, in general, men who have sex with men continue to be disproportionately affected by HIV/STI and account for more than half of the 1.7m annual new HIV/STI infections globally. They also experience HIV-related stigma and discrimination that impacts negatively on HIV prevention efforts including testing, leading to poor health and social outcomes.

Professor Nigel Sherriff’s successful projects in this field have developed from early research to better understand the mental, physical, and emotional, health and safety needs of young LGBT communities in Sussex. His findings recognised a lack of specialist services for young people and necessary practitioner training to meet those needs. Building on this learning, Nigel Sherriff led the Everywhere project, a European-wide research consortium of 17 partners from eight European countries, which focused on a lack of HIV/STI prevention and support activities for men who have sex with men frequenting gay businesses, such as gay night clubs, in tourist destinations across Europe.

Together with high sexual mobility and tourism within and between countries of the European Union (EU), the study was grounded on the principle that interventions addressing major health threats with a cross-border or global impact such as HIV/STIs should involve the cooperation of multiple countries to be most effective.

Engaging with gay bars, clubs, and sex venues as important settings for HIV/STI prevention

The results showed a need to target communities of men outside formal health settings (such as clinics) and engage with gay businesses such as bars, clubs, and sex venues as important settings for HIV/STI prevention. It also highlighted the key role of outreach workers being trained in social mediation techniques to initiate dialogues, build relations, and implement HIV prevention activities for and with populations of men who have sex with men.

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Following the Everywhere project, Nigel Sherriff directed the UK arm of the Sialon II research project (2011-2015), a formal World Health Organization collaborating study, co-funded by the European Commission. This was the largest European study of its kind geographically, bringing 13 countries together, and in terms of participant enrolment. Sialon II data revealed widely varying HIV prevalence estimates for MSM populations across participating EU cities. Moreover, the research revealed that one third of the study participants living with HIV were unaware of their infection emphasising an urgent need for more frequent testing and targeted prevention.

Drawing on learning from Everywhere and Sialon II, the research was taken to Asia in the Everywhere in Japan project between 2012 and 2014, co-funded through sources including the Daiwa Foundation and the Japanese Foundation for AIDS Prevention. It adapted and evolved into the first ever ‘settings-based’ approach to disease prevention and public health in Japan. This novel settings approach has been crucial to effective HIV/STI prevention as it embraces informal spaces, for example gay bars, saunas, and LGBT community centres, as places that support the implementation of health initiatives outside of formal health settings such as clinics. 

Through large-scale collaborative HIV prevention and bio-behavioural research with communities of men who have sex with men, as well as the public and private sectors, Nigel Sherriff’s research has pushed forward alternative understandings of how prevention for vulnerable groups at high risk of HIV/STI infection can be targeted specifically through informal settings in collaboration with members of the populations. Furthermore, it has demonstrated and informed how prevention activities and wider prevention campaigns can be developed and implemented to increase access to, and take-up of, HIV/STI testing, prevention, and linkage.