Harder to reach population: High-rsk MSM
*William Joseph Woods, University of California San Francisco
Keywords: HIV risk, MSM, gay men,
Only a small proportion of men who have sex with men (MSM) are likely to be at risk for HIV infection. Thus, while the population of MSM is a H2R population, to address HIV prevention, it is critical to identify high-risk MSM. This elusive, “harder” to reach population of high-risk MSM can be found in most any venue MSM frequent, but the highest concentration will be in gay bathhouses. The caveat is that high-risk MSM are only a small proportion of bathhouse patrons. Thus, it remains a challenge, even in these venues, to identify this harder to reach population. To compound the problem, high-risk MSM tend not to self-refer to HIV studies. To address these challenges, we recruited men exiting gay bathhouses using time location sampling and a brief survey. Based on customer flow, time slots were selected. Respondents visiting the bathhouse were sampled as they exited during those time slots. The survey screened for risk behavior indicators that would identify someone as meeting the study definition of high-risk MSM. Weights were applied for nonresponse and for differential probabilities of selection. Probability sampling in the first stage reassured potential participants that they were not selected for any personal attributes, and minimized self-selection bias. Staff was blind to the criteria for inclusion to avoid stigmatizing or labeling men in a disparaging way. The procedures identified the small proportion (17%) of high-risk MSM in the sample and 67% of this group agreed to provide contact information for participation in a follow-up qualitative interview. Including the general population of MSM to describe HIV risk distorts the reality of those at high-risk for HIV infection (e.g., most MSM in general tested for HIV in the past year, while a large proportion of high-risk MSM did not). An approach that recruits at the bathhouse and screens for risk behavior indicators is an efficient means of targeting this harder to reach population.