Applying RDS to assess risk & protective factors and HIV related risk behaviors among young men who have sex with men (YMSM) Dr. Myo Myo Mon Research Scientist Department of Medical Research (LM) Ministry of Health, Myanmar

Collaborative research project between Department of Medical Research (Lower Myanmar) and UNESCO Funded by UNESCO

Outline of presentation Background of the study Preparation Field data collection Recruitment pattern Challenges Lessons learned

Background of the study Objectives To identify the risk & protective factors influencing YMSM in relation to HIV transmission at individual level, family, school & immediate environment To find out the association between risk & protective factors and HIV related risk behaviors To provide information for development of appropriate strategies and interventions for HIV prevention & control programs focusing on YMSM

Background (cont.) Study area Two townships  Yangon  Monywa Sample size 200 YMSM in each township Monywa Yangon

Eligibility criteria Age 18 to 26 years Men who have practiced male to male sexual behavior and/or same sex attraction which fall under one of three sub-groups  Apwint  feminine type who dresses and acts as female  Apone  non-feminine type who are mostly hidden  Tha-nge  musculine men who have sexual relationship with either apwint, apone or female Background (cont.)

Research Methodology Training About 30 Hours training (both theory & group work) Capacity building for MSM on research methodology  develop research proposal Facilitate participation of MSM in research studies related to them Select 3 peer interviewers Preparation

Formative Research Selection of seeds Incentive amount and type  Cash or kind  Primary & secondary Interview site Opening hours and days Preparation (cont.)

Coupon Design Two separable parts in different colors Blue part  for recruitment Yellow part  for payment (secondary incentive) Front side - coupon number, expired date, interview site’s address with bus lines info, opening hours Back side - eligibility criteria and terms and conditions for payment Preparation (cont.)

Title of study Coupon No. Expiry date Opening hours & date Interview site address Coupon (front)

Coupon (back) Eligibility criteria and terms & conditions

Training of interview team Interview team  Investigator, 3 MSM, 3 research assistants from DMR Half day training specific to current study Training covered:  Questionnaire  RDS method  Coupon distribution and management Preparation (cont.)

One coupon manager One person managing incentives Four trained interviewers Supervision by Principal Investigator Interview site at user- friendly drop-in centers (PSI & MSI) Field Data Collection

Township-1 (Yangon) 7 seeds 8 waves Within one month Two interview sites Recruitment Pattern Township-2 (Monywa) 4 seeds 5 waves Within two weeks One interview site

Recruitment graph of Township-1 (Yangon) Some seeds are not successful

Recruitment by type of MSM, Yangon Apone Apwint Tha-nge

Recruitment graph of Monywa Short recruitment waves

Recruitment by type of MSM, Monywa Apone Apwint Tha-nge

Seed selection  Although we choose YMSM who have large social networks, 3 seeds were not successful; needed to add more seeds Interview site selection  Although we chose drop-in centers situated close to the downtown area, some MSM did not want to come as it was quite far from their place  Add another interview site for peri-urban areas Challenges

Eligibility criteria  Difficult to recruit younger age group  Definition of some type of MSM (e.g: Tha-nge) should be set carefully Screening of right participants  Important to ask some screening questions before enrollment Challenges (cont.)

Information on the coupon  Detailed explanation is needed although full information was described on the coupon  Providing contact phone number is very important as many MSM would like to confirm the survey location Recruitment period and recruitment wave  Short recruitment period  shorter waves  Long recruitment period  longer waves Challenges (cont.)

Data management and analysis for RDS  Unfamiliar with RDS specific software  Possible errors in coupon numbering  Possible duplication of coupon numbers  Challenging data analysis Challenges (cont.)

Lessons learned Importance of conducting formative assessment Enquiry of fairs and festivals (joined by all MSM) Need of adequate recruitment period Importance of explaining eligibility criteria