An Ounce of Prevention

Nursing professor LaRon Nelson is dedicating his research career to preventing HIV and other sexually transmitted diseases (STDs) among socially marginalized groups in African and African diaspora communities. Nelson feels this focus is essential not only because these groups are most at risk of STDs, but because they often experience significant barriers to accessing health care.

For the past two years, Nelson and his team have been developing an HIV prevention strategy in Ghana for men who have sex with men (MSM). In a country where about 25 per cent of MSM have HIV, these men are afraid to ask for help in preventing HIV infection.

“Because of HIV stigma and the discrimination against men who have sex with men, many do not feel safe seeking out HIV prevention services,” explained Nelson.

To address these issues, the team consulted with public health officials and men in the target group in Ghana’s two largest cities, Kumasi and Accra. “From both an ethical scientific standpoint, you can’t develop an intervention for a community without first understanding who they are, how they live and what they value,” said the Nelson. “We had to make it culturally relevant; otherwise it would just be a waste of time.”

Everyone has something to offer

Nelson’s interprofessional research team includes professors from Kwame Nkrumah University of Science and Technology in Kumasi, and several American universities, including Emory and Brown. The team has members from the nursing, medicine, ethnography, community psychology, African studies and public health fields.

 “We knew that to deal with the complexity, we needed a team that reached beyond nursing and medicine,” said Nelson.

The team is developing a culturally grounded model to facilitate the use of condoms, reduce the number of sexual partners an individual has, and introduce a new medication that helps prevent the transmission of HIV if exposed to it. As Nelson pointed out, “These men are not just bodies from which to prevent HIV, they are living social beings who have a spirit and a culture. They live in communities in which they are valued for their contribution, but threatened for their sexuality.”

The model utilizes key, respected men in the community’s social and sexual networks.

“Within the safety of these networks, the peer leaders will be utilized to deliver HIV risk-reduction interventions,” Nelson explained.

If the Kumasi & Accra Project to Prevent AIDS (KAPPA) model proves feasible, it could significantly reduce and prevent the spread of HIV among MSM in Ghana. Moreover, it could be adapted to prevent the spread of HIV in other countries and among other populations.

A daily pill
The model proposes employing a recent biomedical advance for preventing HIV transmission: pre-exposure prophylaxis (PrEP). In 2010, the New England Journal of Medicine reported that taking
the antiretroviral medication every day reduced new HIV infections by nearly 50 per cent among 2,499 MSM who live in low-income countries. The sub-analyses revealed that as adherence increased, PrEP’s effectiveness in reducing HIV infections also increased, reaching up to 90 per cent.

The study model will be tested in Ghana because of the urgent need there, and because Ghanaians have played a vital role in informing and planning the project.

 “It’s logical and respectful that the community that supported the development of the KAPPA concept have the opportunity to use it first,” said Nelson. “It’s important to the team that Ghanaian men benefit from the research.”

After the study’s conclusion, Nelson will continue to work closely with leaders in Ghana to implement the medical and public health policies necessary to evaluate KAPPA’s effectiveness for preventing HIV and the economic feasibility of the project being locally sustained.